Inspection on 21/07/09 for Cleveland House

This is the latest available inspection report for this service, carried out on 21st July 2009.

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

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

Other inspections for this house

Cleveland House 04/08/06

Cleveland House 12/01/06

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Cleveland House 1 Cleveland Road South Woodford London E18 2AN     The quality rating for this care home is:   three star excellent 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: Jackie Date     Date: 2 3 0 7 2 0 0 9 This is a review of 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 2 1 0 stars - excellent stars - good star - adequate 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. 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. Care Homes for Adults (18-65 years) Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 30 Information about the care home Name of care home: Address: Cleveland House 1 Cleveland Road South Woodford London E18 2AN 02085302180 02082522283 info@cmg-corporate.com www.caremanagementgroup.com Care Management Group Ltd care home 10 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) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Cleveland House is a ten bed home for adults with learning disabilities and challenging behaviour. The building does not have any adaptations for people with physical disabilities and would not be accessible to wheelchair users. It is in a residential area of South Woodford close to local shops and amenities and to transport networks. At the time of the inspection there were 10 people, six males and three females, living at the home. Most people have limited communication. Some people access day services, others are supported in community based activities by the staff team. The scale of charges per week for each person range from 1328 to 2227 pounds per week. The manager provided this information at the time of the visit. Information about the service provided is contained in the service users guide. 10 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection of this service was on 16th August 2007. This unannounced inspection started at 9.30 a.m. and took place over 10 hours on two separate days. This was a key inspection and all of the key inspection standards were tested. Staff were asked about the care that people using the service received and observed carrying out their duties. People using the service were asked to give their views on the service and their experience of living in the home. All of the shared areas and bedrooms were seen. Staff, care and other records were checked. We were joined for part of the visit by an expert by experience who was accompanied by a support worker. The expert by experience had a look around the home and spent time talking to staff and the people living there. She then gave feedback to the manager. Comments from her report have been included in this report. The relatives of three people who use the service were contacted after the inspection and they gave verbal feedback. Care Homes for Adults (18-65 years) Page 5 of 30 Services are now required to complete an AQAA (Annual Quality Assurance Assessment) and completed form was received in May 2009. Information provided in this document also form part of the overall inspection. The inspector would like to thank the people living at Cleveland House, the staff and the expert by experience for their input during inspection. Care Homes for Adults (18-65 years) Page 6 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The service continues to grow and develop and staff support people to be as independent as possible. The manager and staff team are committed to this and continue to look at different ways of improving and developing the service further. Care Homes for Adults (18-65 years) Page 7 of 30 The bathrooms are not in a good condition but work is due to start soon to replace the bathing and showering facilities and renew a lot of the flooring on the ground floor. There are not any requirements from this inspection. 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 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 8 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 9 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. Appropriate information is gathered before a person moves into the home and this gives staff a picture of their needs and how to meet them. People and their relatives can spend time in the home to find out what it would be like to live there and to enable the person to make a choice about living in the home. People and their representatives have a written contract/statement of terms and conditions and will therefore be clear about what they are entitled to. Evidence: Standards 2, 3, 4, & 5 were tested. The organisation has a central referral and assessment team. This team gathers initial information and assessments and then works with the manager to complete more detailed assessments. Assessment covers all of required areas and includes health, communication, behaviour, relationships and sexual needs and cultural and spiritual needs. The newest person moved into the home almost one year ago and following on Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: from assessments transition planning meetings were held and a structured transition was organised. This started with the person having short visits to Cleveland with her relative. This was gradually extended. Staff visited her residential school placement to gather additional information and to get to know her and how to work with her. Records were kept of any visits that she made to the home or any visits that staff made to the school. Therefore sufficient information was gathered on the person to enable their needs to be identified and for a decision to be made about the homes capacity to meet these assessed needs. Also the person was given the opportunity to visit the service and to meet staff and other people before deciding if she wanted to live there. Each person has an individual contract/terms and conditions of residence between themselves and the provider. Copies of these were seen in individual files. Therefore people have details about the service that they are entitled to. Care Homes for Adults (18-65 years) Page 11 