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Inspection on 06/05/09 for Canterbury Adult Support Unit

Also see our care home review for Canterbury Adult Support Unit for more information

This is the latest available inspection report for this service, carried out on 6th May 2009.

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

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

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

What the care home does well

Service users say they like coming to stay at the unit, they like the staff and enjoy doing lots of different activities. Service users make choices about what they will do, such as helping with meal preparation, deciding where they want to go when they go out, or what activities to do when they stay indoors. Staff are well trained and the majority have a nationally recognised qualification in care. This means that they know the right way to support and care for people. Staff are good listeners so that if a service user is unhappy about something there is always someone there they can go to and talk about it. They can be confident that what they say will be taken seriously. The unit is well managed. They continually look at how well they are doing, to see if they need to make any changes. They listen to the views of service users, families and staff and make sure that their comments influence future plans. We have seen how this has benefited service users.

What has improved since the last inspection?

They have introduced home visits, when the manager, or someone else from the unit, goes out to visit a prospective service user to discuss their needs and wishes. This helps them to gain as much information about the person as they can, so that they will be able to provide the right support for them when they come in for a respite stay. They have developed their pen portraits that service users complete with a staff member. These are simply written in the service user`s own words, with pictures to make them easier to understand. This helps make sure that the service user`s wishes are known, so it is clear what they want to achieve during their respite stays. They have provided service users with more opportunities to take part in activities that they have chosen, including attending social events. They have improved the way they look after service users` medicines to make sure that it is done safely. Staff have learnt more about the medicines that are commonly used so that they know how to do things correctly. They have an improvement plan for the home that has included redecorating some rooms, providing some new furniture, including a new three piece suite in the lounge, new beds and new television sets in all bedrooms. This has helped keep the unit looking attractive and improved comfort for the service users. They have started some building alterations to improve safety. The laundry room and ground floor bathroom are being changed to improve them and make them safer. They have continued with their staff training programme and staff have attended lots of training courses which has helped to develop their skills and knowledge. We sawthat staff have used their new skills for the benefit of service users.

What the care home could do better:

