Inspection on 08/06/09 for Beechwood

This is the latest available inspection report for this service, carried out on 8th June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Beechwood 27/04/06

Beechwood 31/10/05

Beechwood 23/06/05

Beechwood 10/05/05

Beechwood 29/11/04

Beechwood 08/09/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 28/03/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Beechwood High Pitfold Hindhead Surrey GU26 6BN The quality rating for this care home is: two star good service 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: Vera Bulbeck Date: 0 8 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 Care Homes for Adults (18-65 years) Page 2 of 33 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 Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Beechwood High Pitfold Hindhead Surrey GU26 6BN 01428608124 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): beechwood@robinia.co.uk Robinia Care South Limited Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 5 Number of places (if applicable): Under 65 Over 65 5 0 learning disability Additional conditions: The maximum number of service users to be accommodated is 5. 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). Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 33 A bit about the care home Beechwood is a purpose built home, registered to provide accommodation for up to six adults with learning and physical disabilities. Each person living at the home has considerable care needs. The home is within a mile or so of local shops, and the town of Hindead. The home is not directly accessible by public transport. The home provides single bedroom accommodation with rooms of a good size, personalised and decorated to individual tastes and interests. The lounge and dining area is combined with a seperate kitchen. The home has two bathrooms with necessary adaptations. There is an enclosed garden that can be accessed through the front door or from the laundry or the office at the back of the home. All of the facilities are on the ground floor including the office. There is ample parking at the front of the building. Care Homes for Adults (18-65 years) Page 5 of 33 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 Care Homes for Adults (18-65 years) Page 6 of 33 How we did our inspection: This is what the inspector did when they were at the care home This inspection of the care home was an unannounced Key Inspection and was undertaken on 8th June 2009. Following the previous key inspection on the 25th June 2007 and the service had no previous requirements. Mrs Vera Bulbeck, Regulation Inspector carried out the inspection and the registered manager represented the service. The Pharmacy Inspector Mrs Geraldine Yates also looked at the medication and administration process. The home had submitted the Annual Quality Assurance Assessment AQAA prior to the inspection, which was well written to inform the commission about the service and some details of the document have been added to the report. The inspector arrived at the service at 10.15 and was in the home for six hours and 15 minutes. It was a thorough look at how well the home is doing. It took into account detailed information provided by the home and any information that CQC has received about the service since the last inspection. The inspector spent time talking and observing the staff members and individuals in order to gain their views and opinions about the service. Care Homes for Adults (18-65 years) Page 7 of 33 The inspector looked at how well the service was meeting standards and has in this report made judgments about the standard of the service. Documents sampled prior and during the inspection included the homes Annual Quality Assurance Assessment AQAA, care and person centred plans, risk assessments, medication procedures, staff files, training records, health and safety records and several of the organisations policies and procedures including the complaints and safeguarding procedures. One complaint has been received to the commission which was anonymous and has been referred to the safeguarding team. There are no outstanding safeguarding issues from previous complaints, these have all been addressed and dealt with. From the evidence seen by the inspector and comments received, it is considered that the home continues to be able to provide a service that meets the needs of people who have diverse religious, racial or cultural needs. The final part of the inspection was spent giving feedback to the registered manager about the findings of the visit. The fees for the home are from £1.255.59 - £2.070.65 these fees do not include personal items. Care Homes for Adults (18-65 years) Page 8 of 33 What the care home does well What has got better from the last inspection Two bathrooms have been completely re fitted and decorated. One service user has a new carpet in his bedroom and a new touch screen computer. Staff have got better at listenning and knowing what people want, you can have your meals when you want. You can go on holidays and use the garden at home at any time. Care Homes for Adults (18-65 years) Page 9 of 33 What the care home could do better 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 Vera Bulbeck The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 01622724950 Care Homes for Adults (18-65 years) Page 10 of 33 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 11 of 33 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 12 of 33 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. The admission and assessment procedures ensure that service users needs are appropriately identified. Evidence: The registered manager is new in post said that no individuals had been admitted to the home since the last inspection. The statement of purpose is in picture form and was not viewed on this occasion as it is still in draft and needs to be printed. The service users guide is also in picture form and is being updated. The AQAA states that the homes policies are good and that robust assessments would be documented by a qualified person to ensure that the needs of the service user could be met by the homes staff before they are admitted to the home. In order to promote peoples rights of choice the person would be supported to visit the home, meet with fellow service users, share a meal time and an overnight stay if they choose to, prior to moving into the home. Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: Care Homes for Adults (18-65 years) Page 14 of 33 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. The support and personal care that people receive is based on their individual needs set out in their care plans. Monitoring of risk assessments is well managed to ensure the safety of individuals. Peoples rights to dignity and confidentiality must be maintained at all times. Evidence: Following the previous site visit the management have improved the standard of the service users care plans, which are currently being up dated. Two care plans were sampled and it was evident that the plans will allow the reader to gain an overview of the persons medical, emotional, sensory, social and lifestyle preferences. The management had commenced to introduce person centred plans which evidenced that service users will be involved in the content of the plans and had been encouraged to maintain an interest and where possible sign the plans for those service users who are able or a service users representative. Within service users bedrooms it was observed Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: that the staff had developed with each service user interesting and stimulating information which included family and friends involvement where possible. The care plans indicated that all service users have a keyworker and there was evidence that the persons keyworker had ongoing involvement in the persons plan of care and their welfare. The homes staff team promotes service users right to have their opinions and concerns listened to and work hard to promote advocacy both within and outside of the home, with the inclusion of peoples family, friends and other health care professionals. The care plans included risk assessments. The assessments were discussed with the registered manager and it was agreed that those sampled did not reflect fully the hazards in an individuals life, the actions that staff or the individuals representative should take in order to minimise the risk. As discussed with the manager the care plans are still being updated and should include all the relevant information regarding the service user to ensure and promote the individuals safety and wellbeing. The registered manager had identified the shortfall. All risk assessments must be reviewed and updated to reflect the hazards presented in peoples lives. The assessments need to be reviewed, monitored and updated when necessary in order to promote the safety and wellbeing of the individual. It was observed that service users were able to have a choice and independence in their lives through being offered choices at meal times in order to promote their rights to autonomy, independence and choice, and going out in the homes vehicle. In the AQAA the manager has stated that staff attending training has increased, better recording, and staff are being supported to document what activity they are doing with service users. The home has started documenting in an activitiy folder containing new things being tried. What could be better and improve the plans is for staff to have more training on person centred planning. Care Homes for Adults (18-65 years) Page 16 of 33 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. Individuals are able to exercise choice in their daily lives, maintain bonds with family and friends and take part in social, cultural, religious and recreational activities. Individuals are encouraged to be involved in the running of the home and maintaining their daily living skills. A choice of a healthy diet is provided. Evidence: Throughout the inspection it was observed that service users were comfortable and settled in their surroundings and the staff on duty were attentive to the needs of each individual. This was apart from one service user who was laying on the floor and making very verbal noises. When seen a short time later he was laying on a sofa asleep. There was evidence in the home that people are encouraged to take part in meaningful and purposeful engagements which include aromatherapy, going on holidays, visits to London and Blackpool, going to the pub, staying with relatives, taking part in day service activities, supporting staff with the homes recruitment and continuing involvement within Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: the local community. The staff are engaged in working alongside the local day centres in order to promote the safety and well being of the individuals attending the on site centres and it was evident that any issues arising are promptly dealt with by staff in order to ensure the well being of the individual attending the centres. Individuals culture and ethnicity is promoted and it was observed that individuals were supported by staff to wear clothes, have hair styles and foot wear which was in fashion and supported the individual to have a good sense about their own individuality and esteem. There was evidence that family and friends are involved in the lives of service users and staff work alongside peoples friends and family for the best interest of the service users. Peoples bedrooms contained family photos and personal items which involved their inclusion in family life. Records confirmed that regular one to one support is provided by the individuals keyworker in order to seek the persons views about their home and to listen and act upon the feedback given. Although people supported at Beechwood have complex communication, staff were observed to understand and have knowledge of the individuals way of communicating and to