Inspection on 15/07/09 for Quality Respite Care

This is the latest available inspection report for this service, carried out on 15th July 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC judgement.

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.

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Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report CARE HOME ADULTS 18-65 Quality Respite Care Valley View Barn Chiddingly Road Horam East Sussex TN21 0JL Lead Inspector Jo Mohammed Key Unannounced Inspection 15th July 2009 09:45 09 Quality Respite Care DS0000073080.V376341.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. 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 home adults 18-65 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. Quality Respite Care DS0000073080.V376341.R01.S.doc Version 5.2 Page 2 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 Quality Respite Care DS0000073080.V376341.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Quality Respite Care Address Valley View Barn Chiddingly Road Horam East Sussex TN21 0JL 07986 384180 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Quality Respite Care Ltd Mrs Heidi Stephens Care Home 8 Category(ies) of Physical disability (0) registration, with number of places Quality Respite Care DS0000073080.V376341.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: 2. Physical disability (PD). The maximum number of service users to be accommodated is 8. Date of last inspection New service Brief Description of the Service: Quality Respite Care is set in a rural location off the A22 about eight miles north of Eastbourne. The home is a converted barn called ‘Valley View Barn’ that was purpose built to provide respite care for a maximum of eight service users with physical disabilities. This condition of registration may not mean service users are completely restricted in mobility. The registered provider is Quality Respite Care Limited. The home is set in two acres of grounds that is currently laid to lawn. There are eight bedrooms all with en-suite facilities, seven of which are located at ground floor level and another on the first floor that is accessed via a staircase. The bedrooms on the ground floor have their own private patio/terrace area. Communal areas comprise of a large open plan living/dining area and a smaller separate quiet lounge/dining area. Internet facilities are available. The home has applied for planning permission to convert an outside barn into a larger more accessible kitchen, gymnasium and office space. The home is changing its pathway to provide a rehabilitation service in addition to respite care. A new vehicle has recently been purchased that can accommodate one wheelchair and three passengers. More detailed information about the services provided can be found in the Statement of Purpose that can be obtained directly from the home as well as Quality Respite Care DS0000073080.V376341.R01.S.doc Version 5.2 Page 5 copies of Care Quality Commission [CQC] inspection reports. Current fees are between £800- £1,800 per week. Quality Respite Care DS0000073080.V376341.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This report reflects a key inspection based on the collation of information since the home was first registered in November 2008 including a review of the home’s Annual Quality Assurance Assessment [AQAA]. An unannounced site visit was conducted on Wednesday 15th July 2009 between 9.45am and 4.15pm. The reader should be aware that the Care Standards Act 2000 and the Care Homes Regulations 2001, uses the term ‘service user’ to describe those living in care home settings. Quality Respite Care is a new home that provides respite care to eight people with physical disabilities. This condition of registration may not mean service users are completely restricted in mobility. The first service user moved into the home in February 2009. There are currently three service users at the home. The length of stay varies between approximately one to three months. The registered provider is Quality Respite Care Limited. The home is altering its pathway to provide a rehabilitation service alongside respite care. The site visit included a tour of the premises, examination of some care, medication, staffing, menus and general records. The visit also included meeting service users, the Manager and speaking with one member of staff privately. The overall quality rating for the home is good. What the service does well: A warm, friendly and relaxed atmosphere was particularly evident during the course of the inspection. The environment was well maintained and comfortable with contemporary furnishings and fittings and a good range of aids and adaptations. It was evident that service users enjoy a relaxed pace of routines and choice of meals. Good interactions and rapport were observed between service users and the staff team. The home has a dedicated group of health professionals who support service users well in promoting their independence through structured rehabilitation programmes. Quality Respite Care DS0000073080.V376341.R01.S.doc Version 5.2 Page 7 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. Quality Respite Care DS0000073080.V376341.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Quality Respite Care DS0000073080.V376341.