Inspection on 14/10/09 for Medora Road, 67

This is the latest available inspection report for this service, carried out on 14th October 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

Medora Road, 67 17/02/06

Medora Road, 67 18/10/05

Medora Road, 67 17/02/05

Medora Road, 67 18/11/04

Medora Road, 67 31/03/04

Medora Road, 67 20/01/04

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Medora Road, 67 67 Medora Road Brixton Hill London SW2 2LW     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: Lynne Field     Date: 1 6 1 0 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 29 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 29 Information about the care home Name of care home: Address: Medora Road, 67 67 Medora Road Brixton Hill London SW2 2LW 02086786645 02086715977 debrahim@southsidepartnership.org.uk www.southsidepartnership.org.uk Southside Partnership care home 5 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 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 5 The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Medora Road is a residential service for five adults with mental health problems. It is one of a number of homes where the care is provided by a voluntary organisation called Southside Partnership, which provides housing and support services to adults with learning disabilities and mental health problems. The building is owned and maintained by Hexagon Housing Association. Medora Road is a few minutes walk from local shops and buses and a short bus ride away from a busy shopping centre with full community and transport facilities. The house is not suitable for people with mobility restrictions as there are steps and stairs throughout. The ground floor has the lounge/diner, kitchen, 2 bedrooms, a bathroom with toilet and the utility room. The Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 5 Brief description of the care home first floor has a toilet, a bathroom with toilet and three bedrooms. The office is on the top floor. There is a small garden at the rear of the house, accessed from the kitchen, and there is unrestricted street parking at the front of the house. Staff liaise closely with the mental health services by use of person centred planning to enable service users to sustain a positive self-image and good mental health. Potential service users would be given a Statement of Purpose, a Service User Guide and verbal information about the home. A copy of the most recent inspection report is kept in the office and in the client?s file in the lounge, and attention is drawn to it at the Tenants? Meeting. The current charge is #981.33 per week, with no additional charges. Care Homes for Adults (18-65 years) Page 5 of 29 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 unannounced inspection was carried out over one day in October 2009. The manager facilitated the inspection and included a tour of the home and examination of records on care plans, medication records and the complaints book. The home has one vacancy at the time of the inspection. We met four residents and spoke to five staff during the course of the inspection and all were very positive. A new member of staff told us about their experience of recruitment and working for the service, which were positive. We checked relevant policies and procedures as well as the residents files, the care plans and building maintenance records. During the visit we were able to observe how staff interacted with residents and how residents responded to staff. We were able to attend the staff meeting that was happening at the time of the inspection. The manager returned a standard form, the Annual Quality Assurance Assessment (AQAA), to CSCI. This was taken into consideration and used as part of the inspection process. Care Homes for Adults (18-65 years) Page 6 of 29 There was an excellent level of commitment displayed by the manager and staff to ensure they were meeting the needs of the resident and complying with the standards. Care Homes for Adults (18-65 years) Page 7 of 29 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. 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 29 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 29 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. The information in the statement of purpose and resident guide is clear and well written and is given to prospective residents to help them decided if the home can meet their needs. Residents have their needs assessed by senior staff before they move to the home and know that staff has decided that the home can meet their needs before they move there. Prospective residents and their relatives can come and look around the home and meet staff before they decide to move there. Evidence: We saw copies of the statement of purpose and resident guide. The residents guide includes the complaints procedure as well as the homes policies on smoking, alcohol and drugs. Each resident has been given a copy of the Statement of Purpose and Service User Guide when they first came in. These were clear and well written. Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: The manager said they had one vacancy and they had a prospective resident. We attended the staff meeting as part of the inspection and going to assess the prospective resident was discussed during the meeting. The home has their own 10 page referral questionnaire/assessment form, which covers all relevant areas such as support, cultural and religious needs, mental health, medication, money/benefits, physical health, education/employment and relationships. We were told the manager or deputy manager with another member of staff would always arrange to meet a prospective resident and complete an assessment before they decided if they could meet their needs. The resident is invited to visit the home to meet the residents and staff as well as being given information to help them decided if the home would be suitable and meet their needs. We looked at three residents files. We noted the files contained a community care assessment and the relevant assessments and summary of needs that were completed by the home before the resident came to live there were seen on file. All relevant information from medical, psychiatric and social professionals is obtained, a preadmission assessment form is completed person conducting the assessment and a referral form from the social worker had been obtained and was held on the residents file. The home encourage prospective residents to visit the home on a number of occasions, accompanied by their social worker and/ or their family, where they can meet the staff and other residents. The manager said they are able to see the bedroom they are being offered and could say how they would like it to be decorated. This enables them to make an informed choice as well as giving the home a chance to assess their needs in the home setting. Care Homes for Adults (18-65 years) Page 11 of 29 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. Residents are consulted and supported to make decisions about their lives by staff and appropriate independent professionals. Care plans are thorough and reflect residents needs and goals and are reviewed within the allotted time scale or before if needed. Evidence: We looked at three residents files and noted that the care plans gave a thorough description of resident behaviours, reactions and preferences and how the resident was to be treated. The residents care plans and risk assessments are individualized that are developed with the resident participating fully and in consultation with the residents family, if appropriate, care co-ordinator and other professionals. Care plans are reviewed regularly within the allotted time scale or sooner if things have changed or there have been developments in the residents behaviour and life. We saw copies of these on the residents files we checked. There were records of monthly care plan reviews. Risk assessments from the previous placements would be checked and then Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: the home would develop their own risk assessments to suit the residents changing needs. Risk assessments were seen in care files and were comprehensive and thorough. A full range of risk categories are assessed, including aggression/violence, self-harm and self-neglect. The aim of the home is for residents to develop social and independent living skills. Residents are encouraged and supported by staff to develop and make as many independent choices and decisions about their daily lives as possible. The manager said she was encouraging staff to help residents do this by enabling them to make decisions on all aspects of their lives. In addition, care plan files also include a cultural needs assessment form and a Life Plan, both of which the service user completes. The Life Plan has three sets of goals: 1-3 months, 1 year and 5 year goals. Care files also have a programme of activities, detailed and clear key worker evaluation meetings, and minutes of CPA review meetings. We were told by the manager and staff they are protective of residents rights to privacy and confidentiality. They said they felt they had a right to choose occupations, activities and lifestyles that suit them. Staff said when residents wanted to make choices that staff know may be detrimental to their welfare, for example to stop taking medication, then staff give them the information, assistance and support that could help them to make a healthier decision. This would include involving external professionals as appropriate. There is information of how residents can contact external independent advocates on the notice board and in addition staff have given each resident an individual copy of the leaflet for reference. In the past staff arranged for an independent advocate to visit the home and speak directly about the service offered. We were told that all residents are expected to help in the day to day running of the home, and staff ensure that residents are given every opportunity to do this. Tenants meetings are held monthly, each with an agenda and often with minutes taken and written up by residents. Copies of minutes are kept in a file in the lounge sideboard so that a record of decisions and agreements is readily accessible to all residents. Minutes evidenced that residents discuss, comment upon and make suggestions and decisions about all aspects of life at the home, including health and safety, household chores, social activities, Southside Partnership policies and procedures, decoration and refurbishment, new service user referrals and improvements to the service. Care Homes for Adults (18-65 years) Page 13 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are encouraged to develop independent skills and interests as well as access the community with the support of staff when required. Residents engage in appropriate, enjoyable and fulfilling activities and mix with the general community. A healthy diet is provided, which the residents enjoy. It would be good practice and beneficial to the residents if staff could eat meals they have helped residents prepare. Evidence: We met all four residents who came and went to a variety of venues and activities through out the day during the inspection. The manager said residents are encouraged to choose what they do each day either by themselves or with the support of a member of staff if this is what they want. We were told one resident attends college Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: regularly, uses the public library regularly and attends a drop in centre weekly. Another resident has attended college since being at the home and obtained paid employment and has plans to undertake further education when the current period of ill health is over. Residents who were not interested in attending college or trying to