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Inspection on 14/04/09 for 76 Canute Road

Also see our care home review for 76 Canute Road for more information

This is the latest available inspection report for this service, carried out on 14th April 2009.

CQC found this care home to be providing an Excellent 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.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 76 Canute Road 76 Canute Road Ore Hastings East Sussex TN35 5HT     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Michele Etherton     Date: 1 4 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. that people have said are important to them: They reflect the things 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: 76 Canute Road 76 Canute Road Ore Hastings East Sussex TN35 5HT 01424457761 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) : fionamacartney@tiscali.co.uk A S D Unique Services Ltd care home 6 Number of places (if applicable): Under 65 Over 65 0 0 learning disability mental disorder, excluding learning disability or dementia Additional conditions: 6 6 The maximum number of service users to be accommodated is 6. 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) Mental disorder, excluding learning disability or dementia (MD). Date of last inspection Brief description of the care home 76 Canute Road is situated in a residential area in Hastings. The home is registered to accommodate six adults with learning disabilities. The property is a two-storey building with one bedroom on the ground floor and five bedrooms on the first floor. Two of the bedrooms have ensuite bathroom facilities. The home is close to shops and amenities and there is easy access to Hastings. 76 Canute Road is one of four homes owned by the proprietors Mr and Mrs Kennard. The current scale of charges for the service range from #1,350 to #2,700 each week. Additional charges are made for hairdressing, chiropody, toiletries and sweets. Inspection reports are made available at the home Care Homes for Adults (18-65 years) Page 4 of 30 Brief description of the care home and reference to the availability of reports is also included in the home?s statement of purpose. Care Homes for Adults (18-65 years) Page 5 of 30 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: three star excellent 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 peterchart Poor Adequate Good Excellent How we did our inspection: The reader should note that whilst the Care Standards Act 2000 refers to Service users in regard to those who use and live in registered services people living in this home prefer to be referred to as Residents and this is the term we shall use for them throughout this report. A key inspection of this service has been undertaken that has taken account of information from the service and about the service since the last inspection, including an annual quality assurance assessment (AQAA) We found the AQAA to be completed to an excellent standard which provided us with detailed information to illustrate the day to day activities of the service and future Care Homes for Adults (18-65 years) Page 6 of 30 planning. In addition to analysis of information received about the service we have also undertaken a site visit to the home. We visited the home on 14th April 2009 between 9:15 a.m -3:15 p.m when we were able to undertake a tour of the premises, meet and speak with staff and be introduced to residents albeit briefly, in the absence of survey information this has been essential in informing our inspection and influential in arriving at our judgments. There is one adult safeguarding alert currently open as a result of an incident between two residents, we consider this has been appropriately managed and reported to relevant agencies. For the purposes of this inspection all key inspection standards have been looked at. In arriving at our judgment we have tried to be proportionate in considering the impacts and risks on overall outcomes to residents of any identified shortfalls and general compliance with regulations. What the care home does well: What has improved since the last inspection? Since the last inspection the AQAA tells us that the service has: Undertaken some improvements to the environment that includes: Replament of dining chairs, the updating and personalization of resident bedrooms, the purchase of new furniture throughout the home, replacement of kitchen flooring, the equiping of the sensory area in keeping with individual resident preferences, the purchase of a trampoline for the garden. Improvements and updating have also been made to documentation including the Statement of purpose, user guide and terms and conditions information, the visitors policy, and adaptation of interview feedback forms, policies and procedures have been routinely reviewed. Residents have been supported with greater access to the community and its facilities, and medication levels have been stabilized and reduced for them. Improved links with Care Homes for Adults (18-65 years) Page 8 of 30 the local hospital have been established to help both planned and emergency admissions of residents. Staff have received updated training in epilepsy and medication, all staff have completed the common induction skills programme and have also attended positive behaviour support training. Fire training has been improved for staff who have responded positively to this change, the service has been commended by the local fire officer for their fire arrangements. There has been a marked reduction in the number of incidents between residents requiring safeguarding adults referral What they could do better: 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 www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 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 Care Homes for Adults (18-65 years) Page 10 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the service and the terms and conditions of being a resident is provided to prospective residents in a meaningful format suited to their needs, they can be confident that they will