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Inspection on 30/06/09 for 11 Buckstone Close

Also see our care home review for 11 Buckstone Close for more information

This is the latest available inspection report for this service, carried out on 30th June 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People who live at 11 Buckstone Close say they like it there. They feel staff help them to make decisions for themselves and that they are encouraged to do as much as they can for themselves.Everyone who lives at 11 Buckstone Close likes to do things differently and staff work hard to help each person live their life they way they want to.One person wants to be able to do more for themselves. They said `I am working with staff to be more independent. I want my own flat with a support worker.`Another person likes to choose how they spend their day. They said `I am having my bath at 4.30 p.m. I am having a takeaway for my lunch. I didn`t want my bath this morning.`Everyone has a plan of care thattells people what they want to do and how staff can help them. They look at this every month with their key worker to see if it needs changing and to see how far they have come in doing the things they wanted to.

What has improved since the last inspection?

Everyone has their own room and have recently chosen new colours for them.Care plans have been written so they are easier for everyone to follow and they have pictures to make them easier to understand.

What the care home could do better:

At night there are two staff working in the home to help people. One person goes to sleep in the lounge so they are there if they are needed. This means no-one who lives in the home can go and sit in the lounge at night.The other night staff sits in the dining room, so anyone coming to talk to them can disturb the person who sleeps in the room at the top of the stairs. It would be good if the night staff had somewhere else to sleep that did not mean people could not use the lounge at night if they wanted to.

Key inspection report Care homes for adults (18-65 years) Name: Address: 11 Buckstone Close 11 Buckstone Close Everton Lymington Hampshire SO41 0UE two star good service The quality rating for this care home is: A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Patricia Trim Date: 3 0 0 6 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983   Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Information about the care home Name of care home: Address: 11 Buckstone Close 11 Buckstone Close Everton Lymington Hampshire SO41 0UE 01590643723 F/P01590643723 thebellbungalow@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ashfield Care Homes Ltd care home 3 Number of places (if applicable): Under 65 Over 65 3 3 0 0 learning disability physical disability Additional conditions: The maximum number of service users to be accommodated is 3. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) Physical disability (PD). Date of last inspection A bit about the care home 11 Buckstone Close is registered to provide care and support to 3 people who have a learning disability and/or physical disability. The home is in the village of Everton, close to New Milton and Lymington, which have a good range of shops and other public amenities. The home is a detached property. There is a shared lounge and dining room on the ground floor and everyone has their own room. One bedroom is on the first floor and would not be accessible to anyone with limited mobility. This has its own bathroom. People with bedrooms on the ground floor share a bathroom. There is a well-maintained and accessible garden. The fees range from 540.75 pounds per week to 2070.06 pounds per week, depending of the level of needs. Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home We used lots of information from different places to write this report. We looked at anything the home might have told us about what has happened since we last visited 11 Buckstone Close. We used some of the information Sarah Brownbridge, the registered manager gave us about the home in a form called the Annual Quality Assurance Assessment (AQAA). This is something the home has to fill out every year to tell us what they are doing to make sure people are helped to do the things they want to and get the care they need. Sarah sent this form into us when we asked for it. It had lots of good information about the service and told us what she wants to do to make things even better. We also asked people who use the service to fill out a form to tell us what they think of the service. Two people filled them out for us. We also sent three forms to other people who sometimes work with people who live at 11 Buckstone Close, like care managers. One person sent us back a form. Two staff who work at 11 Buckstone Close also filled out forms to tell us what it is like to work there. One of our inspectors visited the home and stayed for five and a half hours. While she was there she spent time talking to 2 people who live there to ask them what it what like living at 11 Buckstone Close. There was also an opportunity to talk to some of the staff and to look at some of the bedrooms, lounges, dining rooms, kitchens and bathrooms to see that people lived in a clean, comfortable and safe place. Time was spent looking at the information written down about 2 people who live at 11 Buckstone Close. We did this to try and see if they had been able to say what they wanted to do for themselves and what help they thought they needed. We also wanted to see if they were able to choose what they did each day. We also looked at some of the records 11 Buckstone Close has to keep to make sure they were being kept up to date. What the care home does well People who live at 11 Buckstone Close say they like it there. They feel staff help them to make decisions for themselves and that they are encouraged to do as much as they can for