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Inspection on 23/07/09 for Ocknell Park

Also see our care home review for Ocknell Park for more information

This is the latest available inspection report for this service, carried out on 23rd July 2009.

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

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

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

What the care home does well

The home is increasingly consulting the people living there about their lifestyles, activities and preferences and including findings in care plans. One person said the home "opens doors to the future" another said they do the things they wanted to do and another person said that they liked being at Ocknell Park. The home is having regular house meetings in which people can raise issues and influence decisions about the home. An example that lots of people spoke about positively is the recent changes in the food. Staff tell us that that recruitment checks take place before commencing work and good records are held of the checks that are made. There is evidence that people are getting an improved induction and training is provided for new starters. The manager has also reviewed the training of all staff in the home,has details of those areas that they need training in, and is supporting them to attend sessions. People living in the home have also joined some of these sessions. Staff are being trained in adult protection and safeguarding procedures are being used following incidents and reviews of strategies or procedures are following this. Other health professionals are included in the provision of meeting health care needs and records of needs and action taken is documented well. The manager has a clear direction spelt out in the interim management plan and is making progress in achieving objectives set.

What has improved since the last inspection?

We did not make any specific requirements following the previous inspection but note that the management of the home is working toward specific objectives identified in an interim business plan to improve the service to people living in the home. He and has acquired a third vehicle, developed some of the care plans, made supervision regular, recruited more staff, reviewed how the home is maintained and is promoting a culture of enabling people to develop their lifestyles further.

What the care home could do better:

We have not made any specific requirements following this inspection but have raised some matters for the manager to address in the report. These relate to ensuring that staff competence in medication administration is kept under review and to ensure that there is evidence of: training for all staff involved in a specific health need; their competence; and a record of who carried out that training. The manager when reviewing the business plan will need to ensure that he can demonstrate that all consultation processes with people using the service and others are taken into account.