receive a thorough assessment of their needs prior to admission to ensure these can be met and will be given opportunities to visit at a pace suited to their own ability to cope with the transition. Evidence: The AQAA has been completed to an excellent standard, and tells us that information provided to prospective residents is kept updated and provided in a range of formats to suit the needs of residents and their families, the service has developed innovative ways in which it can make information more meaningful for residents e.g social stories, transition packs, photo books. Since the last inspection four more residents have moved into the home one on a shared care arrangement between home and the care home. We looked at the information gathered by the home about three randomly selected residents prior to Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: admission, we could see from examination of records that comprehensive assessment information is completed to inform decisions about admission. In discussion the manager confirmed she is actively involved in assessment of all prospective residents, and transition meetings are held to discuss arrangements for introducing the prospective resident to other residents and getting used to the environment and staff, and these meetings involve all respective parties. Prospective residents have opportunities to stay for introductory visits overnight and weekend stays prior to admission, existing residents and staff are asked for their feedback on how stays have gone. Our discussion with the manager and staff in respect of individual residents and their routines highlighted the service ability to respond to changes in need, and where necessary seek interventions from other agencies or professionals to better inform support strategies. The AQAA informs us that residents are provided with terms and condition information in widget formats Care Homes for Adults (18-65 years) Page 12 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are actively involved in the development of detailed support plans to inform staff how they prefer and need to be supported. The staff use a variety of methods to enable residents to make know their choices and aide their decision making. Risk is managed positively. Evidence: We examined support plans for three residents, these contain detailed information about individual residents daily routines and their preferences in how support is provided to them, present and future aspirations are recorded, but we found some goal planning to be too broad, this would benefit from being broken down into smaller more achievable elements which the service can then more easily measure and this is a recommendation. Our discussion with staff members indicated that a variety of methods are used to engage residents using the service to contribute to the development of their plans, and Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: this includes using communication passports, photo references, widget symbols dedicated 1-1 time with workers to discuss their daily and weekly support. Similar creative methods are used to enable residents to make active choices about aspects of their daily lives. We found daily records to be well maintained and these can be cross referenced with other records maintained e.g behaviour reports. Plans viewed evidenced regular updating, discussion with key work staff indicated resident plans are discussed with them regularly. The home has developed a considerable amount of information and guidance in respect of individual residents to inform staff practice, this has been reduced to a manageable size for everyday files used by staff and the home should continue to review the size of working documents to ensure their continued viability as working tools for staff. In view of the complex behaviours of the residents the home has developed comprehensive risk strategies, with staff additionally assessing on an informal basis for every outing and activity the level of risk, staff reported this can sometimes lead to an adjustment to the scheduled activity, if risks are thought to be to high. In view of the unpredictability of some resident behaviours there is a close monitoring and supervision of residents but this is undertaken discretely. We found that risk is managed positively without overly impacting on the ability of residents to lead a varied and fulfilling lifestyle, the manager was able to evidence how for some residents the move to the home has enabled them to enjoy greater freedoms and establish a community presence, where the home experiences problems with individual residents good partnership working with other agencies and professionals has been developed to work through specific problems. Care Homes for Adults (18-65 years) Page 14 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Despite their complex needs the residents are enabled to enjoy a varied and stimulating lifestyle, they are consulted about the things they want to do and are supported to maintain or develop their skills and independence to whatever degree they can cope with. They are helped to maintain contact with the important people in their lives. Evidence: Each resident has an activities schedule established for them each week, some residents have this displayed in their bedrooms so they know what they are doing each day, other residents cannot cope with the level of detail and prefer to be given information on a daily basis, we spoke with the activities organizer who advised that activities are rotated to minimize the prospect of residents becoming bored, but even so this does happen and when staff become aware that residents may not be enjoying Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: an activity as much they undertake to consult with that individual using widget symbols and photo references to try and find suitable alternatives, in discussion a staff member was able to give recent examples of how this had been managed with specific residents. From our discussion with staff and observations of daily routines enjoyed by residents we are satisfied that the