themselves. Everyone who lives at 11 Buckstone Close likes to do things differently and staff work hard to help each person live their life they way they want to. One person wants to be able to do more for themselves. They said I am working with staff to be more independent. I want my own flat with a support worker. Another person likes to choose how they spend their day. They said I am having my bath at 4.30 p.m. I am having a takeaway for my lunch. I didnt want my bath this morning. Everyone has a plan of care that tells people what they want to do and how staff can help them. They look at this every month with their key worker to see if it needs changing and to see how far they have come in doing the things they wanted to. What has got better from the last inspection Everyone has their own room and have recently chosen new colours for them. Care plans have been written so they are easier for everyone to follow and they have pictures to make them easier to understand. What the care home could do better At night there are two staff working in the home to help people. One person goes to sleep in the lounge so they are there if they are needed. This means no-one who lives in the home can go and sit in the lounge at night. The other night staff sits in the dining room, so anyone coming to talk to them can disturb the person who sleeps in the room at the top of the stairs. It would be good if the night staff had somewhere else to sleep that did not mean people could not use the lounge at night if they wanted to. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Patricia Trim The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 01622724950 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website http:/www.cqc.org.uk/. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are only offered a place after a comprehensive needs assessment identifies the home can meet their needs. Evidence: The people currently living in the home have been there for a long time, but remembered being asked if they wanted to move in. They also said they were able to visit several times and stay overnight before moving in. The files for two people were viewed. Each person had a detailed assessment, completed before they moved in. This included looking at what they could do for themselves, as well as what they needed help with. For example, one assessment recorded that the person enjoyed social activities, but needed someone with them when they went out in the community. From looking at two of the initial assessments, it was evident they were regularly reviewed to identify changing abilities and needs, and care plans altered to reflect the changes. The service only offers permanent placements and does not provide intermediate care. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to be involved in planning their care and identifying what they want to be able to do for themselves. Risk assessments are used to enable people who use the service to do the things they want to whilst minimising the risk of injury. Any limitations imposed on people who use the service are done so in their best interests and the reasons for them explained to the person involved. Evidence: The AQAA recorded that All our service users have individual lifestyle plans and person centred plans which contain details of their personal, social and emotional needs. One service user has pictorial person centred plan to enable them to have greater involvement and understanding of how we can help them achieve their goals. Two plans were viewed. These were very individual to the person and identified their diverse abilities, needs, wishes and aspirations. Both the people spoken with felt they had been involved in planning what they wished to do and in identifying the support they needed. One person said I am working with staff to be more independent. This person had identified they wished to work towards independent living and their plan showed how they were to be helped to learn household tasks. A progress report was completed each day and this was used to help the person and their keyworker review the plan each month to see if it was working. Annual reviews were also held to which people important to the person who used the service could be invited if they wished them to be. The plans were written in plain language but a large number of different plans were Evidence: completed for each person. There was a care plan, a life style plan, health care plan and a person centred plan. This meant that some information was quite repetitive and might not be easily understood by the person it related to. The AQAA recorded that one person had a pictorial person centred plan, but neither of the people spoken with had their own copy of their plan. The initial assessment identified whether people had the capacity to make their own decisions and the registered manager said staff were expected to support these decisions unless they were unsafe. For example, one person had decided they did not wish to go to the dentist regularly. The risks were explained to the person, but their decision respected. Risk assessments were used to enable staff to support people to do the things they wished. For example, one person wished to access the community independently and a risk assessment and action plan had been completed to work towards this goal. The person concerned was clear why this had to be achieved through risk management and accepted the limitation this imposed on them. Any limitations imposed had the reasons for them clearly identified and the people to whom they applied said they understood why they were necessary. The need for them was kept under review. The home has links with the local advocacy scheme and one person regularly attended their meetings. There was evidence advocates were supporting one person to get the health care they needed. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to take part in a wide range of activities, employment and education, that they enjoy. Staff support them to maintain contact with family and friends and to enjoy relationships. Evidence: Each person living in the home has very diverse interests and daily routines which are clearly identified in their care plans. Both people spoken with felt their needs were met and that they were supported by staff to make choices about how they lived their lives. Activities are risk assessed to make sure staff have the guidance they need to minimise the risk of injury and to enable the person to be as independent as possible. One person has a very active social life and was enabled by staff to access the local community to go to clubs, coffee mornings, church and education classes. They were supported to visit places that were interesting to them, such as motorbike collections and watched their favourite football team play on the big screen at the local pub. This person told us I like it here because its peaceful. I am friends with one of the other people and can use Makaton to talk with them. We are going on holiday to Minehead this year for a change and I am really looking forward to it. They also said how much they liked their room and had chosen the colours themselves. They had a key so they could lock the door to stop others coming into their room. The second person preferred to go for drives, out for coffee or shopping with a member of Evidence: staff. They also preferred to eat their meals at different times to the others and were able to do this. This person said they liked to lock their door at night so no-one came in when they were asleep. Both people spoken with described their preferred daily routine and this information was clearly recorded in their care plans. For example, one person liked to be up for a while, before having breakfast and then getting dressed. This routine was seen being followed by staff during the morning of the visit. One person said I get anxious if staff use the computer while I eat. I like to eat without being disturbed. Staff were seen respecting this preference. Important relationships are recorded in the person centred plan and staff support people to keep in touch with the people they wish to. One person likes to contact their family regularly and staff support them with this, reminding them if it is too late at night to call and making sure their phone is charged regularly. One person has also been supported to use the internet to maintain contact with their family. Pictures were used throughout the home to help everyone identify where things were kept and to promote their independence. This included a folder with pictures of food so everyone knew what meals were being offered. Records showed that people were able to choose what they ate each mealtime. One person said that the weekly menu was planned at the house meeting, but people often changed their minds. This was seen in practice during the visit, when someone asked for a takeway instead of the main meal. The registered manager said people were offered healthy food options but could choose to have an alternative. Fresh fruit was available for people to help themselves. Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service receive help with personal care in the way they like it. They are able to see health care specialists when they need to, which makes sure they receive the health care they need. There are robust systems in place that ensure medication is managed safely. Evidence: Each person had a care plan that described in detail what they could do for themselves and what they needed help with. The people spoken with confirmed staff gave them the support they needed and encouraged them to do what they could for themselves. They also felt they were able to make choices about their personal care. One person said I do not want my bath this morning. I am going to have it this afternoon. The plans recorded if someone needed prompting or actual physical help. For example, one plan recorded one person was able to do most of their personal care independently but needed a lot of encouragement to do so. People who use the service said they could see their doctor when they wished. Health care plans recorded when people had seen the dentist, chiropodist or specialist health care nurse and evidenced people had regular contact with health care professionals. One person had chosen not to visit the dentist regularly as it distressed them too much. The risks of not going had been explained to the person and their decision respected. There was evidence staff worked closely with the specialist health care team to meet the needs of people who use the service. Records showed regular visits by the team to offer help and support to people who use the service and staff. None of the people who use the service self medicate. Two people said they did not wish to, as they felt they would not remember to take it. Each had signed a form giving staff Evidence: permission to look after their medication. The third person did not take medication. The homes medication procedure stated that only trained staff could administer medication. The AQAA stated that all staff had received training and staff on duty confirmed this. Training records seen for two staff showed they had completed medication training. The system for managing medication is robust. Medication is supplied in a monitored dosage system. This is colour coded to help staff identify the time of day each medication needs to be given. A description of each tablet is kept in the medication folder, together with information about it. A record is also kept of what over the counter remedies may be given to each person. This has been agreed and signed by their doctor. Staff give the medication, then sign the administration record. The stock held for one person was checked against the record and found to be correct. A record is kept of medication received into the home and of any returned unused to the pharmacist. Appropriate safe storage is provided. The AQAA recorded that medication is now audited weekly by the registered manager. The records showed it had also been checked by the organisations quality auditors on 25th March 2009, when it was found to be satisfactory. Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have the information they need to be able to make complaints and be confident their concerns will be listened to. Staff have the training and guidance they need to minimise the risk of harm to people who use the service. Evidence: People who use the service felt they knew how to make complaints. Both people spoken with said they told the registered manager if they were not happy and that she tried to make things better. Staff also said they knew how to support people to make complaints. The complaints log showed four complaints had been received in the last 12 months. Records showed appropriate action had been taken and the issues raised resolved to the complainants satisfaction. One person had complained about another person shouting at night. A solution had been sought and an action plan put in place to support them when the noise distressed them. During the visit two people raised issues they were not happy about. The registered manager said she would speak with them and help them make a formal complaint if they wished to do so. The AQAA recorded there was a system in placing for managing peoples money safely. Care plans recorded whether someone needed help managing their money. One person commented Staff help me budget as I would spend everything in one day. I am trying to save for my holiday and staff are helping me do this. This person signed the record to show when money had been taken out or put into their savings. A member of staff also signed. The second person spoken with was happy for staff to look after their money. Their care plan recorded that signing the record caused them anxiety so two staff signed instead. The records were regularly audited to make sure they were correct. Staff spoken with confirmed they had regular training about safeguarding. Records showed all staff were expected to complete this training during their induction and have regular refresher training. Staff spoken with were clear about the action they would need Evidence: to take in respect of safeguarding issues. The safeguarding procedure was clear and a pictorial version was displayed so people who use the service had the same information as staff. The registered manager had demonstrated her ability to identify safeguarding issues and to work with Adult services to protect people who use the service. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to live in a clean, comfortable environment that meets their needs during the day. However, the arrangements for sleeping in staff means the environment does not meet their needs at night. There are systems in place to minimise the risk of infection. Evidence: The house is well maintained and provides a homely environment. There is a lounge and dining room that everyone uses and each person has their own bedroom. The AQAA recorded that bedrooms had recently been redecorated and one person confirmed they had chosen the colour scheme. This person commented how much they liked having their own room, which they had filled with their own things. Two people confirmed they had keys to their rooms and were able to lock their doors if they wished to. Two people were unhappy about the night arrangements. The sleeping night staff uses the lounge at night, which means people who use the service cannot spend time there if they cannot sleep. One person said they often got up at night and would like to be able to eat a snack in the lounge but cannot. Another person was unhappy that people who could not sleep would sit in the dining room, as they could not use the lounge, talking with the waking staff. Their voices carried up to the bedroom at the top of the stairs and disturbed this person. Both people agreed to raise their concerns with the registered manager. The home has an enclosed garden, which people said they liked. Arrangements have been made to provide shelter there for someone who likes to smoke. The garden has also been planted with a herb garden to provide a relaxing environment to reduce stress for one person who has anxiety problems. The home has a maintenance plan and recent improvements include decorating the dining room, hall and bedrooms. Future plans include restoring the garden furniture so people have somewhere nice to sit in the summer. Evidence: There is a cleaning schedule to ensure all areas of the home are regularly deep cleaned. People who use the service are supported to clean their rooms. This is recorded in their care plans and risk assessments are in place to enable them to do this safely. The AQAA recorded all staff have completed infection control training and there are systems in place to protect people who use the service from the risk of infection. Staff were observed following guidance when dealing with soiled linen and clinical waste. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Robust employment procedures minimise the risk to people who use the service. Staff receive training that enables them to fully support people who use the service. Evidence: The staffing of the home is arranged to provide flexibility and enables people to do the things they like during the day, evenings and weekends. Comments from people who use the service showed they thought they were supported to do the things they wanted to by well trained staff. Feedback from two staff surveys and from comments made during the visit evidenced they also thought there was always enough staff on duty to support the people who use the service. The registered manager said the service has a consistent staff team. Only one new staff had been appointed in the last 12 months. Their employment record showed they had been required to go through an in depth recruitment produre before being employed at the home. This included relevant checks such as references from their previous employer and Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks. Information was also sought from their country of origin. People who use the service are involved in the recruitment of new staff. One person said We always meet new staff and say if they are okay. Feedback from staff survey forms showed they felt the recruitment process was thorough and fair. The registered manager said new staff are expected to complete an induction programme during their probationary period of six months. The new member of staff confirmed they had been required to do this and a certificate of completion was seen in their file. The induction includes shadowing experienced staff, attending training and completing a work book to evidence they have understood the training. Staff felt they were supported to attend training and gain qualifications. The AQAA recorded that six out of seven staff had completed a National Vocational Qualification Evidence: (NVQ)2. Four staff had completed their NVQ 3 and three, NVQ 3 in management. A fourth member of staff was completing this. The training matrix showed there was a continual programme of training and refresher courses offered. These included courses that were particularly necessary to meet the needs of people who use the service. For example, recent training had included dementia care, managing challenging behaviour and deprivation of liberty. The registered manager said staff were currently completing a training course about autism and staff confirmed this. Training records also showed staff receive training to protect people who use the service such as safeguarding and medication. People who use the service liked the staff who work with them. Comments included The staff are nice, I like living with Sarah (the registered manager). One health care professional commented They are a very caring staff team, patient and have a great understanding of service user needs. I cannot fault the care my client is given, as they are extremely demanding and require skilled management. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is run in the best interests of the people who use the service and there are opportunities for people who use the service to express their views about it. There are systems in place to monitor the environment and minimise the risk of accidents to people who use the service. Evidence: The registered manager has extensive experience of working with people who have learning disability. She has an National Vocational Qualification (NVQ) 4 and the Registered Managers Award. There was evidence she continued to develop her skills through training and had recently attended a course on the Deprivation of Liberty and one on the new Health and Safety legislation. People who use the service said they liked the registered manager and felt she listened to what they had to say. They were observed talking with her throughout the day and she was seen to take time answering their questions and dealing with their concerns. Staff also felt she was a good manager, always available to give support and advice. People who use the service had plenty of opportunity to give feedback about the service they receive, talking to their key workers at their monthly reviews, at the weekly house meetings, through the complaints procedure or through the annual satisfaction survey. One person explained We have a house meeting on Monday afternoons. We talk about where we want to go and what we want to eat. The registered manager said time was spent talking with people who use the service to find out how well they think their needs are met. They then complete the annual survey, which is also sent to relatives and health care professionals. This information is used to Evidence: write a report about how well the service has done and to identify any areas of concern. This exercise is just being completed. Surveys already returned contained the following comments. People who use the service said I am satisfied with my care and I am always able to make choices. A comment from the relatives of one person was The manager and key worker are approachable, kind and efficient. The organisation carries out its own quality audit and the home is visited every three months. A report is written that identifies what needed doing following the last visit and whether this hss been done. The last report seen confirmed the registered manager had completed all the tasks as usual and that the home was well managed. Regular monthly visits are also completed by a representative of the organisation. These visits include spending time talking with the people who use the service and reviewing practice in the home. A copy of the written report is kept at the home. Staff are able to give feedback about the service at regular staff meetings. They also have regular supervision and can use this to discuss issues. Training records showed staff received regular mandatory training such as first aid, food hygiene,fire safety and moving and handling. They were also able to attend regular refresher training. Every aspect of the service was monitored and audited. The registered manager completed monthly audits of medication and made sure the records of people who use the service were reviewed and updated. The quality audits, completed by the organisation, ensured the environment was well maintained. The maintenance programme made sure improvements were planned and completed. Equipment was regularly serviced. This was evidenced by a number of certificates seen on the visit and by information given in the AQAA. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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