Key inspection report Care homes for adults (18-65 years) Name: Address: Ocknell Park Ocknell Park Stoney Cross Lyndhurst Hampshire SO43 7GN     The quality rating for this care home is:   two star good 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: Sue Kinch     Date: 2 3 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 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: Ocknell Park Ocknell Park Stoney Cross Lyndhurst Hampshire SO43 7GN 02380814246 02380814083 ocknellpark@truecare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Truecare Group Ltd Name of registered manager (if applicable) Mr Russell Weeks Type of registration: Number of places registered: care home 11 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 11 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 (LD) Mental disorder, excluding learning disability or dementia (MD) Date of last inspection Brief description of the care home Ocknell Park is a large detached house set in its own grounds in the heart of the New Forest. The home has two lounge/dining areas and a large conservatory that leads to a patio area with fishpond. The eleven residents each have their own bedrooms and these are located on both floors of the home. The home has large well-maintained Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 0 11 11 Brief description of the care home gardens. Within the grounds there is also a day service that the residents can attend. The aim of the home is to provide accommodation and support for people with complex and challenging behaviour who have either a learning disability or a learning disability with associated mental health problems. The current range of fees charged by the home is £1932.42 to £2767.45 per week. 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: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was the first key unannounced inspection since 17th July 2008 and included:a review of information held by CQC about the home; information supplied by the home in a fully completed Annual Quality Assurance Assessment (AQAA) provided by the manager; information from talking with six people living in the home and information provided in ten surveys;and information from four staff during our visit and in nine surveys from them. During our visit for seven hours we also: observed areas of the home and interactions between people living there, staff and management. We viewed some records required to be held in the home and spoke with the manager and operations manager. Care Homes for Adults (18-65 years) Page 6 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 Care Homes for Adults (18-65 years) Page 7 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good systems in place to use for assessing the needs of people and deciding on the suitability of the service but these have not always been used effectively to ensure that people are assured that their needs will be met before moving in. Evidence: The home has an admission policy provided by the organisation and this includes a plan for assessment, consultation, visits and reviews as part of the process.There is a statement of purpose and service user guide and information is available on the website so people thinking about using the service can find out about the home. The home has not admitted anyone in the last twelve months and in the previous twelve months had four admissions. From surveys and discussions with people using the service we noted that two out of ten people did not always feel that they were consulted about coming to the home or that they had been given enough information. However, when we spoke with one of those people they were very satisfied that the home was meeting their needs. Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: We checked records of admission for three people and found that they did not all show that all aspects of the process had always been fully been followed or that people had been assured that their needs could be met. The above was discussed with the manager who agreed that the admission process needed attention and demonstrated that a detailed process was underway for assessing and liaising regarding someone under consideration for admission.The manager was fully aware of the admission process to be followed and in the AQAA told us that he intends to improve the service user guide available to new people thinking of moving in. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good systems in place to support people to meet their individual needs through care planning and risk assessment. Evidence: The service offers support to an all male group of people with complex individual needs.From a sample of three personal files viewed we noted that there are regularly reviewed care plans based on assessed needs.These include risk assessments.Staff guidance is provided to meet a range of specific individual needs. Areas covered included personal care, physical and emotional health, medication,finance, social and recreation activities,communication. These also take account of the diversity of needs.The manager, in the business plan, had planned to reconstruct all care plans by April 2009,he said that there are still four to complete. People using the service were aware of the plans to support them and said that they had opportunities to discuss their needs with key workers or staff when needed.In the sample of records we viewed there was evidence that this was happening every other Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: month and of peoples involvement.The manager said that the purpose was to help people see their progress.There was also evidence of full reviews including care manager reviews and reviews of aspect of needs with other professionals. The areas covered in care plans include details about behaviours and how they are to be supported including distraction and de-escalation techniques and specific interventions for challenging behaviours.The plans also include physical interventions. Staff are trained in the use of associated techniques identified for people using the service. There is a system for review following incidents and a specific example discussed at the inspection is referred to in the concerns complaints and protection section of this report. The manager spoke of increasing the decision-making of people living in the home and of a more enabling approach to meeting needs.He said that the care plans comprehensive risk assessment aimed at empowering individuals to live as independently as possible while maintaining their safety and well being.In the risk assessments sampled we noted that these include community and computer access and the rationale for support levels is recorded for individuals.The manager gave an example of a person now being able to visit relatives without staff. Another person living in the home spoke positively about planning to move to somewhere offering them more independence.In surveys received from people living in the home eight out of ten said that they could make decisions and all but two said that staff or management always or usually act on what they say. In surveys and verbal feedback most staff said that there are systems in place to be able to share information and that these work well and they said that there are usually enough staff to meet needs although one person said that they were not always competent. 