respond accordingly. It was observed that individuals were given choice at the lunch time meal and service users sat in the dining area at the large dining table. The staff promote individuals choice so that meals can be taken by individuals at different times and in different places within the home. The home promotes healthy eating and it was evident through looking at documents that dieticians and speech and language therapists were involved in the dietary and special needs of individuals to promote their safety and welfare at meal times. Nutritional, eating and drinking risk assessments and a nutritional screening tools with regualr body weight charts were kept within the persons care plans in order to ensure the well being and safety of individuals, which were sampled by the inspector. The AQAA advises service users have regular contact with their families and have over night visits. Family members either come and pick up service users or staff will take service users to their relatives home. Service users are encourgaed to live more independantly and during the inspection it was observed that one individual went with a member of staff to the local town centre to do shopping. Page 18 of 33 Care Homes for Adults (18-65 years) Evidence: Service users have unrestricted access to all areas within the home the office is not exclusive and unless staff are working or taking a confidential telephone call the office door is open. Care Homes for Adults (18-65 years) Page 19 of 33 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. Peoples care plans were up to date and the provision of personal care and support were well documented. Peoples health care needs are well met. Medication is administered in a way that protects the individual and promotes their safety and well being. Evidence: Following concerns brought to the attention of The Commission the handling of medicines was assessed by one of the Commissions specialist pharmacist inspectors. We looked at staff training, policies and procedures, records of medicines given to people and talked to the manager. The staff team consist of a multi racial mixed gender staff group. Gender specfic care and support is provided and staff demonstratated awareness of peoples individual preferences. It was observed that staff supported individuals in a sensitive way ensuring their privacy is respected when providing assistance with personal care and individuals responded favourably to staff. Individual care plans documented how the staff provide individual care and support from staff and it was noted that staff were sensetive and aware with regard to peoples sensory impairments for example specfic individuals in their daily lives with each differing activity. Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: The inspector was told that this way of communicating with the individual had helped them have more control over their life and had decreased their level of anxiety to make their life more predictable. The care plans and health care reports have been well maintained and included records of attended health care appointments, which included visits to the individuals general practitioner, appointments with the dietcian, continence advisors, mobility specialists, speech and language therapists, occupational therapists, dentists, visits by care managers and other specialist health care personnel. The daily records completed by staff were well written and contained good evidence of the care and emotional support provided by staff over a twenty four hour period and the monitoring of any health related concerns. Through sampling care plans and observation it was evident that the home maintains good working partnerships with health care professionals. However one service user had dental problems and these problems had not been resolved. The inspector suggested the management contact the care manager, G.P and make some arrangements for the service user to be seen by the hospital, who are able to deal with these problems more appropriately. Medication cupboards are located in a safe and secure area within the hallway. The Pharmacy inspector was present in the home on the day of inspection and undertook a full inspection of the medication, policies and Procedures regarding the safe handling, administration and disposal of medicines. In the AQAA it states annual medical reviews and regular input with the G.P. annual dental and optical checks, input from behaviour specialists, epilepsy specialists, continence specialists and effective training for staff with regards to assisting service users with their personal hygiene requirements. In addition the home works closely with Surrey Community Learning Disability team to ensure that the staff are exploring the causes of any change or challenging behaviours that may be a medical cause. Staffing levels have been increased to ensure service users neeeds are being met. For improvement within the next twelve months the home plans to work closely with relevant professional teams to promote personal and healthcare support. The records and medicines supplies showed us that people were receiving their daily medicines correctly. Clear records were kept to medicines coming into and leaving the home and of medicines that are given to people. Any handwritten additions to the medication administration record charts, supplied by the pharmacy, were signed and dated by the carer making the entry and then checked by a second person to see that they were correctly written. If people were allergic to any medicines this was clearly documented on the front of their medicines record files. However allergies were not always listed on the medication administration record charts. It is important that details of peoples allergies is clearly and consistently recorded so as to prevent someone being given a medicine that they are allergic to. Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: Personalised care plans were available for some people who were prescribed medicines only to be given when needed. Where these were in place they were very clear and detailed, describing when to give people their medicines and how to recognise when people are in pain. However not everyone prescribed these medicines had a care plan. It was of particular concern that no care plans were available for medicines to be given if people had a seizure. People who use the service have their medicines given to them by care staff who have been trained but whose competency in medication handling has not been formally assessed. Staff had access to detailed written procedures on the safe handling of medicines. They did not however describe the practices in place in the home and referred staff to documentation that the home does not use. So as to avoid confusion the procedures should be updated and describe the current ways staff are expected to work. Some people were being given their medicines disguised in food. We looked at the file for the one person and saw that this was done with multidisciplinary agreement and was seen to be in their best interests. All medicines were stored securely for the protection of people who use the service. The temperature of the storage area was being monitored daily and this showed it to be above the recommended temperature for storing medicines. The manger was aware of this and was seeking agreement for some structural alterations to resolve this. There were no Controlled Drugs in stock when we visited. The home has a cupboard that would meet the legal requirements for storing Controlled Drugs if it were correctly secured to the wall. The commission have requested that the requirement made regarding the improvement of some aspects of the medication protocols in the home be discussed with the link inspector on receipt of the report. Care Homes for Adults (18-65 years) Page 22 of 33 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 homes complaints procedure is in picture form to enable service users to use with staff support, to express any concerns or complaints. Individuals are protected from abuse and harm by the homes policies and procedures and all staff have received safeguarding vulnerable adults training to ensure that all persons are safeguarded from abuse or harm. Evidence: The home has a clear complaints policy and procedure which is available within the home for individuals or any person associated to the home to see in order that their views, opinions and complaints are recognised and acted upon. It was evident during the site visit that the best interests of individuals is strongly promoted by the staff in order that people being supported have a voice and that their views and opinions are considered. The registered manager confirmed that no complaints have been received by the home recently and one complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection. The registered manager demonstrated that they were aware of the local authorities multi agency procedures for safeguarding adults and confirmed that ten referrals had been made to the local authority safeguarding team. There is one complaint currently outstanding which is being investigated. The home must obtain a copy of Surrey Multi Agency Procedures. The home has a whistle blowing policy and procedure, which is Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: available to staff in order to safeguard individuals in their care. Records confirmed that all care staff had received safeguarding vulnerable adults training to ensure that individuals living at the home are protected from harm and abuse. In the AQAA it states recruitment and selection procedures ensure all staff have an enhanced CRB/POVA check, and suitable references are in place on all new staff. New easy complaints procedure is in place, which can be located in the home and in service users support plans. Although not a formal complaint but at some recent reviews parents have raised concerns about changes in staffing and management causing the home to have a breakdown in communication in some areas. The registered manager states these areas have been addressed and the home will continue to improve in this area. Further training for staff regarding documentation, ensuring a factual account is given of any situation or incident, which may arise. Care Homes for Adults (18-65 years) Page 24 of 33 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. All areas of the home are clean improvements are on going to ensure the control of infection in the home and the improved services with regard to repairs amd maintenance to promote the safety and well being of service users. Evidence: During the tour of the premises the inspector observed that the home was fairly well maintained. It was noted that there was one bedroom with a malodour and the inspector was informed new flooring is to be fitted within the next three weeks. While the floor is being laid the service user will stay with his relative. Two bathrooms have been refitted, and a new carpet has been laid in a service users bedroom. It has been recommended that the patio area needs cleaning and the garden generally needs to be more service user friendly. It was observed that staff did practice safe methods of the control of infection in the home for example wearing protective clothing in the kitchen when preparing meals and consistently wear protective clothing when supporting people with personal care. In the AQAA it states the home has a maintenence dept on site and a Health and Safety Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: specialist advisor. All staff attend regular health and safety , COSHH and infection control training as part of their essential training. The home is clean, hygienic and in the main free from any odour. The regular monthly visits by the Quality audit team highlight any problems and are reported and are generally dealt with as soon as possible. Care Homes for Adults (18-65 years) Page 26 of 33 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. The staff provide twenty