obtain employment make use of community facilities such as shops, cafes, banks and post offices and health services. Residents said they were able to make choices of what they did each day and this could vary from day to day. Towards the end of the inspection one resident came back to the home very upset and angry because they had tried to get money from their bank account and were too late to do it. The manager and staff tried to help and were sympathetic and supportive. They said they would help them do this the next day. We checked two care plans and from discussions with residents and staff we could see staff support and encourage residents to maintain family and friendship links according to their individual choice and appropriateness. The regularity of visits varies, from weekly to twice annual visits. Residents confirmed that they are able to choose whether to visit friends and family or to invite them back to the home. On the day of the inspection we met two sets of families who had come to visit the residents and we saw all were made welcome. We noted all residents have keys to their rooms. The staff said they encouraged residents to keep their bedroom doors locked but some choose to lock them only when going out of the home. The home encourages residents to maintain and develop social and independent living skills. Food is very important and residents choose and cook their own meals. The manager said they are encouraging healthy eating menu where possible and there are discussions on healthy eating when they have residents meetings. We saw there are healthy eating guidelines in the lounge where they are easily accessible. In the past staff have arranged for a dietitian to visit the home and speak with residents about healthy eating. Residents were able to choose when and what they wanted to eat and we saw them useing the kitchen regulaly to make drinks to prepare food and snacks of their choice. Care Homes for Adults (18-65 years) Page 15 of 29 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. Residents receive personal support, in the way they prefer and their physical and emotional needs are met. Residents are protected by the homes policies and procedures for dealing with medicines. Medication administration was found to be properly documented and is handled safely. All residents need to have a photo on their medication records. Evidence: We could see from the residents files we checked that although residents do not require staff to provide personal physical care they may at times require prompting to carry out their personal care regularly or to an adequate standard. Staff said they try to do this as sensitively as possible, ensuring that residents privacy, dignity and independence is respected. We discussed aspects of the needs of one resident and how staff tried to encourage them to do their personal care without being insensitive to the resident and respecting their rights. Staff are fully aware of the different needs Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: that may arise for people from minority ethnic groups and there was evidence of cultural assessments in care files. Residents choose their own clothes and their appearance reflected their own choices and personalities. All residents belong to the same GP practice but each have a different doctor. There are good records that show residents are supported to access the full range of health care professionals and facilities as necessary, such as occupational therapist, consultant psychiatrist, general practitioner, psychologist as well as routine checks to the dentist and optician. Emergency appointments are made with the GP, if the need arises. Care plans confirmed that staff work closely with external professionals, whom they contact for advice as appropriate. If residents are feeling low or having a period of poor mental health, staff will support and encourage them to maintain reasonable physical health and personal hygiene, enlisting the help of outside professionals if this becomes appropriate or necessary. We saw documentary and verbal evidence indicated that residents care and health needs are monitored and responded to thoroughly and appropriately. Three of the files viewed did not contain photographs of the residents. This needs to be done to complete the records. All records stated whether or not a resident had any allergies. The manager said they did a weekly audit of all medication and this is signed. The storage, administration and recording of medication was checked and found to be in good order. Staff have undertaken external training in the administration of medication as part of their induction training. The manager said that residents medication was discussed at individual residents reviews. One resident has a dosset box they fill themselves and sign for it. Another resident was considering self medicating and this was discussed with their care manager but it was decided they still were not ready to do this yet. The manager said they were trying to enpower residents. By doing this they hope to get them to make as many decisions for themselves and to do as much for themselves as possible. Care Homes for Adults (18-65 years) Page 17 of 29 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. There are safeguards in place to protect the resident from abuse, neglect and selfharm. Evidence: There is a clear, detailed, easily understood and effective complaints procedure. We saw a copy is displayed on the notice board so that it is easily accessible to residents and a further copy is kept in a complaints file in the lounge. We were shown the complaints book and saw there was one complaint recorded with the outcome and response to the resident. The manager said they take all complaints seriously. Residents said they knew how to make a formal complaint but had none and would speak directly to the manager and staff if they had any concerns. Residents and their family