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. The home supports people to make choices about how they wish to lead their lives and is reviewing opportunities to increase their options and to address diverse needs. Evidence: The home is spacious with several internal and external areas for activities, recreation and leisure.There is a very large garden offering people much space, with a vegetable plot where people can assist the gardener and ample space for football, which several people enjoy,and other activities.There is also a shed where some people have completed woodwork projects and another set of rooms which are also used with staff support based on assessed risks.The facility offers opportunities for activities including art,computer use and cookery. We noted that in the bedrooms viewed people have been supported to develop their own interests and have many personal items to assist with this such as music Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: equipment and televisions.There are also many shared areas of the home so that people have choices about where they want to be and who with. The Manager said that people are supported to several off site activities including bowling, snooker, pub and cafe trips, cinema, cycling and football. During our conversations and observations of records we noted that there was evidence of this occurring. When we visited many people were out. Some were on a trip to Oxford, others were playing football and shopping.Another person was talking of going shopping the following day and another to the bank.A staff member commented that the home offers a regular of trips to people and a good level of choice.We noted that details of local events were posted on the noticeboard for the end of July offering the opportunity to go if they wished. People told us that individual choices are taken into account and people are also regularly support individually in the local community. The manager has obtained a third minibus to improve the transport facilities and is planning to support people who have interests in college courses to enroll next term. Peoples interests and activities are included in the care plans and the reviews that take place every other month. High staffing levels assist in the service being able to respond to individual needs and most people in the surveys said that they could do what they wanted to but three said not in the evenings. Staff said that evening trips did happen including to the pub. Information received from people using the service and staff, indicated that contact with families is supported and assistance given. One person said that families are made welcome. Another was being supported to go to stay with relatives and another spoke positively about regular visits to family members being planned in well in advance. Friendships are also taken into account,for example, one person had taken part in a trip on the day of our visit to accompany a friend. When we completed our annual service review in 2008 we received comments about holidays not being given enough priority at the home. The manager has take steps to address this and told us that as a result, funds were obtained to give people a holiday in Devon at the end of last year. He also told us that this year people were being supported to have individual holidays if they wished. One person told us that they had decided to have days out instead and had really enjoyed them. From talking with people living in the home and the manager and viewing the minutes of the residents meetings we noted that people living in the home have been able to Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: influence the menus recently and they have been changed taking their preferences into account. One person told us that the menus used to be changed twice a year.They said these menus were agreed to be reviewed in three months and they thought there was more choice now. They said that when they did not like food on the menu, they could have alternatives.They said food on the menu is provided.We noted that steaks were on the menu for dinner when we visited and discussions were taking place about how people like them cooked showing that individual needs were being taken into account. Care Homes for Adults (18-65 years) Page 16 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a good system in place for meeting peoples emotional and health needs including medication administration. However,not enough evidence is in place regarding staff competence in medication and a specific health need to ensure that people are not at risk of receiving some aspects of care from unskilled staff. Evidence: In the sample of personal files viewed we noted that personal care and physical and emotional health needs are included in the care plans which means that there is guidance in place for staff to know how to support people on an individual basis. Key workers have a role in ensuring that matters are followed up and a review of health is included in the reviews held every other month. During our visit various health needs were discussed and we were told that people were getting care and support from health professionals, including from dentists, opticians, doctors, nurses and psychiatrists. We were also told that staff were available to take people to appointments and we noted that these are also documented. People told us also that they can talk to staff and most felt that they were listened to. Some feel more able to talk to some staff than others. Two thought that staff did have training in relation their special needs but that they did not all really fully understand their issues. Nine out of Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: ten people living in the home thought that they were always or usually treated well. Staff training for meeting a specific health need was discussed with the manager.The training plan showed that seven staff had received the training although the manager said that other staff were also involved under the guidance of the district nurse. We asked for evidence of the training and that they had been deemed competent and the manager agreed to obtain this within two weeks. Risk assessments have been completed in the file sampled to show