home is supportive of residents developing and maintaining a level of independence, one resident is regularly involved in cooking a meal for residents and staff once per week, another resident maintains their own weekly planner, a resident offered to make us a drink during our visit. The home is actively supportive of residents maintaining links with family and friends, some residents experience regular home visits and good contacts with family members is maintained for others, the manager reports the home has established good working relationships with families to aid their support of residents. Residents likes and dislikes are known and staff reported most have good appetites, whilst many of the rooms are locked when not in use residents have the freedom to walk into the kitchen and make themselves a drink under supervision , picture prompts are located on all cupboards and although these are kept locked to reduce risks residents know what is stored in each cupboard and can ask for the ones they want to be opened in order to make themselves drinks, or snacks. We noted that in most cases records of individual food intake are being maintained however some examples where this is not the case were noted and brought to the attention of the manager, it is a recommendation that all staff are reminded of the importance of maintaining detailed information in regard to individual residents food intake to ensure they are maintaining a healthy and balanced diet and to inform any nutritional assessments undertaken. Care Homes for Adults (18-65 years) Page 16 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal physical and emotional well being of residents is well managed and supported Evidence: Staff demonstrate a good understanding of individual residents behaviour and routines and how they prefer to receive help from staff and they have reference to comprehensive information about individual residents to inform their practice. Health action plans have been established for all residents. We noted medical attendance record information for those resident files viewed including dentists, psychiatrists and chiropody appointments, complex behaviours have meant that many of these appointments take place within the home. A district nurse attended during our visit and we were advised by the manager that the resident concerned has made good progress in accepting the district nurse intervention, we noted the resident waiting patiently for the district nurse to arrive. Residents are also enabled to attend well man check ups annually. In discussion the manager was able to evidence how the home Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: has worked in partnership with the local hospital providing detailed information for health staff prior to a resident admission including a thorough risk assessment agreed by all relevant professionals. The home is proactive in seeking advice and guidance from specialist to aid their work with individual residents, and has worked closely with the local hospital A&E department and the community learning disability team. When we visited the home in the morning we found all residents up and dressed with some already out at activities those residents observed seemed alert and active, we discussed night time sedation with the manager as all residents now have night time medication in most cases having been prescribed prior to admission, the manager is keen to ensure this is used only in the best interests of the residents, and its continued use is kept under review, the medication enables residents to enjoy a normal pattern of sleeping and waking that allows their participation in a full range of activities throughout the day. Resident files contain detailed medication profiles of resident medication and what it is for, PRN medication guidelines are also in place for each medication. Only senior staff administer although all staff are trained to do so, and competency assessments are undertaken regularly. We examined medication records and found these to be well kept apart from one handwritten entry which was unsigned and undated we have recommended that all handwritten entries and changes to dosage instructions are signed and dated by the person making the change. Care Homes for Adults (18-65 years) Page 18 of 30 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. The service takes the views of residents seriously and residents will benefit from increased opportunities to be asked for them. Systems are in place to ensure residents are safeguarded from harm and that staff have the knowledge and skills to respond appropriately and effectively to ensure the continued well being of residents. Evidence: The AQAA informs us that no complaints have been received by the service and this had not changed at the time of our visit. The majority of residents would find difficulty in making a formal complaint and therefore the service needs to consider whether they should be taking a proactive stance on behalf of residents to register complaints on their behalf when incidents occur that are likely to generate complaints in more able residents or that staff themselves might consider warranted recording as a complaint. The service recognizes deficiencies within the current system for ensuring residents are listened to and as such has recently implemented a monthly meeting with residents and the activity co-coordinator which will go through with them aspects of their daily routines and ask them about how they are feeling about this. We discussed with the activity co-ordinator and manager whether this could also offer the opportunity for residents to be reminded of the complaints process and if they express any concerns or unhappiness for this to be reflected in the complaints record, Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: this has been received positively by the service who have agreed to look into including complaints within monthly meetings and we recommend this is progressed. From our discussions with staff, and examination of resident records we are satisfied that there are systems in place to ensure