four hour support to the individuals living at the home. The homes recruitment practices, induction, mandatory training and supervision of staff is consistent to ensure that service users needs are appropriately and safely met and staff have equal opportunities with regard to their own professional development. Evidence: The homes staff are currently supporting 6 people and a number of agency staff have regular shifts so that they know the service users very well. The level of staffing was observed to meet the needs of the individuals on the day of the site visit however it was noted that the morning routine of generally taking service users out was not possible as the transport had broken down. Some of the service users were unsettled because they were unable to go out. The manager stated that she had made arrangments with another home next door to use their transport in the afternoon. It was not known how long the vehicle was going to take to be repaired. As previously documented the staff were observed as skilled in supporting individuals in their care and were knowledgeable regarding the specific needs of individuals to ensure their safety, well being and offer reassurance. Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: The home has a recruitment and selection policy, which incorporates equal opportunities. The inspector sampled two care staff files which were well recorded and contained application forms, with two references, evidence that face to face interviews had taken place and the job description in order that the staff member was clear about their roles and responsibilities. There was documented evidence that a CRB clearance had been obtained. The care staff mandatory and induction training records evidenced that staff had received updated training and had also undertaken specilaised training in order to support the needs of the individuals in their care. The AQAA identifies that over 50 per cent of staff have achieved their National Vocational Qualification in Care awards. The care staff records evidenced that they are formally supervised by the registerd manager and staff confirmed that they felt supported by the manager on a day to day basis. Care Homes for Adults (18-65 years) Page 28 of 33 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 management and administration of the home is robust and the home continues to be run in the best interests of the individuals and their views and opinions and those of others associated with the home are sought. Individuals welfare is promoted through monitoring of health and safety in the home. Evidence: As documented within the report it was evident through observation that the home continues to meet the needs of the individuals and the care staff present during the site visit demonstrated a good knowledge about individuals in the home to ensure their safety and well being. The home has a registered manager who has been in post for a short time. The manager is currently undertaking NVQ Level 4 in Leadership and Management. Staff confirmed that Care Homes for Adults (18-65 years) Page 29 of 33 Evidence: the manager conducted the home in the best interests of the individulas and offered an open and inclusive style of management. The registered manager undertook her duties in a professional and calm manner and was very knowledgable about the running of the home to benefit the people being supported and the staff. The management of files and related documents were well established and orderly. Accident and incident records were sampled. The registered manager was reminded of the homes responsibility in giving notice to the commission without delay regarding any event, which affects the safety and welfare of the supported people. Hand washing facilities remain available throughout the home. Records indicated that servicing of fire equipment had taken place however the fire risk assessment needs updating and the records for the testing of the fire alarm system or when the last fire drill was undertaken were not avialable. The manager stated the maintenance person had the records but they had been checked. Health and safety checks had been undertaken and recorded. A current insurance indemnity, gas and electric certification was sampled and the current certificate of registration of the home dispalyed. Confirmation was seen that the home continues to seek service users and their representatives views and opinions about the service through the Quality Assurance procedures. All substances which are hazardous were stored in compliance with the control of substances hazardous to health COSHH legislation in order to ensure the safety and welfare of service users. In the AQAA it states service users are involved in reviews and decision making within the home. Annual reviews take place on all the service users. A focus has been undertaken on person centred planning and person centred approach. The home has appointed a new deputy manager and in the process of recruiting a second deputy manager. The home plans in the next twelve months to implement a robust management team to further develop the home and service delivery. Recruit more permanent care and support staff and involve service users in the process. Also to up date the homes statement of purpose. Care Homes for Adults (18-65 years) Page 30 of 33 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 Care Homes for Adults (18-65 years) Page 31 of 33 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 1 20 13 Arrangements must be made 25/09/2009 that identified areas of the safe administration and recording of medication be strenghenned. In order that service users are protected from harm with regard to the administration of their medication. 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 24 The patio area needs cleaning and the garden more service user friendly. Care Homes for Adults (18-65 years) Page 32 of 33 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. 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