that self medication had been considered. The manager told us that all those who administer medication, usually the person in charge on a shift, have been trained. He said that there now needs to be further assessments of the competence of the staff and that this was being planned. Medication in the home is held securely. People are able to choose where they take their medication. Most medication is held in an monitored dosage system and where checked this has been followed accurately.The person in charge of each shift is responsible for ensuring that medication has been given. Care Homes for Adults (18-65 years) Page 18 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. Systems of support are in place to address safeguarding issues and the home makes referrals under local procedures for investigation meaning that people are provided with support. Complaints are addressed and changes needed in response to these are acted on. Evidence: In the AQAA the manager told us that he welcomes complaints and suggestions from people living in the home. He said that day to day contact with the him helped people to raise issues. The home has an easy to follow complaints procedure which includes pictures and is prominently displayed on the notice board in the home. People have been provided with copies in their contracts. It is also included in the service users guide. In our survey of people using the service, they all said that they knew what to do if they were not happy about something and how to make a complaint. There are other systems in the home for people to make their needs known such as the key worker and co key worker systems, the reviews every other month and, regular house meetings. The manager keeps a log of the complaints made and we noted from records held that these have been responded to. Comments made by one of the people living in the home gave an example of how one matter had been addressed with a good outcome. The manager said that staff are trained in adult protection as part of the induction Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: process and that policies are in the home.He said that staff are then given further training.The training plan on the wall included a record of those trained and of further training needed. On the morning of our visit some staff received training in safeguarding.In surveys staff sent to us they all said they know what to do if concerns are expressed about the home by someone. A discussion was held with the manager about a sample of the more recent safeguarding referrals that he had made to social services this year. Both had involved allegations about staff and the manager demonstrated that he had attended the meetings and followed up matters where needed. In one situation the matter had not been evidenced and in another re training issues had been followed up. The manager said that he sends all notifications of incidents to social services at their request. One matter reported about the behaviour of someone living in the home had subsequently been addressed under these procedures. The manager attended the meeting and had reviewed procedures in the home.This shows that the manager takes action to listen to people and addresses their concerns. As stated in the individual needs and choices section, strategies are in place to deal with challenges to the service.This can include physical interventions which are monitored and reviewed. A comment was received about a recent specific incident when a staff member was hurt and they said that the guidance should allow staff to intervene sooner.The manager was aware of the incident and had taken steps to review the agreed procedure with relevant parties involved in the original plan. This included a review of the timing of interventions. Care Homes for Adults (18-65 years) Page 20 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. People using the service are provided with a comfortable, safe and clean environment although the system for repairs and maintenance is still under review to ensure that a swift enough service is provided. Evidence: In the AQAA the manager said that Ocknell Park is a large spacious country house in the New Forest and visitors often comment on the attractiveness of the home and its setting. The home is situated back from a main road and set in large gardens which offer people plenty of spaces and choices over where they want to spend their time. There are large shared areas in the home including two large lounge/diners and a conservatory. They are comfortably furnished. Other buildings in the grounds are also available for recreational use. Areas viewed are decorated to a good standard and people were noted to be choosing where they wanted to be. In the AQAA the manager had referred to experiencing difficulties in ensuring that repairs and maintenance are responded to sufficiently. He said that he had included improvements to the environment in his interim business plan and has been successful in reducing some of the outstanding jobs but was monitoring to see if the system in place was good enough to maintain an acceptable environment. The manager said that some people living in the home have been involved in some aspects Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: of maintenance and an example is that two designed and erected a gate to the rear garden to improve safe access. Some of the people living in the home showed us their rooms and these were spacious and furnished with necessary items of furniture and many personal items showing that people have different preferences and needs. Some people have been helped to make furniture for their rooms.The rooms were clean and people said they were comfortable in them. Where checked there were window restricters, rooms have hand washing facilities and people have been provided with keys. People have access to bathrooms and wet rooms near bedrooms. The manager told us in the AQAA that the home has a comprehensive cleaning schedule and that people living in the home help staff with tasks.They confirmed this and the areas of the home that we viewed during our visit were clean. In the AQAA the manager told us that the home uses the essential steps monitoring tool for auditing its infection control processes and we noted that the home was fresh and ventilated. We noted also that infection control training is provided in induction and then refresher training is given. In the surveys that people returned to us they 9 out of 10 people told us the home is usually or always fresh and clean. 