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Inspection on 02/12/09 for Insight - Eastchurch

Also see our care home review for Insight - Eastchurch for more information

This is the latest available inspection report for this service, carried out on 2nd December 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.

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 has successfully provided support to some people with very challenging behaviour, where other services have failed. The service is proactive in developing its own training in minimising and responding to behaviours that challenge and is seeking accreditation by the British Institute for Learning Disabilities for its own training programme The focus of the service is on the individual person. There is a clear aim in the home of setting goals for each individual and monitoring that they are met. People who live at the home have opportunities to try out different experiences in the community such as going to the cinema and dancing and listening to music. The home employs a behavioural therapist providing psychology input which is not available through the local learning disability team. The home has a good understanding of Mental Capacity Act and is keeping its knowledge in the area up to date, by attending relevant training courses. There are comprehensive checks to monitor how well the home is meeting its own targets. This makes sure that the main aim of the home is to provide a good quality service to the people who live in the home. The home has got the balance right between making the environment safe, but also homely.

What has improved since the last inspection?

The home has employed a person centred coordinator full time, whose responsibility is to make sure that each person has clear goals to aim for, and that these goals are met. The home has employed a full time human resources officer to ensure that staff receive all the necessary training for them to perform their roles. This person is also responsible for making sure the correct procedures are followed when a new member of staff is employed. Taking these tasks away from the registered manager has freed his time to more effectively undertake his other responsibilities.

What the care home could do better:

The registered manager is aware that he is not up to date with formal supervisions of the care staff team and is working towards addressing this shortfall. Copies of documents about the quality of the home and checks of new staff must be kept on the premises. This will ensure that the registered manager, who is responsible for the running of the home, can monitor their effectiveness.

