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Inspection on 18/08/09 for Dimensions 47-48 Chichester Court

Also see our care home review for Dimensions 47-48 Chichester Court for more information

This is the latest available inspection report for this service, carried out on 18th August 2009.

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

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

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

The home is very well managed. The Registered Manager provides Staff with the motivation to assist each Service User to achieve their individual potential. Service Users continue to show improvement in their personal development and general behaviour. Residents benefit from a well established staff team who is fully aware of their needs, likes and dislikes. Health records are of very high standard and peoples health care needs are fully met. The quality rating of the homes have improved and outcomes for people using the service are now judged to be excellent.

What has improved since the last inspection?

The home met all requirements made during the last key inspection. All staff have received training on abuse awareness an d prevention, which ensures people using the service are protected. Over the past two year the home demonstrated their understanding that significant incidences must be reported to the Care Quality Commission, ensuring that people using the service are appropriately safeguarded. Staffing levels are appropriate and sufficient and peoples needs are fully met. Daily records are of good standard, ensuring the care of people using the service can be monitored.

What the care home could do better:

We have made one requirement during this key inspection. The home must review the statement of purpose and service users guide, which ensures up to date information is provided to current and prospective people using the service.

Key inspection report Care homes for adults (18-65 years) Name: Address: Adepta 47-48 Chichester Court 47-48 Chichester Court Stanmore Middlesex HA7 1DX 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: Andreas Schwarz Date: 1 8 0 8 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 28 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 28 Information about the care home Name of care home: Address: Adepta 47-48 Chichester Court 47-48 Chichester Court Stanmore Middlesex HA7 1DX 02089050442/0310 02083438876 eugeniadelgado@adepta.org.uk www.pentahact.org.uk Dimensions (ADP) Limited care home 8 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 Over 65 8 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 8 The registered person may provide the following category of service only: Care Home only - 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 Code LD Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 28 A bit about the care home 47 and 48 Chichester Court are two homes within a purpose-built complex managed by Dimensions(previously named Adepta). The homes are managed by one person, but otherwise generally function individually, for instance in terms of staffing. The homes provide long-term care and accommodation for up to eight adults who have learning disabilities, four people in each home. The building is maintained by the Metropolitan Housing Association. Everyone using the service has their own bedroom. The bedrooms are spread across two floors. Each house has its own lounge and dining area as well as bathrooms on each floor. There is a garden to the rear of each house. The homes are fully wheelchair accessible downstairs. Access to the first floor is by stairs only. The homes are quite close to shops, leisure facilities and local transport. A minibus is shared with the other houses in the same complex. Unrestricted parking is available on the road leading to the house. The homes Service User Guide is available on request. The weekly fees for services are £1375, based on the current block contracts in operation at the homes. Care Homes for Adults (18-65 years) Page 5 of 28 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 Care Homes for Adults (18-65 years) Page 6 of 28 How we did our inspection: This is what the inspector did when they were at the care home This key inspection took place in August 2009 and lasted six hours . The deputy manager was available during this key inspection and assisted us during this inspection. Service users and staff surveys have been returned. We spoke to two members of staff and observed staff interacting with people using the service. We spoke to two people using the service. We looked at two care plans and case tracked two people using the service. We would like to thank everybody involved in this key inspection. What the care home does well The home is very well managed. The Registered Manager provides Staff with the motivation to assist each Service User to achieve their individual potential. Service Users continue to show improvement in their personal development and general behaviour. Residents benefit from a well established staff team who is fully aware of their needs, likes and dislikes. Health records are of very high standard and peoples health care needs are fully met. The quality rating of the homes have improved and outcomes for people using the service are now judged to be excellent. Care Homes for Adults (18-65 years) Page 7 of 28 What has got better from the last inspection What the care home could do better We have made one requirement during this key inspection. The home must review the statement of purpose and service users guide, which ensures up to date information is provided to current and prospective people using the service. Care Homes for Adults (18-65 years) Page 8 of 28 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Andreas Schwarz 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 02072390330 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 28 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 28 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. We assessed National Minimum Standards 1 and 2 during this inspection. People using the service are involved in the assessment process and the home is only admitting people if the needs of the person can be met. Evidence: We assessed the Statement of Purpose and Service Users Guide, both documents are of very good standard and a range of pictures and symbols are used. This allows people with limited reading skills to access both documents The Statement of purpose is providing detailed information of the care provided by the home and how service users needs can be met. Cultural issues such as religion, food, clothing is addressed. We noted that the documents have not been reviewed and changes in staffing and contact details of the Care Quality Commission (CQC) are not up to