Inspection on 07/12/09 for Byways

This is the latest available inspection report for this service, carried out on 7th December 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.

Other inspections for this house

Byways 06/11/07

Byways 01/08/06

Byways 24/10/05

Byways 05/05/05

Byways 07/12/04

Byways 07/07/04

Byways 30/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Byways 80-82 London Road Warmley South Glos BS30 5JL 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: Elaine Barber Date: 0 7 1 2 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 40 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 © (2010) 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 40 Information about the care home Name of care home: Address: Byways 80-82 London Road Warmley South Glos BS30 5JL 01179612426 01179709301 max@aspectsandmilestones.org.uk admin@aspectsandmilestones.org.uk Aspects and Milestones Trust Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Madelynne Silcock Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 8 0 care home 8 learning disability Additional conditions: The maximum number of service users who can be accommodated is 8. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection 2 3 1 0 2 0 0 8 Care Homes for Adults (18-65 years) Page 4 of 40 A bit about the care home Byways is a two storey; extended detached house It has good sized wellmaintained gardens that are easy to access. The home is in Warmley, five miles from the centre of Bristol. It is close to shops and the local bus service. Byways provides accommodation and support for eight people with learning disabilities and additional needs. Page 5 of 40 Care Homes for Adults (18-65 years) The home provides single rooms with wash hand basins. There is ground floor accommodation for two people. All other bedrooms and a staff sleeping in room are on the first floor. There is a passenger lift. The home has assisted bathroom facilities and a separate toilet on each floor. All areas of the home are accessible to people. Hallways, corridors and door ways are wide enough for wheelchairs. Page 6 of 40 Care Homes for Adults (18-65 years) There are at least two members of staff on duty in the home during the day and evening. One member of staff is awake at night and one sleeps in. Care Homes for Adults (18-65 years) Page 7 of 40 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 8 of 40 How we did our inspection: This is what the inspector did when they were at the care home We asked the home to complete an Annual Quality Assurance Assessment (AQAA). This told us about what has happened during the last year, and about their plans for the future. We sent out surveys and we had surveys back from 6 people who lived in the home and 2 staff members. Page 9 of 40 Care Homes for Adults (18-65 years) We visited the home on the 7th December 2009. We talked to the manager and two staff. We talked to three people who lived in the home. Care Homes for Adults (18-65 years) Page 10 of 40 We looked at some of the records. The last inspection of the home was on 23rd October 2008. What the care home does well There was clear information about the home that was easy to read. Care Homes for Adults (18-65 years) Page 11 of 40 Each person had care plans and a person centred plan. These told staff how to meet peoples needs. People saw the doctor, nurse, dentist and optician when they needed to. Staff helped people to take their medicines. People could go out and could do what they wanted when they were at home. Care Homes for Adults (18-65 years) Page 12 of 40 Staff supported people to keep the home clean and do the cooking. They chose their own meals and did the shopping with staff support. The shared rooms and the bedrooms were nicely decorated. People liked their rooms. Care Homes for Adults (18-65 years) Page 13 of 40 People knew how to make a complaint. Any complaints were looked into and if something was wrong it was put right. Proper checks are done so that new staff were suitable to support people. Staff had the right training to support people. The manager and staff made sure the home was safe for people to live in. Care Homes for Adults (18-65 years) Page 14 of 40 What has got better from the last inspection The manager has applied to become the registered manager and been approved. Care plans and risk assessments were being reviewed so that staff had upto-date information to support people. Care Homes for Adults (18-65 years) Page 15 of 40 Clearer instructions had been obtained from the doctor for giving one medicine so that the person who received it was kept safe. Peoples money was being stored more securely. Staff were checking the temperature of the hot water so that people were not at risk of scalding . Care Homes for Adults (18-65 years) Page 16 of 40 The minutes of the residents meetings were easier to understand. What the care home could do better The manager should update the service user guide so that people have clear information about the service. The manager should make the arrangements for the storage of medication safer. Care Homes for Adults (18-65 years) Page 17 of 40 The manager should make the arrangements for staff training about medication safer. The manager should gather peoples views and make sure that any service developments are based on peoples views. 