Key inspection report Care homes for adults (18-65 years) Name: Address: Insight - Eastchurch 83 High Street Eastchurch Sheerness Kent ME12 4DF     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: Nicki Dawson     Date: 0 2 1 2 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: Insight - Eastchurch 83 High Street Eastchurch Sheerness Kent ME12 4DF 01795880484 F/P01795880484 paul-insight@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Lynda Jane Cashford,Mrs Jacqueline Frances Hales care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 10. 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 Insight Eastchurch is a home providing care and support for up to ten adults who have learning disabilities and additional challenging behaviours. It is one of a group of three homes owned by Mrs J Hales and Mrs L Cashford. The home is located in the village of Eastchurch, on the Isle of Sheppey. It is close to all amenities and is on a bus route. Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 10 Brief description of the care home The accommodation comprises of ten single bedrooms. People who live in the home have use of a dining room and two lounges. There is a large garden surrounding the property and parking facilities at the fron of the home. The current fee levels range from £1283.88 to £3555.90 per week. The last key unannounced inspection visit to the home was on 2nd March 2007. 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: 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 inspection was unannounced, which means that the service users and staff did not know that the inspector was calling at the home. The inspection started at 9.50 am and took 7 hours. Eight people that live in the home, three care staff, two visiting relatives, the house administrator, domestic housekeeper and the registered manager took part in the visit in order to gain their views and knowledge of the level of care, provided by the service. The inspector joined some people that live in the home for lunch. The shared areas of the home and some peoples bedrooms were entered. Time was also spent looking at records to do with clients care and safety. Prior to the inspection an annual quality assurance assessment (AQAA) was sent to the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. The AQAA was received shortly after it was asked for. It gave very clear and detailed information about how the service strives to meet and improve the service for Care Homes for Adults (18-65 years) Page 6 of 30 the benefit of the people who use it. Survey questionnaires Have Your Say About were sent by us to the home before the inspection visit. We sent surveys to ten people that live in the home and they were returned by five people. We sent ten surveys to care staff and two people returned them. The responses were positive and when asked what the home does well people made the following comments: A relative commented that, The home does what it should, which is to provide care and cater for the needs of the resident. A service user commented that the home Looks after me best way they can. A member of staff commented that, Everyone works well together. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? 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 on page 4. Care Homes for Adults (18-65 years) Page 8 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live or may want to live at Insight, have all the information that they need to help them decide if this is the right place for them to live. New people moving to the home can be confident that their needs and aspirations will be fully assessed and met. Evidence: All care homes are required to give details about the service that they provide. This is to help people decide if a particular care home is somewhere that they would like to live. The aims and objectives of the home are clearly set out in the homes Statement of Purpose. The Service User Guide sets out the services and facilities for people that live or plan to live in the home. It has been developed into a pictorial guide so that the document is accessible to those people for whom the service is intended. The home gave us a lot of information in their AQAA (annual quality assurance assessment) about how they assess peoples needs before they move into the home. Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: No one new has moved to the home recently. However, the last time we looked at assessments, we found that the home had gathered an abundance of information. They had conducted their own very detailed assessment, obtained information from other people and professionals involved in the persons care and spoken to the prospective person and their family members. The service specialises in supporting people who have severe challenging behaviours in addition to a learning disability. The home has a number of strategies in place to ensure that they meet this aim. They employ a behavioural therapist, whose role includes providing training in the areas of communication, crisis management, behaviour management, care planning, risk assessment, and autism. They have good links with local health professionals such as diabetic nurses, district and practice nurses, psychiatrist, neurologist and epilepsy nurse specialists. Some staff attend training at the Tizard Centre, which offers specialist courses in adults with learning disabilities. The home has designed its own training workshop proactive and responsive support to challenging behaviours which it is seeking accreditation by the leading organisation in this area, the British Institute for Learning Disabilities. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their individual needs and personal goals are contained in their care plans and that clear instructions are in place for staff to follow to ensure that they are met. People are supported to make decisions and choices, and are consulted on all aspects of life in the home. Evidence: Each person should have an individual plan of care that clearly sets out their health, personal and social care needs, together with the staff support that is required to meet these assessed needs. Two care plans were looked at. Each plan contains a pen picture of the person, which gives the reader a good description of the persons individual personality. Although all the people in the home have challenging behaviour and this is included in the persons pen picture, the pen picture also contains the positive aspects of the persons character such as their charm, agility or contagious laugh. Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: In addition to care plans, people also have a person centred plan which contains pictures and important information about the persons life, including their likes and dislikes, and communication needs. All care plans should have written plans in place to minimise the effect of any potential risks. Detailed but clear risk assessments were seen in the two service user files that were looked at. Where a person has a number of risk assessments in place a summary is given which gives an overview of their individual needs. Some people who live at the home have limitations on choices. The reasons for these are fully documented. One person who lives in the home talked about a particular limit that they have on their freedom. They said why this was and that it was a good thing. Therefore it can be seen that the home manages risk, whilst at the same time ensuring that people are supported to lead as normal a life as possible. Peoples changing needs are observed and recorded on a daily basis. The behavioural therapist reviews all the information regarding peoples challenging needs, communication and behaviour. Their findings are then fed back into individual care plans, risk assessments and behaviour guidelines. This information is presented and discussed with service users and their representatives at six monthly care reviews. There is an important emphasis in the home on setting and meeting peoples individual goals. People who live in the home have a monthly meeting with their key worker and the person centred planning coordinator to ensure that progress is being made towards setting and meeting their goals. People who live in the home have a regular opportunity to make their needs know at client forum meetings. These meetings are made up from people who live in the three homes in the company and give those who want to and are able to, a real say in day to day decision making. The meetings are facilitated