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective, current service users and representatives have available to them information about the home in order to make an informed choice about their accommodation despite some updating, additions and amending of information. EVIDENCE: The home was initially registered in November 2008 to accommodate eight people; at this time the staff team were being formed and inducted into post until the first service user moved into the home in February 2009. On the day of the inspection, three service users were residing in the home. The average length of stay was reported as ranging between one-three months, however longer stays are accommodated. Each service user has a folder in their bedroom containing a Statement of Purpose dated April 2009. There is no separate Service User Guide although some aspects within the Statement of Purpose could be utilised to create a Service User Guide. The Manager was requested to work through this documentation to ensure the Statement Of Purpose and Service User Guide contained all they should according to current legislation, clearly defining how the home operates, the ethos, structure, composition and services provided. Quality Respite Care DS0000073080.V376341.R01.S.doc Version 5.2 Page 10 This information should be kept regularly updated with current and accurate details; as some information seen required amending for example in respect of staffing details, the frequency of reviews, the address and contact details of Social Services. Other information available to service users in their folders includes fire details, the complaint protocol and a questionnaire. The home are in the process of transferring the information held in folders onto a DVD so that it is more accessible to service users. Pre and post admission records relating to two service users were viewed; the date of admission for each service user was either not found or not easily identifiable. In one service user’s file there was no evidence of pre-admission assessment details or trial visits recorded. There was though a detailed discharge report from the service user’s previous placement covering several daily living areas and multi disciplinary care plans with pictorial exercise details. The Manager advised that a pre-assessment form had been completed for this service user. In this service user’s file were detailed terms and conditions in a pictorial format; however these were unsigned and undated. The Manager said that the home’s pre-admission assessment form had since been updated and revised. In another service user’s file a pre-assessment form was in place dated 13/1/09, although this was unsigned. Also on file was a discharge report and care plans from the service users previous placement. Terms and conditions of residence were in place in a narrative format that had been signed by the service user and staff member on 3/2/09. A discussion was had with the Manager to consider whether service users’ assessment information adequately matched with the care plans that had been drawn up in respect of covering all areas of daily living. It was also identified to review the composition, sequencing and evidencing of information held in service users files so that it matched with what the home say they do and ensure documentation is signed and agreed by all relevant parties. In the home’s Annual Quality Assurance Assessment it identifies that if possible, the service user, family or advocate are invited to the home to have a look around and to meet the team. That they encourage people to stay for as long as possible on these occasions and encourage a meal time visit. Due to the distance it says that many of our prospective service users need to travel to visit us prior to admission and it is generally not common for individuals to spend longer than a couple of hours with us. The home are working towards service users spending more time in the home prior to making a decision before they move in. Quality Respite Care DS0000073080.V376341.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have care plans and risk assessments in place that need some adjustment and expansion in a way that makes it clearer how their changing needs and personal preferences are reflected in all areas of daily living and how they are supported through a detailed risk assessment strategy in promoting independent living. EVIDENCE: The care records of two service users were tracked that included an examination of their care files, discussions with service users and the Manager. There was a considerable amount of information contained within these files and some difficultly in tracking the care needs of service users due to where information was located. On file were recent Physiotherapy reports, missing person, profile and emergency contact details. Daily notes. Likes and dislikes. Medication. Care plans with goals. Quality Respite Care DS0000073080.V376341.R01.S.doc Version 5.2 Page 12 It was raised and discussed with the Manager to review the range and content of care plans formulated to date to ensure they comprehensively and sufficiently covered areas relating to service users daily living needs. For example mobility, physiotherapy or manual handling care plans were not evident. There is some very good and informative detail in these files, however further steps should be taken to ensure they are placed possibly with care plans as active documentation in order to better inform service users and guide staff. A Physiotherapy and daily exercise guidance was placed at the back of the files and vital information like this could be overseen. Risk assessments in place primarily related to environmental matters and consideration should be given to developing these further according to service users daily living needs. In one service user’s file there were detailed review meeting minutes and new care plans. It was discussed with the