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 Elaine Barber Care Homes for Adults (18-65 years) Page 18 of 40 CQC South West Citygate Callowgate Newcastle Upon Tyne NE1 4PA 03000 616161 Are 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 19 of 40 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 20 of 40 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 had most of the information that they needed to make an informed decision about whether the home was the right place for them. Peoples needs were assessed when they moved into the home so that their needs would be met. People had the opportunity to visit the home before deciding whether to move in. People had information about the terms and conditions of the home so that they knew what they had to pay for. Evidence: There was a statement of purpose which contained all the required information. This had been updated in June 2009. There was a service user guide in simple words and pictures. This informed people about the service and what they had to pay for. The service user guide contained information about the previous manager and the contact details for The Commission for Social Care Inspection and needed to be updated. The manager told us in the AQAA that new peoples needs were assessed to see if the home could meet their needs. We looked at the files of four people. We saw that each person had an assessment of their needs. Three people had community care assessments and care plans. The third person had an assessment from a social worker and a large amount of assessment information from their previous home. Care Homes for Adults (18-65 years) Page 21 of 40 Evidence: We saw that there was information in the statement of purpose about the admission procedure. The manager told us in the AQAA that people who lived in the home were encouraged to be involved in initial meetings and their views and feelings were obtained about new admissions. They said that they met new people in their previous home and sought the views of people who knew them well. They also said that they encouraged people who knew the person to visit the home and feedback. They said that they arranged visits to fit in with everybodys timetables. We found that one new person had moved into the home since the last inspection. The manager said the family visited before the person moved in and the person visited the home several times. People in the home were involved in the decision about them moving in. When we looked at the files we saw that each person had a license agreement which contained information about what they had to pay for and what was extra. One person also had a contract with Swindon Borough Council. Care Homes for Adults (18-65 years) Page 22 of 40 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. Each person had their needs set out in a care plan so that staff knew how they should be supported and their needs would be met. People were supported to make choices and decisions. Risks were assessed and action was taken to reduce risks to people and promote their independence. Evidence: The manager told us that when a new person moved into the home the people who lived there were involved in the decision about whether they should move in. The manager said that people showed by expression and signs whether they were happy for the person to move in. At lunchtime we saw staff offering people the choice of what to drink and a choice of fruit. When we looked at the essential lifestyle plans we saw that these contained information about how people communicated decisions. Additions had been made to the essential lifestyle plans since the Mental Capacity Act. These additions recorded when in the day people were best able to make decisions and how they made decisions and choices. Four out of six people who completed surveys said that they made decisions about what they did each day. They also said that they could do what they wanted during the day the evening and at weekends. The other two people did not Care Homes for Adults (18-65 years) Page 23 of 40 Evidence: answer those questions. We made a requirement at the last inspection that call bells must be available to people so that they can request assistance. This was because we found that one persons call bell had been tied up. This person no longer lived in the home. The manager told us that no one currently needed a call bell. However, they said that a call bell would be made available if a person needed it and they could learn how to use it. When we looked at the files we saw that each person had a series of risk assessments for example for accessing college and having a bath. Some of the risk assessments were in a new format and these contained information about the decision-making process. The risk assessments focused on promoting independence. One person also had a moving and handling assessment. We made a requirement at the last inspection that all the risk assessments should be reviewed to make sure they contained accurate information. All the risk assessments had been reviewed and revised and the date was recorded. Care Homes for Adults (18-65 years) Page 24 of 40 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 had a range of activities and opportunities to go out into the community. They were supported to keep in contact with their family and friends. People were involved in the routines of the home. They were offered a healthy diet with meals that they enjoyed. Evidence: We talked to the activities organiser who told us that she worked four mornings a week. She said that she worked with people individually and in groups to do activities. These included craft work, puzzles, construction, painting, drawing and games. On the day of our visit one person was playing a game, one person was doing construction and one person was making biscuits