1 said sometimes. In a survey 1 staff member told us that a new washing machine was needed but no problems were reported in discussion during our visit. People are supported with their washing as needed. Care Homes for Adults (18-65 years) Page 22 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. An increasingly effective staff team with appropriate training and support are providing care in a friendly way and with increasing consultation and consistency. Good procedures of recruitment are in place to offer protection to people living in the home. Evidence: The manager told us that one of his initial priorities was to reduce the number of agency staff working in the home to provide more consistency for the people living there. We note that comments from staff, people using the service,and from the rosters that this has been achieved. We also looked at elements of the recruitment process in place and sampled some of the records required to be held in the home.We note that records are held of the pre employment checks required to be carried out.Responses from staff in surveys also told us that checks are carried out. We discussed induction with the manager and noted that, where sampled, new staff have been given supervison and records are held of their induction.We also noted that these new staff have been given opportunities to complete core training courses and that training is ongoing. In staff surveys most said that induction was carried out well. The manager told us that it is a requirement of the organisation that all new staff complete a full induction course and that they are supernumerary in the first week. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: Another priority of the manager was to provide more training for staff and he has devised a matrix of training posted on the office wall to monitor the training provided.There is a rolling programme of training and all the staff in our survey told us that they did have the training they required to fulfill their role although one wanted more about health and medication.Another was concerned that new staff may not have the experience needed for working with the challenges of the service and one commented that it would help to recruit more experienced staff. In our surveys staff had told us that they usually had the support or experience or knowledge to meet peoples needs.We noted that new staff are being trained in managing behaviour and that supervision, another initial priority of the manager, is taking place and provides staff with opportunities to discuss their work.He commented that he is keen to develop the change of culture at the home to provide an environment which enables people living there to develop. We saw certificates for fire training recently completed and a person living in the home told us they had also taken part.Training in safeguarding was taking place for some staff on the morning of the inspection and the manager said that 9 staff were about to start National Vocational Qualifications in September 2009. The staff levels are provided to meet assessed needs. Some people have higher staffing ratios and staff confirmed that the ratio of 9 staff to 11 people is provided in the day time. This does change as the evening progresses.The manager and a staff member said that they thought that the level was sufficient to meet needs.In surveys most staff said that there was usually enough staff to meet needs. 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 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 well organised to meet peoples needs and there are systems in place to increasingly consult them about the service, make changes and to promote their health and safety. Evidence: A new manager has been employed since the last inspection in October 2008 and has previous experience of working in a similar environment with the organisation and has been registered. He was registered in respect of this home in March 2009. He has a National Vocational Qualification level 4 in care and a Registered Managers Award. People spoken with during our visit said that they were able to talk with him and we saw evidence of this. In staff surveys most said that they get enough support from their manager although a couple of people said sometimes. Supervision responsibilities are spread across the management staff and we saw records to demonstrate that the manager has started a system of regular supervision. He said this was not fully in place before and that he would expect that people are receiving supervision in line with the the standards required by the end of this year. He is also planning to provide regular staff meetings. Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: A copy of the certificate is displayed in the front hall and the manager agreed to replace this with the original certificate. In the AQAA the manager told us that the home has quality assurance systems and that he works in consultation with the groups health and a safety committee , the maintenance team and the contracted health and safety consultant to ensure the safety of all residents staff and visitors. The organisation has a policy of consulting people using the service and others on an annual basis although the current interim business plan was established by the manager based on his assessment of the service. His priorities include training,recruitment care plan reconstruction, maintenance, and supervision and he has provided evidence that work is taking place to achieve this. He said that people have been informally consulted and would be using this years consultation process to inform the next plan. We have noted from conversations with people during the inspection they have influenced the service including their care provision, menus, the environment and holidays. The minutes held of residents meetings show people are involved in decisions and a conversation with one person about the location of the telephone for people using the service confirmed that people had influenced this decision and preferred its new location. Staff are receiving health and safety related training and plans are in place for refresher and training and updates. In the AQAA the manager told us that the servicing required in the home takes place routinely. We viewed some records in relation to this and noted that fire equipment and the fire system have been tested within required timescales by an external organisation. A visit was made to the home by the fire and rescue service in June 2009 and made some requirements which the manager said he had followed up. A review of the fire risk assessment was included and had been recorded as done showing that the manager follows up matters in the interests of the safety of people living in the home. We also noted that a number of certificates dated 22 July indicated that some staff had just completed fire training and one person living in the home told us that they had attended and was hoping to do the food hygiene course. 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). 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