that risks, behaviour and staff interventions are appropriately and safely managed. Staff are well trained in use of SCIP, behaviour guidelines are in place to inform staff and behaviour monitoring is maintained with incidents analyzed to inform support strategies. Staff we spoke with have an awareness and understanding of safeguarding and the service has developed a good working relationship with the local community learning disability team in reporting and managing adult safeguarding issues which usually involve residents towards each other. At the time of our visit there were no outstanding safeguarding alerts and there has been a marked reduction in such incidents as residents settle into the home and learn to live with each other, however between our visit and writing this report an alert has been raised following an incident between two residents and this has been managed appropriately with relevant agencies alerted. Restrictions are in place for residents in their best interests, individual restrictions and interventions are documented within support plans. Staff we spoke with commented on the professionalism of the service and were able to make comparisons with previous employment in other care settings. Although new to working with adults with challenging behaviour staff we spoke with reported they felt well prepared and informed about the residents. Their feedback indicates the pace of work with individual residents is dictated by the needs of the residents and their ability to accept new staff and not the needs of the service. The manager and staff are aware of recent legislation in respect of mental capacity and deprivation of liberty, a programme of training is underway to ensure all staff have received this training. The manager confirms that at the present time none of the residents are experiencing deprivation of liberty as defined by the legislation. Care Homes for Adults (18-65 years) Page 20 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents enjoy living in a comfortable,clean homely and well maintained environment. They are encouraged and supported to personalise their own space, and can choose to spend time with and apart from their fellow residents. Evidence: Residents live in a comfortable well maintained environment , each resident has their own bedroom and are encouraged to personalize their own space, staff are supportive in helping residents do this. One resident bedroom we looked at has a hole in the door which the resident uses to open and close the door in preference to a door handle, whilst staff have tried to ensure that the residents privacy is not undermined by the placing of furnishings away from the door we have suggested a sliding door cover may provide additional privacy and this is a recommendation. In view of the risk to residents of injuring themselves or each other most are always under the observation of staff unless in their own bedroom, rooms not in use other than the kitchen dining room and lounge are kept locked, whilst this could provide a sense of oppression and restriction the home is spacious and homely and the securing of rooms is undertaken in a discreet manner, residents can enter any room they request to but this must be in the company of staff unless it is their own bedroom, and Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: in some instances some residents need staff support there too at times. Good quality furnishings and fabrics are used throughout the home and communal spaces are bright modern and homely. There is a well maintained rear garden which has garden furniture and in which barbecues are held from time to time weather permitting, a trampoline has recently been purchased for residents to use in the garden. Residents benefit from a sensory area which they can access with staff support. There is a suitably equipped laundry area and we are advised that a replacement washing machine is due to be installed shortly, incidents of incontinent laundry are minimal but in discussion staff had an understanding how this is to be managed in keeping with infection control procedures. The home is maintained to a good standard of cleanliness. Care Homes for Adults (18-65 years) Page 22 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good systems exist for the recruitment, training and supervision of staff to ensure residents are safeguarded Evidence: The manager has provided us with training information for the staff team this tells us that the service has exceeded the 50 level of qualified staff with all the staff but one having completed an NVQ 2 or NVQ3, the remaining staff member is in the process of completing this training ,the service is to be commended for progressing this programme of training with staff. Staff we spoke with said they always felt well supported and there were always enough staff around to call on or to faciliate activities with residents . The Manger reported that some residents are funded for 1-1 time with staff. We looked at files for three newer staff and found that all necessary vetting and checks had been conducted prior to their taking up post. We noted that the quality of some information within staff files could be improved upon particularly the standard of photocopies of photographic Identification, we also noted inconsistencies in the content of health statement information present in files viewed and this needs Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: standardizing. There are comprehensive interview records maintained but improved clarity is needed with these to ensure that verification is sought of applicants either through application forms or through interview reasons for leaving previous care roles, particularly where these may not feature as a reference. We recommend that the service implements improvements in the areas highlighted. In discussion staff reported positive experiences of induction into the service indicating that they were given time to learn about individual residents and the practice within the home before being asked to work with individual residents, introduction to residents has been set