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. Peoples individual plans provide staff with the information that they need to meet individual needs. People are encouraged and supported to be involved in decisions about what they do and what happens in their home. Risk assessments are appropriate and people are supported to take risks according to their needs and have the opportunity to try things and develop their skills as safely as possible. Evidence: Standards 6, 7, 8, 9 & 10 were tested. Each person has a care plan and these contain information about them and about the support that they need. The expert by experience said, Staff follow every residents Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: person centred plan and work with the manager and the deputy manager if they need any clarification or extra support. Each person had an individualised care plan, a pen portrait and life history. Areas covered included cultural needs, finance, communication, daily living skills, health needs, sexual needs, personal care and mobility. There was clear information about peoples likes and dislikes, routines and needs. There was also information about how people communicate. For example for one person it says that she will show she is happy by smiling, laughing or waving her arms. When shes upset she will pinch, scream or cry. Peoples cultural and spiritual needs are clearly stated and are actively promoted. For example some people go to church but they do not all go to the same church because of their differing beliefs. Another person likes to have stories from the Bible read to her. The care plans seen had all been reviewed regularly and were up-to-date. Some people had signed their care plans, others were not able to do this. The information available shows the staff have a good knowledge of peoples individual needs and how to meet them. Daily records are made about what each person has done and the support that they have been given. In addition night staff also make recordings. Therefore there is information about each individual which can be used as part review process and identify ongoing changing needs. There are risk assessments in place and these identify risks to people and indicate ways in which the risk can be reduced to enable people be supported as safely as possible. The risk assessments seen were up-to-date and covered areas relevant to each individual and the activities that they do. The expert by experience said, Staff treat the residents well and with respect. Residents have a choice of what they do from day to day. A monthly meeting with staff and residents is held so that they can say what activities they want to do. Residents are involved in the running of the home and involved in household chores. Some people have been involved in staff recruitment and people have also been involved in choosing furniture and decorations for the home. As far as possible people are consulted about aspects of life in the home and are encouraged and supported to make decisions about their life. Peoples records and other information is securely stored in the office and staff are aware of issues of confidentiality. Care Homes for Adults (18-65 years) Page 13 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to be as independent as possible, to take part in activities and be part of the local community. People are supported to keep in contact with their relatives and visitors are made welcome at the home. People are given meals that they have chosen, like and that meet their needs and preferences Evidence: Standards 11, 12, 13, 14, 15, 16 & 17 were tested. Three people attend Waltham Forest College and another has been attending a drama course. This person said that she really enjoyed drama and in September she was Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: going to go to college to learn about writing and money. In addition to this people often go out into the local community. For example they go to the cinema, pubs, library, restaurants and coffee shops. Some people are supported to attend a local church and others to attend a Pentecostal church. Each person had an activity chart and these are in a pictorial format to help each person to understand them. The organisation has a day centre on the same site as one of their other residential homes and people sometimes go there to use the facilities. The facilities include a sensory room, a gym and a swimming pool. In addition an aromatherapist visits each week and also there is a weekly keep fit session provided by qualified physiotherapist. The home has a seven seater lease vehicle and this is used to take people out but people also use public transport. Holidays are arranged each year and people are encouraged to choose where they want to go. One person is going to Egypt with a member of staff and later in the year is going to Mauritius with her family. At the time of the visit another person had gone to stay with her brother for a week. Some other people said that they want to go to Clacton. There are lots of photographs on display around the home of people doing different things. The expert by experience said that people have a lot of choices and told her that they go out, they do karaoke and they go to the movies. She also said that the atmosphere and the photographs confirm it is a lively and busy home. Residents meetings are held regularly and minutes show and people said that they are involved in decisions about developments in the home, about what they do and what they eat. People are involved in day-to-day tasks around the home. One person said she helped to tidy and clean and talked about how she had made a cake to take to college to share with her class. Other people were observed to be helped to make their drinks and to prepare and serve the evening meal. All of the people have contact with their families. Some of their families visit regularly and some people visit their families at home. Families and friends are invited to celebrations at the home and a relative spoken to talked about barbecues and Christmas parties. Recently the home had an African themed night. People made flags and cooked meals from different African countries. There was African music and dance and most people were dressed in traditional African clothes. People living at the home told the expert by experience that it was very good. As previously stated people are involved in preparing the menus and in the preparation of their meals. They are encouraged to eat healthily and use fresh ingredients. A dietician is working with one person to help her with a weight problem. As a result of a healthy diet and more exercise two people have lost quite a lot of weight and are more mobile as a result of this. One person was able to say how happy Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: she was about this and that she had bought a lot of new clothes. Individual plans give information about what people can do in terms of preparing drinks and food. They also contain information about what people like and dont like. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service receive personal care that meets their individual needs and preferences. They are actively supported to receive the medical and healthcare that they need and to remain as healthy as possible. People are given their prescribed medication safely and in line with good practice. Evidence: Standards 18, 19 & 20 were tested. People using the service require differing amounts of support with their personal care and some require a lot of support and are dependent on staff to meet their personal care needs. Some people are more independent and only require reminders, prompts and minimal supervision. Staff know how each person needs to be supported and this information is detailed in their care plans. For example one persons care plan states that she prefers a bath to a shower. Another person said that she baths herself. Three of the people living at the home have had problems with regard to continence. However the staff team have worked with these individuals and this is no longer an issue for any of these people. The care plans seen also included information about choices that people should be offered and how they should be encouraged and Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: supported to do as much as possible for themselves. There is a mixed staff team and this usually enables people to have same gender support with personal care. The male staff spoken to confirmed that they do not assist any of the females with personal care. In addition staff meeting minutes clearly state that female staff must not leave the home at the end of their shift until they have been relieved by another female worker. Thus ensuring that there is always a female worker available to support people if needed. Therefore people are supported to receive the personal care they need in a way that is appropriate for them. Each person is registered with the local GP and receive specialist input as and when required. This includes input from the dietician, physiotherapist and psychologist. Staff support people to attend their medical appointments. The files seen contained a record of medical appointments and these include the optician, dentist and when needed the chiropodist. The outcome of all visits are clearly documented and actioned and show that peoples health care needs are closely monitored and that they have regular access to other healthcare professionals. People are encouraged to have a healthy lifestyle both in terms of diet and exercise and there is a weekly keep fit session which is run by a physiotherapist. People spoken to said that they enjoyed this. As previously stated some people have been supported to lose weight and this has helped their mobility and overall health and well-being. Each person also has a hospital passport and this contains the information needed when supporting someone to a hospital appointment or in the case of an emergency. The staff team have also been active in supporting people to attend healthcare screening. They obtained pictorial documents and support information to help people understand what will happen. As a result of this one person did attend and have a breast examination and another person a smear test. Each person has a health action plan. Therefore people are supported to receive the healthcare that they need. None of the people living in the home are able to self-medicate and medication is administered by the staff. This is usually the senior member of staff on duty. Staff cannot administer medication until they have received training and been assessed as competent. Staff have received training from Boots and also complete a medication section on the companys new e-learning. (Further information about e-learning can be found in the section on staffing later in the report.) Staff have to have a competency test and this is signed off by the manager or deputy. Medication is stored in an appropriate metal cabinet in the office. Medication keys are kept separate from other keys and the designated senior keeps these with them all the times. There is a lockable box for controlled drugs bolted to the inside of the cabinet. A lockable medicine case is available and used when medication is administered away from the point of medicine storage. This means that medicines can be secured in the case of a Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: carer having to deal with an emergency. Therefore medication is securely stored. There is not a separate medication fridge but if required medication is stored in a locked tin in a separate fridge in the basement. There are policies and procedures for the administration of medication and this is done by two staff, usually the senior and another trained person. As part of the handover medication and medication records are checked to ensure that everything is correct. The medication file contained photographs of each individual and a record of any allergies. There was also a list of staff that are able to administer medication and a sample of their initials. This is good practice. The file was appropriately completed and up-to-date. Any handwritten entries had been signed and dated by the person making them and when temporary medication had finished this had also been signed and dated. Guidelines/protocols are in place for the administration of PRN (when required) medication and these were clear and included information on how often people should have the medication and the gaps between doses. These had been signed by the doctor. Some staff have been trained to administer rectal Valium and there is a protocol in place as to what should happen if trained staff are not available. One person is prescribed controlled drugs. These are correctly stored and the necessary records and checks are in place. Therefore people receive their prescribed medication safely. 