They have acted to address the things raised at out last inspection and have met the one requirement that was made. They have also acted on all the recommendations made. There are no requirements or recommendations in this report. They have shown their commitment over the past two years to develop the service and we are confident that they will sustain their performance and continue to improve the standards within the service.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Canterbury Adult Support Unit 88 Whitstable Road Canterbury Kent CT2 8ED     The quality rating for this care home is:   two star good 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: Christine Grafton     Date: 0 6 0 5 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: Canterbury Adult Support Unit 88 Whitstable Road Canterbury Kent CT2 8ED 01227454020 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) : mandy.gerlack@kent.gov.uk Kent County Council care home 5 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 5 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 Brief description of the care home The home is a three-storey, semi detached property that provides short-term respite care for people who have a learning disability. Communal areas include a lounge and separate dining room. Bedrooms are mainly on upper floors, but there is one ground floor bedroom with en-suite toilet and walk in shower. There are some adaptations and some building improvements are currently being made to make it more accessible for individuals with mobility problems. The home also provides a day care service. The home is located about 1.5 miles from Canterbury City Centre and is on a direct bus route to the seaside towns of Herne Bay, Whitstable in one direction and with Canterbury itself in the other. There are several parking bays on a vacant site to the side of the home and some sections of Whitstable Care Homes for Adults (18-65 years) Page 4 of 30 Brief description of the care home Road. There is a small back garden and patio area for the service users use. There are staff on duty throughout the day and two staff sleep in at night. The current fees for the service are subject to financial assessment in each case. Information on the homes services and the commission reports for prospective service users should be detailed in the Statement of Purpose and Service User Guide. The email address of the home is mandygerlack@kent.gov.uk 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: 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 peterchart Poor Adequate Good Excellent How we did our inspection: This report takes account of information received since the last inspection of 16th May 2007 and included a visit to the home. An unannounced visit took place on 6th May 2009 between 12.15 hours and 16.15 hours. The visit included talking to the staff on duty and some of the service users. We also observed the interactions between staff and service users. Some records were looked at and we looked round parts of the home. Information sent to us by the manager prior to the visit, in the form of the homes annual quality assurance assessment (AQAA), has been used and information from the previous inspection referred to. Care Homes for Adults (18-65 years) Page 6 of 30 Some surveys were also sent out prior to the visit and at the time of writing this report, two service user surveys and four staff surveys have been returned. Their responses are positive and have been incorporated in this report. At the time of the visit there were four service users staying at the unit for their planned respite period, plus three people using the day care facility. The atmosphere in the unit was welcoming and relaxed. What the care home does well: What has improved since the last inspection? They have introduced home visits, when the manager, or someone else from the unit, goes out to visit a prospective service user to discuss their needs and wishes. This helps them to gain as much information about the person as they can, so that they will be able to provide the right support for them when they come in for a respite stay. They have developed their pen portraits that service users complete with a staff member. These are simply written in the service users own words, with pictures to make them easier to understand. This helps make sure that the service users wishes are known, so it is clear what they want to achieve during their respite stays. They have provided service users with more opportunities to take part in activities that they have chosen, including attending social events. They have improved the way they look after service users medicines to make sure that it is done safely. Staff have learnt more about the medicines that are commonly used so that they know how to do things correctly. They have an improvement plan for the home that has included redecorating some rooms, providing some new furniture, including a new three piece suite in the lounge, new beds and new television sets in all bedrooms. This has helped keep the unit looking attractive and improved comfort for the service users. They have started some building alterations to improve safety. The laundry room and ground floor bathroom are being changed to improve them and make them safer. They have continued with their staff training programme and staff have attended lots of training courses which has helped to develop their skills and knowledge. We saw Care Homes for Adults (18-65 years) Page 8 of 30 that staff have used their new skills for the benefit of service users. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users are given information about the service to decide if it is right for them. They have an assessment that tells staff about them and the support they need. They can be confident that their needs will be met by the home. Evidence: The unit is designed to provide short term periods of respite care and day care. Referrals are initially made by care managers who provide the home with a copy of their assessment of the prospective service users needs. They then carry out their own assessment and a care support plan is drawn up. Since our last inspection, they have introduced home visits to go out and meet with the prospective service user at their own home. This has meant that new people now have the opportunity to meet with the manager, or another staff member, before they first visit the unit. Their needs are discussed with them and their parent or carer, and they can learn about the service and what to expect. Following this, a visit to the unit is arranged at a time when the staff member that did the home visit will be on duty to Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: meet them and show them round. This is followed by tea visits and when the person feels comfortable, overnight stays are arranged. This gives them the opportunity to gradually get to know the staff, other service users and the routines of the unit. During these visits, staff add things they have learnt about the persons needs to the support plan. All the information gathered is used to compile a detailed support plan. This incorporates the views of the individual, their parent or carer and care management. This makes sure that staff can meet the needs of the service user. When the service user comes for their first respite stay, they complete a personal responsibilities agreement between them and the unit. This covers things like core values, key safety, room maintenance, smoking, medication, finances, daily routines, fire safety and complaints. This document is illustrated to make it easier to understand. A staff member described the procedure followed when a service user returns for subsequent stays. This always includes going through the agreement with them again and updating the support plan. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are involved in decisions about their lives and play an active role in planning the care and support they receive. Evidence for Report Evidence: Each service user has their own individual support plan that is updated each time they arrive for another respite period. This contains all the things that staff need to know about them so that the right support can be provided. It covers all aspects of the persons health, personal and social care needs, including things like how any specific medical conditions are to be managed. For example, diabetes or epilepsy. We looked at two support plan files for people currently staying at the home for respite periods. We saw that these had been reviewed and updated and now include pen portraits that have been developed since our last inspection. These have helped to Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: make sure that the plans are personal and completely centred around the individual. Service users are involved in completing these with their key worker, or other staff member. They have been written in simple language and include pictures to help with understanding. Service users sign their own support plan. We spoke to two staff members about the current service users needs and found that they have a well developed understanding of each individual and what they said matched with what is written in the support plans. Staff explained how they encourage service users to make decisions. For example, they involve them in choosing menus, deciding if they wish to help with preparing meals and clearing up and planning their own activities. Routines and choices are discussed at the weekly house meetings. We spoke to two service users who talked about the things they like doing during their stays. These include specific activities that they enjoy, such as going to see a show, going to the cinema, or to an internet cafe. They also spoke about making choices for themselves, for example, choosing their bed times and times of getting up in the mornings and planning how they are going to spend their time at the unit, when they are not attending their planned day care or workplace activities. Staff are trained in communication skills and they make sure that people are treated equally no matter how diverse their needs are. Anything that comes to light regarding things like disability, age, sexuality, race and religion or belief is well considered. We saw that sensitive arrangements are put in place to make sure that service users needs are fulfilled Risk assessments are completed and look at things like activities, environment and risks associated with any medical condition. We saw that these contain detailed guidance for staff on how to keep the individual safe whilst encouraging their independence. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from being supported to make choices about their lifestyle and to develop their life skills. They can be confident that when they stay at the unit they will be supported to achieve their social, educational, cultural and recreational expectations. Evidence: Service users interests and daily activities are recorded in their support plans. They continue with their day centre, college or workplace activities while they stay at the unit. As well as this, they say what other activities they wish to pursue and plans are made with their full involvement. The unit is well placed for service users to easily visit local shops, pubs, cafes, restaurants and all things in the local Canterbury community. They are within easy Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: reach of bus and train services. The unit has its own 7 seater people carrier transport which is used to take people out. On the morning of our visit, four service users (including three day care clients) and two staff had gone on a trip to Dover. The annual quality assurance assessment (AQAA) provided us with lots of information about things they have done to improve peoples lives when they stay at the unit. These include providing more opportunities for community activities and outings. There have been several arranged outings to venues in neighbouring towns to see shows, cinema trips and pub trips. Staff and service users spoke to us about some of the shows and films they had seen over recent months. When each service users stay comes to an end, a staff member sits with them to complete an exit questionnaire that gives them the chance to say what they have enjoyed and anything that they might not have liked. These, together with the annual quality assurance questionnaires indicated that there was a welcome return of activities. Staff spoken to during our visit and comments in the staff surveys returned also confirmed this. Parents or other important family members are fully involved in the planning of respite and day care services and say what they want for their relative using the service. A summary of the annual quality assurance survey indicated that they wanted more information about what service users do during their respite stays. This is being acted upon and a newsletter is being drawn up. Relationships and friendships are supported. Staff and service users spoke to us about meeting up with their friends at discos and meeting up with like minded service users when they attend the unit for day care, or come for their respite stays. For example, it has been arranged that three people who have similar interests come on the same day each week for their day care, so that activities are tailored to suit them. We also learnt of a very positive example of how a service user has been supported with a relationship. Service users are asked if they wish to have a key to their bedroom and can keep them locked if they wish. Respecting other peoples privacy is discussed at house meetings and everyone knows not to enter bedrooms without knocking and asking to be let in. Daily routines are flexible. House rules are discussed at the weekly house meetings and relate to safety matters such as fire safety. Menus are decided then and written up for the week and placed on the notice board. Meal times are flexible so that service users can attend their planned activities. Service users can help with meal preparation, Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: if they choose, as part of developing their everyday living skills. Staff and service users also spoke about having meals