at a pace suited to resident respective needs and coping abilities. Staff demonstrated confidence and understanding of their roles and clearly take pride in a service that they judge to be providing very good outcomes for residents. Staff were open to suggestions for improving the service where this would be of benefit to residents. A staff training matrix highlights that staff are kept updated with core mandatory skills training and are provided with additional training to support their work with residents in the context of new legislation and current best practice. The manager advised that whilst additional external qualifications and training are supported the service is also proactive in funding training with specialists in the area of ASD to advise and guide ways of working with specific individuals better. Staff comments included: The first time Ive had supervision was here There has been so much training this is the best place Ive ever worked Induction is good youre not rushed into things Staff spoken with conveyed confidence in working with the residents, indicating that they felt secure in doing so because of the professionalism of the service and the systems in place to support their practice and safeguard residents. Staff reported that they are provided with opportunities to meet regularly with a senior Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: for supervision and records viewed confirmed this. Staff commented on the the friendliness of the team and how they felt well supported by colleagues, newer staff felt able to express comments and views at staff meetings which are held routinely and minutes of these are available to view if they are absent. Care Homes for Adults (18-65 years) Page 25 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is very well managed with the best interests of residents a key consideration at all times. Evidence: In discussion we found the manager demonstrated a commitment and passion for the development of the service, she has undertaken to update her own training on a regular basis and has a well developed understanding and experience of the client group as a whole and individual residents within that. From information provided in the AQAA and from our discussion with the manager she has shown herself to be forward thinking and innovative in seeking new and better ways of working with this comlex group of residents to aid support strategies. The manager advises that the service is seeking accreditation for its work with ASD. We found the AQAA information sent to us to have been completed to a very high standard telling us most of what we needed to know. Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: The service has achieved a skills pledge commitment, statement of intent from train to gain and the learning skills Council. A monthly magazine is produced of happenings in the house and news stories relevant and of interest to residents, their families and significant others. The March issue viewed highlighted the changes to the regulatory body and provided contact details for residents and families. In view of residents complex behaviours residents meetings have not worked well, in order to engage meaningfully with residents on an individual basis the activities organizer will be meeting monthly with residents on a 1-1 basis to try to ascertain their views about the service and their own personal service in particular. Any issues that arise from this will be taken to staff meetings or directed to the manager. Record keeping and documentation contained with in the home are well maintained and updated and to a consistently high standard. The AQAA informs us that all Health and safety checks and servicing have been conducted and this was confirmed in a random sampling of these records at the site visit. The fire officer has visited recently and has indicated satisfaction with the arrangements in place, an examination of records confirms that regular testing and checks of equipment is being undertaken and staff are attending fire drills on a regular basis, the manager in response to our query the manager confirmed that all staff including night staff should be participating in at least two fire drills annually. A review of accident report indicates these to be minimal in number and appropriately managed. We consider the home does most things very well with evidence of forward planning , self reflection and assessment of practice and a creative and innovative approach to working with residents and getting the best out of them. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Adults (18-65 years) Page 28 of 30 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 Requirement 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 Requirement 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 1 6 Residents would benefit from goals being broken down into smaller more achievable elements making thereby making their achievement easier to monitor and measure. Staff to be reminded of the importance of maintaining detailed and accurate food intake records for residents to ensure a healthy balanced diet is being maintained and to inform nutritional assessments All handwritten entries must be accompanied by a signature of the person making the entry or changes and the date the entry or change is made. In the absence of residents capacity to make formal complaints consideration should be given as to whether the service should be proactive in interpreting residents likely response to incidents as complaints and provide increased opportunity to consult with residents about how they are feeling Improved copies of photographic ID should be provided for recruitment files, health statements information retained in staff files should be standardized, and clear evidence that the reasons for applicants leaving previous care roles has been verified if not by reference. 2 17 3 20 4 22 5 34 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: 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) Commission for Social Care Inspection (CSCI). 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