Manager to ensure the existing care plans matched the new ones that had been devised as a result of this review. In essence, some re-organisation and composition of files is recommended as well as further development of care plans and risks assessments with clearly defined dates of service users admission, implementation and review dates of care plans. Consideration should be given to evidencing more clearly what has been done, how to do it as well improving the tracking and cross referencing of information. More vigorous quality monitoring of service users care records when the regulation 26 visits occur would be advantageous to assist the home in the monitoring of these practices. Service users care files are located in the office. The Manager advised that service users are actively involved in developing their care plans. Ongoing consideration should be given to assist service users in easily accessing their records. Quality Respite Care DS0000073080.V376341.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have opportunities to participate in activities and this is an area that is continually being developed, however the systems in place to evidence this needs improvement. Service users rights and responsibilities in their daily routines are respected. The meals available are varied and enjoyed. EVIDENCE: All service users were at home during the inspection. On arrival, two people were finishing their breakfast and another service user had a later breakfast. Choice of food was evident. Daily newspapers were displayed on the dining room table for service users to read. A relaxed and informal atmosphere was particularly evident. During the course of the morning each service user had an individual Occupational Therapy session. Later in the afternoon, the activities co-ordinator engaged with different service users in craft work and baking a cake. Staff were also seen interacting with service users and playing Dominoes Quality Respite Care DS0000073080.V376341.R01.S.doc Version 5.2 Page 14 and Connect games. Another service user was observed spending time using the computer in the main lounge. It was raised with Manager how it was insufficiently evidenced and recorded within service users files their activities schedule to show how they accessed the community or participated in other activities. The Manager advised that from this week the activities co-ordinator had set up a file to record activities and that these sessions occurred three times a week for two hours. The activity co-ordinator follows on after these sessions by preparing a meal for service users. There was evidence in daily records and from speaking to service users that families and friends visited the home and they were supported to meet up with relatives. The Manager advised that they were linking with a College for one service user to do music and with a day centre for art and woodwork. It was reported that a service user received support from the Outreach team. Another service user attends a weekly stroke group, shops regularly, goes to the pub and has lunch out. On Fridays service users have relaxation therapy sessions and go out for personal items about twice a week. Last week the home purchased their own adapted vehicle and it was said this would enable more activities to take place as they had previously borrowed a vehicle from a local day centre. Conversations had with service users demonstrated they enjoyed being at the home, that they liked the food and there was plenty of it. They also maintained contact with their families and friends. Two service users said they did not go out much. The kitchen was clean and well equipped, although small in size. The Manager advised the kitchen was not entirely fit for purpose in enabling service users to use and promote independent skills and that planning permission had been applied to convert an outside barn into a working kitchen for service users. There is a three week menu in place with a choice of two main meals each day. Service users main meal is in the evening with a light lunch during the day. Service users are asked in advance about their meal choices. It was said that meals are freshly prepared and cooked and the menu showed a good variety of meals served. Service users and staff eat together. Shopping for the home is ordered on line and delivered. The home employs a private Dietician. The activity co-ordinator is the main cook and care staff prepare and cook food on the days when this person is off. Quality Respite Care DS0000073080.V376341.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported in meeting their health and welfare needs. EVIDENCE: The home employs its own Speech & Language, Dietician, Occupational Therapist and Physiotherapist as well as accessing other health and social care professionals. There was evidence in service users files pertaining to their personal care requisites and reports, proposals made by the Occupational Therapist and Physiotherapist. Service users are supported to attend health care appointments as necessary. The Manager advised that service users stay in the home around one to three months, although this can be longer. The home is altering its pathway to provide a rehabilitation service as well as respite care. The home does not provide nursing care, and service users are admitted once medically stable. The Manager identified they can care for people who have had strokes, brain injuries and traumas, Motor Neurone disease and Multiple Sclerosis. Quality Respite Care DS0000073080.V376341.R01.S.doc Version 5.2 Page 16 All service users have an Occupational Therapy session twice