date. The home was in the process of admitting a new person on a trial basis for six weeks from another home managed by Adepta. We viewed the assessment which was judged as very detailed and the persons needs were clearly defined. The person had the opportunity to test drive the home on four occasions and clear evidence of his involvement in the transition was documented. Care Homes for Adults (18-65 years) Page 11 of 28 Care Homes for Adults (18-65 years) Page 12 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We assessed National Minimum Standards 6, 7 and 9 during this inspection. The care plan is a working document reviewed regularly involving the person and their representatives, as appropriate. Staff are able to communicate with people using the service, and understand what their needs are. The management of risk is positive in addressing safety issues while aiming for improved outcomes for people. Evidence: We looked at two care plans which were randomly chosen. One of the care plans was of a person living in 47 and another care plan was of a person living in 48 Chichester Court. Both care plans were of very good standard and have been reviewed in July 2009 and January 2009. The home has a key worker and co-key worker system. Care plan reviews are arranged together with the persons family and any significant others. Care plans are persons centred and the persons religious as well as cultural needs are addressed. The home is providing care for two people from Muslim faith. We viewed clear and detailed information of how the person is best supported so the needs are fully met. Peoples aspiration such as going on holiday to the West Indies is discussed during reviews and Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: long term action plans are made to meet the goals. People using the service told us that they meet regularly with their key worker and records of this internal reviews are in place. We observed residents making choices during this inspection, for example people using the service made their own tea and we observed staff asking people using the service where they would like to go during the day of this key inspection. We checked residents finances, money is checked during each handover and records of income and expenditure are of very good standard. Money is spent for lunch, purchasing clothes and toiletries, etc. Peoples support needs around the management of finances is documented in care plans viewed. We observed good interaction between staff and people using the service and two service users spoken to told us that they like staff and are happy with the way they are supported. The home has a wide range of risk assessments in place. All risk assessments viewed have detailed risk management plans for staff attached. Risk assessments viewed are individual. Assessments such as having a bath and environmental risk assessments, such as using the cooker and collective risk assessments such as residents doing activities together are in place. The deputy manager told us that risk assessments are reviewed if needs are changing or during planned review meetings. The home is using pictures and symbols to make the risk assessments more accessible and easier to read for people using the service. Staff spoken to informed us were the risk assessments are kept and that the they find them very useful when working with people using the service. Care Homes for Adults (18-65 years) Page 14 of 28 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. We looked at National Minimum Standards 12, 13, 14, 15, 16 and 17 during this inspection. The home supports people using the service and ensures their wishes and choices are taken into account. People using the service are encouraged to take part in social activities outside the home to promote their personal development. There are good standards of providing occupational and recreational support for people using the service, relative to their individual needs and wishes. There is excellent support for people using the service to uphold and develop relationships with family and friends. The service supports the personal development of people. Healthy diets are provided for people, and their cultural needs are met. Evidence: People using the service have individualised activity plans, some people access local day centers and other people stay at home were they receive extra support. This support allows people using the service to choose activities tailored to their needs, abilities and Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: behaviours. None of the people are in paid or unpaid employment. The deputy manager told us that the home explored this, but were unable to access employment opportunities, which is meeting the complex needs of people using the service. One comment made by a person using the service: I like to go to Strathcona daycentre and meet my friends. The deputy manager told us that one person has enrolled in Harrow College, where he will start an Arts and Crafts course in September 2009. People using the service access the community regularly. Records viewed over the past months show, that people using the service have been to the pub for lunch, KFC for take aways, BBQs, regular football sessions, fruit picking, etc. We observed people using the service going out for walks during the day of this inspection. One relative commented when asked in surveys what the home is doing well: The home encourages my family member to go out in the community regularly. The home has no problems with their neighbours. People using the service have access to a shared vehicle and the deputy manager is using her car to support people using the service in accessing community facilities. Appropriate insurance documentation is in place. Staff working in the home reflect the cultural background of people using the service. We observed staff interacting with people using the the service. People using the service appeared relaxed with staff. A comment made by one of the clients: I like going out with staff. People using the service celebrate religious festivals such as Eid, Diwali, Christmas, Easter, etc. Staff could explain arrangements for many of the people using the service to visit family at the weekend, and occasionally during the week for some. One person told us, using signs, about visiting their family shortly. They were clearly looking forward to this. Family are generally involved in care review meetings, and are supported by the service to attend other meeting such as with health professionals. Staff are aware of responsibilities to keep next-of-kin updated where appropriate. We observed staff entering rooms together with people using the service. Staff demonstrated respect when interacting with people and we observed staff asking rather then telling people what is