with support of the activities organiser. We saw that there was information about activities recorded in the daily diaries. People had a range of daytime activities including attending a resource centre and various college courses. One person went to a group for older people. A staff told us that people were very active in the home. They said that several people went out a lot for example to the pub and to social clubs. They also told us that people Care Homes for Adults (18-65 years) Page 25 of 40 Evidence: had holidays, usually on their own or with one other person. They said that two people had been to the Lake District. Another member of staff told us that they had supported two people to go on holiday on a coach trip to Bournemouth in October. We looked at the daily diaries in the last month. These showed that people had been on a range of outings. They had been to a garden centre, disco, the pub, shopping for clothes, Christmas shopping, a cafe, McDonalds, the Beefeater, the Christmas market, a social club and food shopping. When we looked at the files we saw that there was information about peoples contact with their family and friends recorded in their care plans. When we read one of the diaries we saw that one person visited their father for their birthday and there were records of when they phoned their sister and brother-in-law. The manager told us in the AQAA that people were encouraged to do tasks for themselves rather than staff doing them for them. When we looked at the diaries we saw examples of people being involved in the routines of the home. People went food shopping. Each person had a house day when they cleaned their own rooms, changed the bed and put their washing in the washing machine. People did baking as part of the daily activities. One person liked to tidy away the tea cups and people took their own cups and plates away after meals and put them in the kitchen. There were residents meetings. We made a recommendation at the last inspection that the minutes of the residents meetings should be produced in a more accessible format. These were now available in simple words and pictures. The manager told us that people chose the menus on a Sunday evening using picture recipe cards. She told us that staff tried to rotate the recipe cards offered so that people got a good selection of meals. When we looked at the menu we saw that a variety of meals was being served including fresh fruit. The manager told us how they encouraged people to have five portions of fruit and vegetables a day through offering fruit regularly and including vegetables and salads in the main meals. We saw people being offered a choice of fruit at lunchtime. Care Homes for Adults (18-65 years) Page 26 of 40 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 were supported in ways that they preferred. Peoples health care needs were being met. People were generally protected by the medication practices. Evidence: We saw that there was information in the essential life style plans and care plans about the ways in which people liked to be supported. We saw that each person had a health action plan. These were reviewed about once a year and the date was recorded. Records were kept of appointments with healthcare professionals. We saw that people had appointments with the GP, dentist, optician, community nurse and chiropodist. They also had access to specialists and saw a psychiatrist, occupational therapist, physiotherapist and speech therapist. There was a medication policy. A monitored dosage system was used for managing medication. There were printed medication administration record sheets. Medication was stored in a locked cupboard bolted to the wall. There was a controlled drugs cabinet screwed to the bottom of the medication cupboard. This did not comply with the new requirements for the storage of controlled drugs. Medication that was not in the monitored dosage system was stored in a locked trolley. One person took a medicine that had to be given in a special way. There was a protocol for the administration of this medicine drawn up by the consultant. Staff were trained by a learning disability nurse Care Homes for Adults (18-65 years) Page 27 of 40 Evidence: who worked for the organisation. However there was no record to show that the professional who prescribed the medicine deemed staff to be competent to administer it. The manager had obtained agreement from the GP about the giving of homely remedies. We saw that the medication administration record sheets were appropriately recorded. Medicines received into the home were recorded on the medication administration record sheets. There was also a record of medicines return to the pharmacist. We made a requirement at the last inspection that one particular medicine should must be administered correctly and in line with the instructions from the general practitioner and the homes policy. There was a protocol written by the consultant about how this medicine must be given. Care Homes for Adults (18-65 years) Page 28 of 40 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. Peoples complaints were taken seriously and acted upon. People were protected from abuse and harm by the procedures for safeguarding adults and managing money. Evidence: We saw that there was information in the statement of purpose about the complaints procedure. Each person had a copy of the pictorial complaints procedure in their file. There had been no formal complaints to the home since the last inspection. There had been one informal complaint from a person who lived in the