out on some occasions, or of having take aways to eat in. We saw that they use fresh foods wherever possible and there was a well stocked fruit bowl in the dining room with fruits including, grapes, oranges, apples, bananas and kiwi fruits. A staff member said they have an open policy and service users are encouraged to help themselves. Care Homes for Adults (18-65 years) Page 17 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can be confident that they will be supported with their personal care in a way that they prefer and that their health care needs are recognised and addressed as needed. They are protected by the good system for dealing with their medicines. Evidence: The support plans contain significant details about the individuals health and the level of personal support that they need. Each persons wishes are recorded about how much support they need, for example, if they need prompting with things like teeth cleaning and shaving, or if they need more support, such as with hair washing, or showering. Staff described some of the personal routines for two service users, which emphasised respecting their self care skills, respecting their dignity and being there for them, not doing for them, unless asked or needed. We saw that service users have developed good relationships with staff, many of whom have worked at the home for several years. This together with the key worker system makes sure that service users preferences are known and respected. Staff regularly refer to the support plans, so that any changes are picked up and followed Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: through. The induction of new staff routinely includes personal care issues. The current service users only need to be prompted to self care. The AQAA states that although they are a respite unit, they do support service users with medical appointments and we saw that staff know what to do if a service user is unwell. Support plans contain details of medical conditions, with guidance for staff. Staff that we spoke with knew relevant health matters about the two service users whose support plans we looked at. Staff receive training on health related matters such as epilepsy, autism, Aspergers syndrome and diabetes so that they know how to deal with behaviours and medical emergencies associated with these conditions. We looked at the way that service users medicines are managed. We saw that they have developed a safe system that includes checking medicines in when service users first arrive, keeping administration records and having a handover procedure at each shift change. We observed this in practice and saw that each service users tablets and medicines are checked and counted, then signed that they are correct. This makes sure that any discrepancies are promptly picked up. They have acted upon the recommendations made at our last inspection to demonstrate staff competency in medication arrangements and they have a dedicated secure medication fridge. The AQAA states that the medication procedure has been reviewed and amendments made to make their process more robust. It states that staff are fully trained in medication administration and they are not allowed to administer medicines without this training. We saw that this is correct. Since our last inspection, each staff member has completed a medication workbook. A staff member described their medication training and spoke about completing the medication workbook. This was given a timescale of six months to complete, but staff worked at their own rates and some completed it sooner. Care Homes for Adults (18-65 years) Page 19 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. Service users can be confident that any concerns or complaints will be listened to and sorted out. They can be assured that staff practices in the home will safeguard them from harm. Evidence: We saw that service users and staff get on well together. Staff were seen listening to service users and encouraging them to express their views. There is a formal complaints procedure, which is displayed in the entrance hall. The AQAA indicates that there have been no formal complaints during the past twelve months and we have not received any. The AQAA states that during the past year staff have supported service users to attend the local District Partnership Meetings and attend the new drop in centre in a neighbouring town. This, together with their contacts at their day centre and work placements give service users several outlets to talk about things that might be troubling them. They can also talk to their key worker or any other member of staff on duty. A staff member described how worries are listened to and discussed within the staff team to decide the best course of action. We were given one good example of how a worry had been followed up and acted upon. This had been recorded in the service users support plan. Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: All staff have to complete training on how to protect vulnerable adults and two staff have recently gained awards as trainers for adult protection. We saw training records confirming that staff also undertake training in valuing diversity and Mental Capacity Act awareness. Two staff have also attended a training course entitled Living and Loving aimed at supporting relationships for people with learning disabilities. Discussions with staff showed good understanding of all of these issues. Care Homes for Adults (18-65 years) Page 21 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. Service users benefit from staying in a comfortable, homely environment that suits their individual and collective needs and encourages their independence. Recent investment to improve the premises will make it safer and a more pleasing environment to stay in. Evidence: Since our last inspection they have made a number of improvements to the environment. They have acted upon the requirement made at our last inspection and some building works have recently started to improve the laundry and ground floor bathroom. The builders were on site during our visit. Staff have carried out risk assessments and put plans in place to make sure the unit is safe. As a result of service users comments, they have provided new beds in all of the bedrooms. A service user told us that their bed is comfortable. They have also provided new televisions in all bedrooms and two bedrooms have had new carpets fitted. The lounge has been redecorated with new carpet and furniture. There is a new three piece suite and a new television. The room looks very homely. The dining room will be decorated and improvement work carried out on the kitchen when the building works are completed. Service users told us they like their bedrooms. Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: At our last inspection we recommended that the staff sleep in arrangements be reviewed as one staff member sleeps in the lounge at night. They have a futon for staff use, but have made an alternative arrangement that suits people at this time. We were told that this is being kept under review. Changes to the laundry will mean that people do not have to take dirty laundry through the kitchen any more, as it will be reached from the dining room. Alterations to the ground floor bathroom will make it easier for people with disabilities to use. We did not look all round the home on this occasion, but looked at one service users bedroom and saw one that was unoccupied. All bedroom doors have sound activated closures so that they will close in the event of a fire. We also saw one other bedroom when a service user returned home from college. As well as this we saw all communal areas and one bathroom and toilet. All areas seen were clean and homely. There are plentiful supplies of liquid soap and paper towels to help control the spread of infection. There is a maintenance person who carries out repairs and decorating to keep the home well maintained. There are plans to improve the access to the front door by having a ramp put in to make better access for people using wheelchairs. The AQAA indicates that contractors have been identified to carry out the works. Care Homes for Adults (18-65 years) Page 23 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. Service users benefit from the well trained enthusiastic and supportive staff team. The staff have a good understanding of the service users and positive relationships have been formed. They are protected by the good recruitment procedures and practices. Evidence: The majority of the staff have worked at the unit for a number of years. We met and spoke with three staff on duty for the morning shift and two staff that came on duty for the afternoon and evening shift. Two staff had worked at the home for two years or more and one for many years. Staff were each enthusiastic about their work, knowledgeable about the needs of the service users that stay regularly for respite care and each has completed lots of training courses. We looked at some of the staff training records and talked to staff. The AQAA states that over seventy percent of the staff group have achieved a National Vocational Qualification (NVQ) level 2 or above in care. Two staff said they had completed the learning disability framework component. Three staff have achieved their NVQ level 3 and two more are currently working towards it. All staff also have to complete certain core training, including first aid, moving and handling, food hygiene, fire safety and various other health and safety courses. Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: Two staff members showed us their training files and we saw that there is a system in place to identify when refresher courses are due. Each staff member has a personal action plan used to identify training needs and there is an annual staff training and development programme. Staff spoke to us about some of the training courses they have completed and it was clear that these have helped them develop their skills and knowledge for the benefit of service users. As a result of some of the training they have been making changes to the way they support service users which have helped some of the service users develop their confidence and potential. Staff confirmed they have formal supervision meetings every six weeks, which is above the National Minimum Standards. They also have staff meetings every two weeks which include discussion about service users needs and training needs. Rotas show that there are always two staff on duty and two people sleeping in at night. However, we saw that arrangements can be made to have a waking staff member at night if a service users needs require this. There is a team of permanent relief support workers that cover for holidays and sickness. There is also separate cleaning and maintenance staff. The AQAA states that service users are involved in the recruitment process. A staff member spoke about having three interviews for three different roles. They spoke about the service users involvement and the questions that they asked. The staff member saw it as a very positive process. We looked at one staff members file and saw that good recruitment procedures are being followed. Checks are carried out before a person starts working at the home, for example, two references and a criminal records bureau check. A staff member confirmed that they had a thorough induction training programme. One staff member said, I love my job and went on to say that it is a good organisation to work for, saying that staff are valued and treated with respect. Feedback in the service user surveys indicates that staff treat them well and two service users that we spoke with also confirmed this. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is managed in a way that promotes the best interests of the service users, protecting their health, safety and welfare and developing their independence. Evidence: The unit has been established and run as a respite service for people with learning disabilities for a number of years. The manager is registered with us, which means that she has the skills and qualifications to run such a service. The manager was not on duty at the time of our visit, but staff had a good understanding of the role of the commission and competently assisted us with our inspection visit. Previous inspections have shown that there are good management systems in place and the home has been consistently well run. Our visit confirmed that the good standards evident at previous inspections have been maintained. The AQAA was well completed and includes a good level of understanding of the importance of equality and diversity. It contains a wide range of evidence that shows how they have listened to service users and made changes as a result of this. They clearly recognise where Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: they need to improve and it shows how they are going to do this. There are well established policies and procedures in place, an annual business plan, regular health and safety checks, staff meetings, service users meetings, staff supervision meetings, annual appraisals and development plans in place. We saw that the manager has created an open and positive culture within the home. Staff say they have good communication within the unit and all staff that we spoke to showed a good understanding of the aims and purpose of the home. A staff member said about the manager, She is the best manager Ive ever had. There are good quality monitoring systems in place, including exit questionnaires and annual quality assurance questionnaires. The results are summarised and the information used to inform future changes. They also have a monthly visit from a Kent County Council manager who writes a report on the conduct of the home, which is used to inform the ongoing monitoring process. The AQAA indicates that all equipment is being maintained, including electrical, fire safety and gas safety. It also shows that they have a number of other safety checks in place to make sure things are kept safe for service users and staff. 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 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. 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