we spoke to during the inspection said they were happy with the home. Staff have discussed the use of mental health advocacy services with all residents and literature about how to contact the service is displayed on the notice board. All residents handle their own finances and two completely independently. This includes money to by their food. Staff retain the food allowance for the other two residents, who are given the full amount weekly when they request it. All staff have had abuse training, both during induction and then as a separate external course. Staff said they did annual refresher courses to keep them up to date with the latest training. They said they were aware of the many different forms of Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: abuse and the procedures to be followed should abuse be suspected. Staff also demonstrated understanding of how to deal with verbal or physical aggression and cited a recent example, which had been dealt with sensitively and safety with the correct procedures followed. Care Homes for Adults (18-65 years) Page 19 of 29 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. The home is safe and comfortable with adequate private and shared space, toilets and bathrooms. The home is well maintained and furnished. Residents bedrooms are comfortable and are decorated to reflect their personalities. Evidence: The home is an ordinary end of terrace house that is in keeping with the surrounding houses and therefore not distinguishable as a care home. It has three floors and no lift and so is not suitable for people with mobility problems. The home is located close to local community amenities and transport and is also a short bus ride from a major shopping and transport centre which has full community facilities including a main library, large recreation centre, cinema etc. We were given a tour of the home and found it is attractively decorated, fitted and furnished and very homely throughout. There are three separate communal areas in the home, the lounge/diner, the kitchen and the garden, and all three are attractive and well maintained. The lounge/dining room is comfortable with a leather sofa and chairs. There is a dining table and chairs near the kitchen. The manager said they were hoping to change the furniture around so more people could see the television. Since the last inspection they have put a computer in the lounge for the residents to Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: use. Residents have agreed to a policy whereby they undertake to smoke outside in the garden, rather than the lounge and a shelter has been built in the garden for this. The kitchen is a normal domestic kitchen and residents are able to access it at all times. The kitchen was recently refurbished and is well laid out with fixtures and fittings of high quality. Each resident has their own cupboard for dry foods for which they have a key. They share space in the two fridge/freezers. Residents and staff keep the kitchen clean and on the day of inspection it was found to be very clean and tidy. There is a laundry room on the ground floor which is suitably equipped and in which any hazardous household substances are kept locked in a cupboard. One resident let us see their bedroom and we were able to see one bedroom that was unoccupied. The manager said they would decorate it for the new resident and consult them about how they wanted it to be decorated. Residents said that their rooms were warm and comfortable and that they were happy with them. One resident said they had moved rooms to make it more accessible for them and they were happy with their room. They were observed to spend time both in the lounge and in their bedrooms at choice during the day. The home has a bathroom with toilet on the ground floor and a separate toilet and bathroom on the mezzanine/first floor. All three rooms were well fitted and equipped, and although none of the residents require aids and adaptations, the rooms have been fitted with support rails and bars should they be needed at any time. Residents are expected to keep these areas clean as part of their shared household chores, with staff prompting and support as necessary, and all three rooms were found to be clean and hygienic with no unpleasant or offensive odours. The home had a number of paintings that we were told the residents had chosen. These made the rooms very individual. Care Homes for Adults (18-65 years) Page 21 of 29 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. Appropriately trained staff meets the residents individual needs. The recruitment procedures followed are safe, thorough and comply with legal requirements. Formal supervision is happening for all staff on a regular basis. Evidence: We were able to meet all staff during the inspection because there was a planned staff meeting on the day of the unannounced inspection which we were able to attend. We were told they had regular staff meetings that all staff are put on duty to attend. The staff team is mixed in terms of gender and race, reflecting the cultural and gender composition of service users. The team is also stable, with very low use of agency staff, and therefore provides good continuity of care. Monthly, minuted staff meetings are held, at which staff said they feel able to express their views and contribute to team working. We checked the staff rotas, which showed that the ratio of care staff to residents is determined by the assessed needs of residents. We were told when it is known that residents will need to be supported to go out the staffing levels will reflect this. Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: The registered provider runs a very well organised and comprehensive training programme, providing individual training profiles for staff and regular reminders to homes when refresher courses are due. Staff profiles showed that staff have undertaken a full range of relevant training during the year including advanced supervision, financial management, adult abuse, the Disability Discrimination Act, how to deal with difficult people, fire safety, steps to management, assertiveness, manual handling, how to deal with depression and welfare benefits. A new member of staff told us of their experience during their recruitment and induction program. They said they were nearly out of their probationary period and hoped to much more training. They said they were very impressed with the training program and training offered. We were told staff have a learning and development portfolio and are encouraged to take responsibility for their development. The home has exceeded the 2005 NVQ Level 2 training recommendation, with all support workers except the new member of staff having NVQ Level 2 or 3 qualification. The organisation has a training manager who has devised a training program. This is sent around to all the homes in the organisation. The learning and development calendar is colour coordinated to indicate what type of training it is. The manager is also sent reminder when staff are due to have training. The number of courses the organisation has is impressive. The staff at the home have attended a wide range of training to help them with their work supporting the residents. Managers are involved with the recruitment of staff for the home and organisation depending on their availability. The organisation uses a competency based interview when recruiting support workers and managers. Staff are only appointed after CRBs are in place and two references have been received from their previous employer. New staff are given a job description, a contract and must have medical checks. All staff are given a copy of the staff handbook. The organisation holds an induction day for all staff who join the organisation. This gives all new staff a general induction into the organisations policies and procedures as well as giving them an over view of the organisation including their vision and values. There is an organisational induction checklist for support staff that the managers must follow to ensure all staff have the same induction standard. New staff undergo a six month probationary period and take part in a twelve week LDQ induction training, as well as having core and mandatory training. The manager said they assist new members of staff develop an individual development program to make sure their induction and development training was relevant to the needs of the residents. Even when staff transfer within the organisation, references are still taken up. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: Staff all said they had regular supervision every month and had their annual appraisal. This was confirmed in the three staff files we viewed. Care Homes for Adults (18-65 years) Page 24 of 29 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. Residents benefit from a home that is well run and managed. The registered manager is qualified and experienced and runs the home well. Working practices and associated records need to be more robust to ensure that the residents health and safety and well being is maintained. Evidence: The manager is well qualified and has many years of experience working in a variety of settings with people who have mental health issues. They are very committed to helping the residents develop socially and to become as independent as possible. We saw them supporting staff to do this. They say are encouraging residents to do this through empowering them to make their own choices and have self-determination. This was evident in the way they spoke and interacted with the residents and staff. We saw records of staff and residents meetings that are held regularly and this was confirmed verbally by staff and residents. All the records we saw were clear and well Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: kept. There was a clear audit trail of how the residents best interests were being met as well as by having best interest meetings involving all the relevant professionals. The organisation has a quality assurance monitoring system in place, which systematically gathers feedback from the residents and other professionals and enable their views to continually influence service development. The organisation has been inspecting the home under Regulation 26 of the Care Regulations 2001 and keeps copies in the home which we saw. Residents said they would speak to their key worker or the manage if they were not happy. There a business plan that is reviewed each year that states how the home aims to improve over the next year. The homes managers have regular meetings with senior and executive management, to discuss and plan the homes requirements. The home has policies and procedures in place around health and safety. The records we saw indicated the homes health and safety services and equipment have been checked, serviced and maintained at the appropriate intervals. There is a fire procedure in place. The break alarms are being tested weekly and fire-fighting equipment has been checked regularly. Fire drills have been carried out with residents at various times of day on different days, ensuring all staff have taken part in fire drills over the course of six months and there is a record of the date and time drills have been carried out. The organisation has recently updated the procedures for carrying out a comprehensive risk assessment with services. House risk assessments as well as COSHH risk assessments are in place. Copies of the reports and records of the checks are kept at the home. Care Homes for Adults (18-65 years) Page 26 of 29 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 27 of 29 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 28 of 29 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. 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. 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