home about being unable to go to their Day Service. The reasons for this were explained to the person and the manager said that they had tried to make sure that this did not happen again. A record was kept in the persons personal notes. Staff supported six people to complete surveys. Three people indicated that they knew who to talk to if they wanted to make a complaint. The other three did not understand the question. A member of staff told us that they had received training about the protection of vulnerable adults. The manager told us that all the staff had just completed training about safeguarding adults. When we looked at the training records we saw that staff had received training about safeguarding adults. The manager told us that they had received updated procedures for safeguarding adults. They told us that they knew to make a referral to the duty desk at Adult Services. We saw that the homes policy for protecting vulnerable adults showed that staff should contact the on-call manager who would tell people what to do in the event of an allegation of abuse. Care Homes for Adults (18-65 years) Page 29 of 40 Evidence: Staff managed money on behalf of people. We looked at the arrangements for managing this money. We checked three files and reconciled three purses with the financial record sheets and found that these balanced. We saw that two staff signed the records when money was checked out. The manager told us that the financial records were checked three times a day. Receipts were kept for all transactions. We made a requirement at the last inspection that money kept on behalf of people who lived in the home was stored securely. This was because we saw that someones money had been left out for part of the day. No money was left out during our visit and the manager told us that money was kept locked away. Care Homes for Adults (18-65 years) Page 30 of 40 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. People lived in a homely, comfortable, clean environment suited to their needs. Evidence: Byways is a large house on the main road through Warmley. The home is in keeping with the other houses in the street. It is in a residential area close to some local amenities such as a community centre, pub, post office and shop. There is a regular bus service which can take people to the local shopping area in Kingswood or into Bristol city centre. We made a recommendation at the last inspection that a mattress stored at the side of the house should be removed. The manager said that this had been removed shortly after that inspection and it was no longer there. There was a lounge and a dining room. These areas were comfortable, bright, airy, clean and free from odours. We saw people making good use of these areas for activities and at mealtimes. All areas were well decorated. We had recommended at a previous inspection that the carpet in the front hall should be replaced. This had now been replaced with vinyl flooring. We saw several of the bedrooms during our visit. Each person had a single room and had personalised their bedroom to reflect their taste and style. All the rooms had furnishings of good quality. Care Homes for Adults (18-65 years) Page 31 of 40 Evidence: We noted at the last inspection that the water to one of the showers was very hot. The manager had completed a risk assessment about this. The manager told us that a valve had been fitted to the shower to control the temperature. She also told us that this is currently not in use because nobody liked to use the shower as they preferred baths. We made a recommendation at the last inspection that the aprons and gloves in the bathrooms should be stored more discreetly. The manager showed us small chests of drawers in the bathrooms where the aprons and gloves were being stored. We saw that there was information about infection control. We looked at the laundry and found that there were two washing machines and two tumble dryers. Staff told us that they do the laundry and people help by putting items into the washing machine and putting clothes away. Four people who completed surveys told us that the home is always fresh and clean. Care Homes for Adults (18-65 years) Page 32 of 40 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. People were supported by sufficient staff who were appropriately trained and qualified. People were protected by the recruitment practices. Evidence: We looked at the staff rota and saw that during the week there were two staff on duty during the morning and two staff in the afternoon plus the manager. The activities organiser worked four mornings a week. There was one member of waking night staff and one member of staff sleeping in. At weekends there were two staff during the day with three staff for a two hour handover period. The manager told us that if people were going out they would put on extra staff. The manager told us that she and the deputy were both qualified learning disability nurses. There were 10 care staff altogether. Staff records showed that five of these had a National Vocational Qualification (NVQ) level two and two staff were working towards an NVQ. A member of staff told us that they had all the required training including protection of vulnerable adults. We looked at the staff training records. These showed that staff had received training about food hygiene, safeguarding vulnerable adults, first aid, Health and Safety, Control of Substances Hazardous to Health (COSHH), manual handling, fire safety, values of the organisation, medication and administration of medication by a Care