going to happen next. We observed people using the service moving around freely in the home and accessing all areas. People using the service are involved in the cleaning and upkeep of the home. We observed residents accessing the kitchen and helping themselves to drinks. Surveys from people using the service found that everyone likes the food provided. There was enough food available, including fresh food. Menus are discussed in house meetings with tenants. Sampled weight records showed no significant change in weight over time. Menu records were also checked through. These all suggest appropriate nutrition. Two people using the service are from Muslim faith and are not allowed to consume pork. The deputy manager told us that the home is purchasing Halal meat. Care Homes for Adults (18-65 years) Page 16 of 28 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. We assessed National Minimum Standards 18, 19 and 20 during this inspection. People using the service excellent support with heath needs, including liaison with community health professionals. They receive appropriate personal support through staff assistance where needed. Peoples dignity is appropriately considered. There are very strong standards of safe and effective medication support to people, which very much minimise the chances of mistakes occurring. Evidence: People using the service were appropriately dressed for the time of the year. We noted that one person was wearing a sari, which reflects the cultural background of the person. Surveys raised no concern of inappropriate intimate care support. Clear guidance were found in care plans, reflecting peoples wishes and choices. One person told us that staff helped him to purchase clothes for an up coming holiday. The ho,me has facilities for people with mobility problems in place. The deputy manager told us that a new bath has been ordered, to ensure the service continues to meet peoples changing needs. We observed staff supporting people immediately if clothes got spoiled due to accidents. One person showed us his room and gestured that he is wearing shirt and ties when visiting his family. Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: Health records are of good standard, ongoing monitoring of peoples weight, bowel movement, menstruation is in place. Staff told us this aids the service to intervene early and refer the person to the appropriate health care professional. People using the service are encouraged and supported to attend regular dental and optician appointments. Issues around peoples consent is addressed and discussed with health care professionals and family members. We viewed correspondence demonstrating clearly that consent is paramount if people using the service lack capacity in making their own decisions. We viewed the homes medication cupboard in 47 and 48 Chichester Court. Both cupboards are lockable and meet recommended specifications by the Royal Pharmaceutical Society for Care Homes. The medication cupboard in 48 Chichester Court is located in the homes utility room, due to the dryer the room can get quite hot. The majority of medicines should be stored bellow 25 degrees Celsius. We recommend to monitor the temperature inside the cupboard to ensure that medicines are appropriately stored. Staff told us that they have received medication training and training records viewed confirmed this. The medication policy is of good standard and meets National Minimum Standards. We viewed individual medicines risk assessments in care plans, which is seen as very good practice. Medication is administered by two members of staff and Medication Administration sheets had no gaps. Medicines returned to the pharmacist is documented and service users refusal of medication is clearly recorded. Care Homes for Adults (18-65 years) Page 18 of 28 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. We assessed National Minimum Standards 22 and 23 during this inspection. Service Users and their representatives are confident that their views and complaints are heard and dealt with fairly and without fear of reprisal. The home has good standards of protecting people from abuse, including through the use of relevant policies, making safeguarding referrals, and cooperating with investigations. Evidence: The home did receive five complaints since the last inspection. All complaints have been investigated appropriately and the complainant has been informed of the outcome of the investigation. Relatives told us in surveys that they know whom to complain to and were satisfied with the actions taken following a concern was raised in the past. The homes complaints policy is displayed in the hallway and is available in pictorial format. Staff spoken to demonstrated understanding of how to deal with and record complaints. Staff confirmed of having received Safeguarding adults training and demonstrate understanding of the common forms of abuse and how to report and record safeguarding adults allegations. The home has a Safeguarding adults policy in place, which is based on the local councils procedure. Previous issues of the lack in reporting allegations of abuse to the appropriate authorities has been addressed. Care Homes for Adults (18-65 years) Page 19 of 28 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. We assessed National Minimum Standards 24, 25 and 30 during this inspection. The home is appropriately kept for people to live in, in terms of homeliness, cleanliness and safety. Maintenance issues are addressed. Individual bedrooms have appropriate facilities. There are enough toilets and bathrooms to meet the needs of people living there. Evidence: The deputy manager showed us around both flats during this inspection. Facilities and equipement is of good standard and working order. During the day of this inspection we observed the deputy manager meeting delegates from the housing association responsible for repairs to address outstanding maintenance issues. People using the service were observed relaxing in the lounge and the garden, which demonstrates their satisfaction with the environment. One person invited us to see his room, which was nicely decorated and personal affects were on display. When asked if he likes his room, he confirmed his satisfaction by nodding and with a smile. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: The home was clean and tidy and no offensive odours were noted. A relative commented on the cleanliness of the home in a survey received. Appropriate infection control procedures are in place. Staff told us, that they always wear gloves when supporting people using the service. Care Homes for Adults (18-65 years) Page 21 of 28 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. We assessed National Minimum Standards 31, 32, 33, 34, 35 and 36 during this inspection. Tenants are provided with staff who have had very appropriate recruitment checks and who are hence safe to work with vulnerable people. Staff receive sufficient training, support, including NVQs, to better enable them to meet tenants needs. Evidence: Staff informed us that they have been working in the home for a number of years and are clear with their responsibilities. Part of the induction is addressing the aims and objectives of the home, policies and procedures and needs of people using the service. The home has a key working system and conversations with key workers demonstrated that staff are confident in full filling this role. We observed staff interacting with people using the service, which showed us that staff as well as service users feel comfortable in their company. All staff are issued with the General Social Care Council code of conduct during their induction. Staff told us that they would seek advice from the manager or outside professionals if they have difficulties meeting peoples needs. This is done during one to one supervisions and regular staff meetings. The home has seven permanent members of staff employed, five hold or work towards the National Vocational Qualifications in care. Training of how to manage challenging Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: behaviour, risk taking, Autism and other issues relating to people using the service is provided and easy to access. Staff spoken to demonstrated good understanding or service users needs, guidance and how to achieve the best possible outcome for people using the service. The home has currently two vacancies. Rotas have shown us that adequate staff is provided to ensure peoples needs are met. Staff confirmed that on a whole they have enough staff available on shift. Te deputy manager told us that staff numbers can be increased if people using the service choose to take part in specific activities. The home has access to a staff bank and an agency to fill vacancies, training, sickness, etc. The recruitment records held on site, of two newer staff, were checked through. Each had an application form, an employment history including exploration of gaps where needed, and three appropriate references in place. Dates of receipt of the Criminal Record Bureau checks were also recorded. It was evident that sufficient checks had been made of people before allowing them to work in the home. Recruitment records of staff working in the home for a number of years are stored centrally, which has been discussed with the Care Quality Commission (CQC) Provider Relationship Manager and have been assessed as compliant. Staff informed us that they have easy access to training. Training records confirmed that staff have attended a wide range of training and regular refreshers are arranged. For example during the day of this inspection we overheard the deputy manager arranging Strategies for Crisis Intervention and Prevention training (SCIP) for all staff working at the home. Training records were updated. Staff spoke very highly of the support they receive from the registered and deputy manager. We viewed supervision records of four members of staff, which showed us that supervisions are regular and take a high priority in the home. Staff told us that they can access independent counseling services, if they wish. Annual performance reviews are undertaken and staff development is paramount. Care Homes for Adults (18-65 years) Page 23 of 28 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. We assessed National Minimum Standards 37, 39 and 42 during this inspection. The management team is experienced and committed to improve the outcomes for people using the service. Regular stake holder surveys ensures that service users, staff and any significant others are involved in the running of the home. Health and Safety is seen as a priority ensuring people using the service live in a safe and healthy environment. Evidence: We spoke to three members of staff during this inspection, all spoke very highly of the registered manager, this was confirmed by surveys received prior to this inspection. One comment made. The registered manager is always available and will help us if we get stuck. The registered manager has been working in the home for a number of years and has appropriate qualifications in care and management. During the time of this inspection the registered manager was on sick leave and the deputy manager was dealing with all aspects required to run the home safely. The deputy manager is highly motivated to improve outcomes for people using the service and is a qualified nurse. Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: We viewed the homes quality assurance folder, regular annual development plans are in place. The deputy manager told us that regular stakeholder interviews are undertaken to obtain their views of the quality of care provided by the home. Areas of importance in the most recent annual development plan is service users involvement, developing service users independence skills, how to support people to build meaning full relationships, how to make the garden accessible for all people using the service and how to support people using the service in improving their communication. In addition to regular stakeholder surveys, the staff team is meeting monthly to discuss service users needs and other issues relating to the home. People using the service meet regularly to discuss future activities, holidays and any other issues which matter to people using the service. Minutes for these meetings are provided and pictures are used to make them more accessible. We assessed the homes fire records, which were all found up to date and regular fire evacuation is undertaken to familiarize people using the service and staff with the evacuation procedure. The London Fire and Emergency Planning Authority visited the home in October 2008, which raised no concerns. General environmental risk assessments are in place and external Health and Safety audits are undertaken. Health and Safety tests such as Potable Appliance test and gas safety checks are in place and up to date. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 1 6 The responsible person must 01/10/2009 review and update the statement of purpose and service users guide. This ensures that prospective and current people using the service receive up to date information about the home. 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 20 We recommend to monitor the temperature inside the medication cupboard in 48 Chichester Court, to ensure that medicines are stored safely. Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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. 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. 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