by an individual who is not employed by the company. The views of the service users are then fed back through the senior management meetings and any action is taken to address any matters arising. In the AQAA (annual quality assurance assessment) the home gave an example how one issue that was raised at the client forum, was addressed in practice. This is an excellent piece of work. In the AQAA the home has told us that service users are now involved in the recruitment process for new staff and provide feedback on whether or not they like the person. They have told us that this process has lead to changes in the recruitment process as it has identified peoples individual and diverse needs Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: Where monies are kept on behalf of people who live in the home, evidence was seen that they are well organised to ensure that monies are spent in the best interests of each individual service user. Care Homes for Adults (18-65 years) Page 15 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 supported to live fulfilling lives. Evidence: The aims of the home, as set out in its Statement of Purpose, are for people with learning disabilities and severe challenging behaviours to live in an ordinary home in the community, to grow and develop and to become more independent. There is evidence that people have the opportunity for personal development, since their wishes, aspirations and goals are identified in their care plan and these goals and progress towards them is regularly monitored. One person said, I am independent. It was observed that people are encouraged to do tasks for themselves such as making drinks and clearing the table. Everyone who completed a survey said that they can choose what they want to do Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: during the day, evening and weekend. Some people commented that they would like to go out more. It is acknowledged that peoples access to the community is always based on a risk assessment and that they do not take place unless it is deemed safe to do so. The home keeps a record of all activities offered and whether these take place. At the inspection people said that they went to disco last night. One person was excited that they are going Christmas shopping and to the cinema tomorrow. Another person was out for most of the day on a day trip. In the afternoon someone came to sing and play the guitar for the benefit of the people who live in the home. The domestic house keeper joined in this activity showing that all members of staff at the home interact and take an interest in peoples lives. A visitor said that their relative goes out a lot and that big celebrations are held for Christmas and birthdays. Life in the home was mainly calm on the day of the inspection. Any behaviours that challenged, or voices that were raised, were dealt with appropriately. Therefore, it is sometimes easy for a visitor to forget that this is a home for adults with challenging behaviours. In the AQAA (annual quality assurance assessment) the home has said that in the next year it plans to continue to identify more opportunities for individuals to attend weekly structured activities which offer a variety of educational and vocational learning. People who live in the home are encouraged and supported to maintain links with their friends and family. It was clear during discussion that the home plays a key role in supporting these positive relationships. Visiting relatives said that they are able to visit the home at any time and that they are always made to fell welcome. The inspector joined some service users for lunch. It was observed that people who need help to eat are supported discretely. Mealtimes are social occasions. People who live in the home re offered choices and it was seen on the day of the inspection that people eat different things for lunch. There is a six weekly menu which is prepared with input from a dietician. On week six, the menu is chosen in its entity by the people who live in the home. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal and healthcare needs are fully met. People living in the home benefit from their healthcare needs being promoted in their best interests. Evidence: Peoples personal care and preferences are identified in their care plans. All tasks that are carried out are clearly recorded and tracked in daily care notes. Peoples health care needs are detailed in a separate health care record. This record is a detailed document of historical and ongoing health or medical concerns, and provides information and guidance regarding specific health needs. Any visits by or to healthcare professionals are recorded in the daily notes, and the detail of the visit is recorded in the health care plan. As part of the initial assessment, the home undertakes a health check on all people living in the home and evidence was seen that this is reviewed every six months. A relative commented, the house monitors xs health well, which can be see by the fact that x looks well. Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: The home employs a behavioural therapist providing psychology input which is not available through the local learning disability team. Many community resources for mental health, epilepsy and speech and language are accessed on behalf of the people who live in the home. One member of staff has the additional role of health and social care coordinator. It is their responsibility to make sure that all clinical and health appointments are booked and that there is sufficient staffing levels for clients to attend. In the AQAA (annual quality assurance assessment) the home told and gave examples of how they are good at recognising when there is a conflict between an individuals health needs and their personal choice. In such instances they use a Best Interest meeting as a forum for shared decision making. They also told us that due to the behaviours of some service users, access to healthcare appointments can be difficult. A lot of preparation work is undertaken with each service user and some appointments have to be re-scheduled a number of times before being achieved. However, this work has enabled some service users to undertake health appointments that they have previously refused. The home uses a pre-dispensed system for administration of medicines. This system is used to reduce the risk of people receiving incorrect doses or incorrect medication. The person that is giving out the medicine records on a pre printed form the medicine has been given or, if it hasnt been given, the reason why. On examination of this record it was found that there were few gaps in recording showing that medicine is given out to people as prescribed by their GP. Evidence was seen that only people who have been formally trained in the safe administration of medication are responsible for giving out medicines in the home. It was found that there are good systems in place to audit medication records to ensure that all medicines in the home are handled 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured their views are listened to and acted upon, and that they will be protected from harm. Evidence: Neither the home nor the commission have received any complaints about the service since the last inspection. People who live in the home and relatives who were spoken with said that they could talk to anyone if they have any worries or concerns. All service users who completed surveys stated that they know who to speak to if they are not happy. Each person has a copy of the complaints procedure in their Service User Guide. The service user forum also provides a safe environment for people to raise any concerns or complaints they might have by ensuring anonymity. The staff training matrix evidences that staff receive training about abuse neglect and self-harm. Staff who were spoken with described the appropriate action they would take if they suspected abuse having taken place. They said that they felt confident to speak out if they observed any potentially abusive behaviour. Visitors said that they felt that their relative is safe living at the home. As stated earlier in this report, the service specialises in supporting people who have severe challenging behaviours in addition to a learning disability. Physical intervention is seen as the last resort by the home, and guidelines inspected evidenced a professional and measured approach to responding to aggressive incidents. All staff Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: attend courses in how to manage challenging behaviour. Staff demonstrated that they have a good understanding of the individual programmes in place for people that live in the home. The home is seeking accreditation by the British Institute for Learning Disabilities for its own training programme in minimising and responding to challenging behaviours. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a home that is comfortable, safe, clean and well maintained. Evidence: The home is an older property situated in the main street in Eastchurch, with good access to local amenities. People who live in the home have use of two lounges and a dining room. It is not obvious from first entering the home that the service is intended for people who present behaviours that challenge. The service has informed us that in order to reduce the impact of challenging behaviours on the environment, a high level of maintenance is required. This strategy has paid off, as it was evident on the day of the inspection that the home is pleasant and comfortable and kept in a good decorative state both internally and externally. Relatives told us, The home is always clean and does not smell. The home has got the balance right between making the environment safe, but also homely. Some peoples bedrooms were entered and contain a varying degree of personal belonging depending on the persons individuals choice and safety. People benefit from a large garden that surrounds the home. The home presented as clean and hygienic on the day of the inspection. There is a Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: rolling programme in place to make sure that staff know how to minimise the spread of infection in the home. 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. People who live in the home benefit from being supported by a competent and qualified staff team. Evidence: The staff rota indicates that there is seven and eight care staff on duty during the day. High staffing levels reflect the assessed needs of the people in the home, with around half of them requiring one to one staff support. The shift leader is responsible for allocating a member of staff to an individual person for that shift. The service copes well with the delicate balance of recognising gender and diversity issues whilst maintaining individuals continuity of care. At night time there are two staff that are awake and one on sleeping duties. Through their regular visits to the service, the home owners closely monitor the staffing levels and how this impacts peoples opportunities to achieve their goals, which are identified in their care plans. People who were surveyed were complimentary of the support that they receive from the staff team. One person commented, They help with problems, another said, If I ask for things people help me or support me. Information provided by the home in the AQAA (annual quality assurance assessment) is that 55 of staff are trained to National Vocational Qualification (NVQ) level 2 or above. This meets the National Minimum Standards. This award is useful because it helps staff develop good care Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: practices and their skills in working with people who live in a residential care home. The home told us that the recruitment and training of staff has vastly improved due to the employment of a human resources manager. Evidence was seen that the relevant checks are undertaken before employing new members of staff. This means that the homes recruitment process protects the people that live at Insight. The registered manager is responsible for making sure that care staff have the skills they need to support the people who live in the home. The registered manager stated in the AQAA that all new care staff receive the appropriate introductory training, which gives them the basic competencies they need to be able to work without direct supervision. The staff training matrix is comprehensive, showing that a rolling programme of training is carried out with the staff team to make sure that they have the necessary skills to support the people in their care. The registered manager acknowledges that he is not up to date with his formal supervisions of care staff. Supervision is important because it gives staff the opportunity to discuss care practice and to identify any areas of development that are needed, should take place six times a year. The National Minimum Standards recommend that supervisions take place for each member of staff six times a year. The registered manager has set aside times for individual supervisions to take place and has plans to delegate some of this responsibility to other members of his staff team. 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 benefit from living in a home that has clear, effective, and innovative management. Evidence: The registered manager has worked at the home for a number of years and was appointed as the registered home manager a year ago. He has obtained qualifications that are recognised by the commission, as being useful in helping people who manage residential care services to have the competencies that are necessary to do so. The two people who own the home have been developing specialist behavioural services for adults with a learning disability and additional behaviours that challenge since 1991. They have a sustained track record for delivering services that are both innovative and visionary. Everyone was very complimentary about the management style of the home. Leadership of the staff team is clear and it is evident that staff, service users and relatives are valued. A service user said about the registered manager and a Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: complimentary, but honest way, Paul. He is alright for me. Sometimes. A relative said, X is part of the family. She is treated like she is part of the family. A member of staff commented, When you need support there is always someone to help you. When needed. Evidence was seen that regular staff meetings and management meetings take place at the home. Staff said that this gives people the opportunity to put across their point of view about how a person is supported in the home. One member of staff commented, If something should be done then we will voice it. In their AQAA (annual quality assurance assessment) the service told us that they conduct annual quality audits to ensure that the home is run in the best interests of the people who live in the home. The data collected is used to determine areas for improvement and for target setting. Questionnaires are sent out yearly to people who live in the home and their families. The last time this was done, people were very satisfied with all aspects of the care that they received. Feedback from people who live in the home is also regularly sought in service user forums, key worker meetings and service user reviews. It is required that a copy of the results of the quality assurance questionnaires and of all the monthly, documented visits to the home by the home owners, are kept on the premises in accordance with the Care Homes Regulations 2001. The registered manager told us that there are no people living at the home subject to a deprivation of liberty authorisation under the Mental Capacity Act 2005. In the AQAA the home told us that one of the homeowners is currently undertaking the Kent and Medway Best Interest Assessors course at Kent and Canterbury University. She is taking the lead within the service with regard to the Mental Capacity Act and the deprivation of liberty safeguards and is disseminating learning through the senior management team meetings and clinical reviews. The registered manager made a declaration in the AQAA that all items of equipment in use in the home remain in good working order and has given dates on which all equipment has been serviced. Records about what the home does to make sure that the home is doing all that it can do to minimise the spread of a fire were looked at and found to be in order. As stated earlier in the report, the home has a rolling staff training programme in place to make sure that staff know what to do if there is a fire, how to offer emergency first aid, how to move and handle people safely, how to minimise the spread of infection, how to keep people safe and how to prepare food safely. 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 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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