Homes for Adults (18-65 years) Page 33 of 40 Evidence: special method. The manager and the deputy had received training about the Deprivation of Liberty Safeguards and the Mental Capacity Act. The manager said that they planned for other staff to have this training. One member of staff had been recruited since the last inspection. The manager told us that their Human Resources Department (HR) dealt with all the recruitment. She told us that all the recruitment checks were at head office and once all the checks were complete HR would send copies to the home. She told us that she had seen two written references at head office. There was a letter in the home to say that a clear Criminal Records Bureau (CRB) check had been obtained. A check of the Independent Safeguarding Authority list had also been made. The manager showed us copies of the checks for previous members of staff. These included references, CRB checks, an application form, health declaration and proof of identity. Care Homes for Adults (18-65 years) Page 34 of 40 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 manager was suitably qualified and experienced and people were benefiting from a well-run home. Further work is needed to the quality assurance process to ensure that service developments are based on peoples views. Peoples health, safety and welfare were promoted by the health and safety measures. Evidence: The manager was a learning disability nurse and had completed the Registered Managers Award (RMA). She had been approved as a fit person to run the home. The training records showed that she kept her training up to date. The deputy manager was also a learning disability nurse. They were both supported by senior managers in the organisation. The manager was present throughout our visit. She showed a good understanding of the needs of the people who lived at Byways and of her role and responsibility in managing a care home. The manager had completed the AQAA before the inspection. This provided all the information that we asked for and showed what had improved since the last inspection, what they did well and what they could do better. The manager said that there was an internal audit of the service by another manager. There were also yearly finance audits Care Homes for Adults (18-65 years) Page 35 of 40 Evidence: and health and safety audits. The manager told us that they obtained peoples views through service user meetings. The manager was not aware of any quality audit as there was for other homes in the organisation. She said that she would follow this up. We recommended at the last inspection that the local policy on pressure areas should be revisited and updated to include information about pressure area assessments and the use of equipment. The manager was unable to find an updated policy. However, everyone had had a now Waterlow assessment and one person had had a pressure area risk assessment as a result of this. There had also had a new bed and a pressure relieving mattress. There were annual health and safety checks and annual audit checks of the wheelchairs and hoists. We saw a gas safety certificate and an electrical installation certificate. Portable appliance testing took place in March 2009. There had been problems with the heating and an engineer visited twice during our inspection to fix it. There were certificates for the servicing of the bath hoist. There were generic risk assessments and information about Control of Substances Hazardous to Health (COSHH) and cleaning materials were stored in a locked cupboard. We made a requirement at the last inspection that a record should be kept of hot water temperatures to show that staff were monitoring water temperatures and people were protected from the risk of scalding. This had been addressed. The water temperatures were being checked and a record was made in a book in the bathroom. All the required checks of the five safety measures were being made and recorded in the fire log book. Staff were receiving quarterly fire instruction. The fire officer had visited in August 2009 and said that the procedures and measures were suitable. There was a fire procedure to help people to get out of the home in the event of a fire. There was a fire risk assessment. Care Homes for Adults (18-65 years) Page 36 of 40 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 37 of 40 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 1 1 The service user guide should be updated to include information about the current manager and how to contact The Care Quality Commission. This is so that people will have up-to-date information about the service. The registered person should make sure that the controlled drugs cabinets meet with the new requirements for the storage of controlled drugs (The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007). The Controlled drugs cupboard should be bolted to the wall with rawl bolts. The registered person should make sure that when staff are trained to administer medicines by a specialised technique, the responsibility has been delegated to the staff by the responsible medical professional. They should also make sure that the homes insurance covers the staff for this task. 2 20 3 20 Care Homes for Adults (18-65 years) Page 38 of 40 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 4 39 The manager should make sure that there is a quality assurance process based on the views of people who use the service. This will make sure that any service developments are based on peoples views. 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