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. People living Cleveland house are safeguarded by the working practices and support of staff team. Evidence: Standards 22 & 23 were tested. The complaints procedure is in an are easy to understand format and has pictures so that people are clear on how and to whom they can voice a concern. The complaints procedure is displayed around the home. Regular residents meetings are held and people that are able have a chance to raise any concerns at this time. Some people are able to say when they are not happy about anything but due to the degree of their disability other people cannot. All of the people living at Cleveland House have relatives that visit regularly and who could raise concerns on their behalf. A relative said that the manager is good and always gets things that are needed done. A member of staff said that any issues or concerns can be raised with the manager or deputy. All staff have received Protection of Vulnerable Adults training and were aware of safeguarding issues and their responsibilities in this area. The organisation has a whistle blowing hotline and also a safeguarding board and actively promotes safeguarding. When a safeguarding issue arose the appropriate procedure was followed and the necessary action taken to safeguard people using the service. One Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: relative said that there was nothing untoward at the home and that they did the best for her daughter. Feedback from another relative was that clients are very well looked after. The expert by experience said that staff treat the residents well and with respect. The manager and staff are aware of the Mental Capacity Act and Deprivation of Liberty. The manager has spoken to the local authority about some issues and is in the process of completing an individual potentially restrictive practices checklist in the form of risk assessments. This will also offer additional safeguards to people using the service. The section on staffing later in this report gives information confirming that there is an appropriate recruitment procedure and this also helps to safeguard people living in the home. None of the people using this service are able to manage their own finances. For some people their relatives or the local authority act as appointees. Other people have individual bank accounts. These accounts have to have two signatures which include the manager, deputy and regional director. There is a safe that only the manager and deputy have access to and the bulk of any money and cheque books are kept there. Smaller amounts of money are kept in individual wallets and the senior on duty has access to these. At each hand over cash is counted and records checked. The manager and deputy make periodic checks on these but do not sign the records. The cash held for three people was checked as part of the inspection and was correct and there were appropriate receipts and records. The regional director checks a random sample of residents cash and records during monthly monitoring visits but does not sign the records. It is recommended that when checks are carried out the person doing the check signs the record to say that they have been checked. This will help to provide an audit trail. Safeguards are in place for peoples finances. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean home that is suitable for their needs. The house is more homely now and the scheduled refurbishments will mean that people live in a comfortable home that is decorated, fitted and equipped to a good standard. Evidence: Standards 24, 25, 26, 27, 28, 29 & 30 were tested. The house is in South Woodford and is near local shops, bus routes and a train station. The communal areas comprise of a combined lounge diner, a quiet room with TV, a garden, kitchen and laundry. There is a lift to the first floor but all of the people living there can use the stairs. Each person has a single bedroom with ensuite toilet and hand basin. The expert by experience said that residents bedrooms were decorated with individual decor and personal items in place and that the garden was tidy and used by residents. There are enough baths, showers and toilets to meet peoples needs and none of the people living there at present need any special adaptations. However all of the bathing and showering facilities need refurbishing and funding has been agreed for this. It is anticipated that the work will start in the August. In view of this is a requirement has not been made with regard to the bathrooms. Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: Bedrooms were appropriately decorated and furnished. One person has the flag from his native country displayed on the wall. One bedroom has been redecorated and a new carpet fitted. In another bedroom on the ground floor the carpet had some damage and although not unsafe at this stage will need replacing in the near future. As a result of this the handyman was called to check the carpet and the appropriate department in the organisation was contacted to agree for a replacement. There are lots of photographs around the home and also a map of the world is displayed on the wall and peoples native countries are marked on it. The lounge was redecorated recently and people living there chose the colours. A new suite has been ordered as this needs replacing and all flooring in the communal areas is being renewed as well. In view of the fact that the organisation has agreed for all of the improvements to the house to be carried out in the very near future no requirements have been made for this. The expert by experience commented that although the residents in the home do not need ramps to access the garden the step out of the back door was quite high. It is recommended that this be discussed with the people living at Cleveland and that staff observe people using the step. Then if necessary alterations can be made to make this easier and safer for people. People using the service are encouraged to help with chores and there is a weekly planner for this. At the time of the visit the house appeared to be clean and hygienic. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Cleveland House are supported by a consistent staff team who know them well and who are committed to provide a very good quality service that meets individual needs as far as possible. People are supported and protected by the recruitment practices of the service. People are supported by a staff team that receive good training and support to enable them to meet peoples needs. Evidence: Standards 31, 32, 33, 34, 35 & 36 were tested. From examining the rota, staff records and from discussions with staff it was evident that people are being supported by a regular staff team that know them well. As a result of this and of consistent ways of working people using this service now have far less instances of challenging behaviour and are more independent and do more things in the home and in the community. There are usually five staff on duty during the daytime shifts and two waking night staff. From observations during the inspection, examination of the rota, discussions with staff and feedback from relatives it was evident that there are sufficient staff on duty to meet peoples needs. There is always Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: a senior on duty and they are responsible for organising and coordinating the shift. At the beginning of February CMG launched a new online learning and development programme for all of its staff called fulfilling potential. This is a computer based program delivering bespoke models of learning in many subjects. It was launched with six modules including introduction to learning disabilities and safeguarding. From discussions with staff and looking at records it was apparent staff have been working through this and have found it useful. In addition staff have already received mandatory and specialised training. This included induction, fire training, protection of vulnerable adults, food hygiene and infection control. Nine staff have already achieved NVQ level 2 or above and in the last 12 months four staff have completed NVQ level 3. Another is studying for NVQ level 4. Therefore staff are receiving the training they need to carry out their duties and provide a good quality service to the people in Cleveland House. Staff files seen included the required information to demonstrate that staff had been appropriately recruited. This included application forms, appropriate references, interview questions, identification details and details of CRB (Criminal Records Bureau) and POVA (Protection of Vulnerable Adults) checks. This is in line with good practice. Staff confirmed that they had regular supervision and also that regular staff meetings gave them the opportunity to discuss any concerns with the management team. Staff said:the staff team is stable and work well together. We get good support and the staff team is good and help each other. Thing seems settled and staff are on the ball and pulling together. Feedback received was very positive about the staff team. Relatives said: the staff are amazing, friendly and happy and this is a happy house. The staff and manager are great, there are no problems whatsoever. Our son is always happy. Clients are very well looked after. There is a team of excellent staff and things have never been better. The expert by experience said, staff treat residents well and with respect. Staff said they were happy at the home of and that they received a lot of training to be able to support residents with their changing needs. Care Homes for Adults (18-65 years) Page 25 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Cleveland House benefit from a service that is very well managed and where their opinions are sought, valued and acted upon as far as possible. They live in a safe home. Evidence: Standards 37, 38, 39 & 42 were tested. The manager started working at the home in November 2006. She has a lot of experience of working with people with learning disabilities and residential services. She has completed the RMA (Registered Managers Award) and is registered by the Commission. The manager is supported by a deputy, who is also studying for the RMA (Registered Managers Award), and a team of seniors. Feedback from staff is that the service has improved greatly, the service users are very involved in what happens and are doing more. They also said that they were clear about the direction the service was going in. Feedback from one relative was that the manager was excellent. Another said that Lucy is very good and get things done. A third said that the staff and the manager were great. Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: The quality of the service provided is monitored by the manager and deputy and also by the organisation. A representative of the organisation visits the home regularly to carry out monitoring visits and then writes a report. The format for these reports has changed recently to be more comprehensive and it covers all of the areas in a more detailed way. Feedback from the manager and staff to the regional director visits regularly and is supportive and clear about her expectations as well. Regular residents meetings are held to seek feedback and relatives are also asked for feedback on the service provided. Therefore systems are in place for the quality of the service to be monitored, for people to express their views and for feedback to be obtained. All of the necessary health and safety checks are carried out by the staff team and records are kept of these checks. These records were up-to-date and accurate. A safe environment is provided for the people living there. The manager provides an excellent role model to staff and is aware of issues of equality and diversity, human rights and person centred thinking. She ensures that working practices in the home are safe. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 23 It is recommended that when financial checks are carried out the person doing this signs the record to say that they have been checked. This will help to provide an audit trail. It is recommended that the height of the step into the garden be discussed with the people living at Cleveland and that staff observe people using the step. If necessary alterations can be made to make this easier and safer for people. 2 28 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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