a week and a Physiotherapy session three times a week with programmes devised for staff to follow. In the home’s Annual Quality Assurance Assessment [AQAA] it identifies that ‘Specialist equipment is available to ensure that service users are supported in an appropriate, dignified, safe and beneficial way. Equipment and specialist input is reviewed at least every thirty days to ensure the changing needs of individuals are addressed and reacted to in an appropriate and timely manner. Care given to individuals is service user led and given by well trained staff members, we endeavour to provide same sex support workers to service users to maintain dignity, when this is not available the consent and views of the individual are taken into account before care proceeds. Service users are encouraged to participate in all decision making with regard to their own health care needs.’ The management and storage of medication was examined and found to be satisfactory. There are no current service users who self administer and no controlled drugs are used. The Manager advised that Boots the chemist deliver medication and provided staff with medication training. It is planned that medication refresher training for staff will take place six monthly/yearly. The Annual Quality Assurance Assessment [AQAA] identifies that ‘All support workers complete detailed and in depth accredited medication training followed by shadowing before the staff member is deemed competent to administer medication independently. All staff are aware and understand medication policies and procedures.’ Quality Respite Care DS0000073080.V376341.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are protected from harm and abuse and their views are listened too. EVIDENCE: Since the home was registered in November 2008, there have been no safeguarding investigations or complaints. A matter relating to a service user that was referred to Social Services by the home earlier this year was not deemed as safeguarding. Following discussions with the Manager about this matter it was requested that it be retrospectively reported to the Care Quality Commission [CQC] as a significant event under Regulation 37 which the Manager agreed to do. The Manager reported that all staff have received safeguarding training and a copy of the East Sussex Multi Agency Procedures is available in the home. Service users have copy of the complaint procedure in their information folders and the home are planning to provide this information in DVD format. All service users currently self advocate. Information taken from the home’s Annual Quality Assurance Assessment [AQAA] shows that policies and procedures are in place for complaints, safeguarding, whistle-blowing, management of finances, physical intervention and restraint. The AQAA identifies that ‘The staff team have an excellent understanding of the safeguards in place to protect individuals using our service and the correct procedures to follow in the event of an incident occurring.’ Quality Respite Care DS0000073080.V376341.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a comfortable and well presented home with a high standard of décor and furnishings. EVIDENCE: A tour of the premises was undertaken. The home has an entrance area that is currently used as an office/main reception. There is a large open plan lounge/ dining area with a computer for service users to access. There is a separate disabled toilet, wet room and laundry room leading off from this area. There is under floor heating with thermostatic controls in each area of the home. There are eight bedrooms in total; one of these is located on the first floor with a staircase to climb. This room is currently used by staff as their sleepingin room. At ground floor level are seven other bedrooms; all bedrooms have en-suite facilities. The bedrooms on the ground floor have patio doors that open out into the garden; there are no other window openings. The Manager advised this was due to building restrictions when the barn was being Quality Respite Care DS0000073080.V376341.R01.S.doc Version 5.2 Page 19 converted. The patio doors lead out onto a patio/terraced area that is divided by fencing and plants for privacy. In order to facilitate extra ventilation in rooms air conditioning fans are available. Bedrooms seen were well presented. Access to the ground floor bedrooms is via a glass walkway and leading off from this is an area of the home called the ‘bungalow’ where there are a further two bedrooms with a small quiet lounge/dining room area. The home has a range of equipment and adaptations including a new tilt and space shower chair and other shower chairs. They have recently purchased an inflatable bath. There are two hoists, several slings and special profiling beds in service users bedrooms. At the rear of the property are two acres of land currently laid to lawn and communal patio area with tables and chairs. The home has plans to develop this land so that it can be more self sufficient with their own vegetables and to landscape it. They are also considering building a conservatory. The premises were well presented and maintained. The decor was of a high standard and a great deal of thought has gone into the choice and colour of the furnishings and fittings. There were no odours and the standard of cleanliness was good. The doors around the home are wide; however service users would need staff assistance to open them according to their individual mobility needs. The kitchen is modern and well equipped, however small. The home has applied for planning permission to convert an outside barn into a gymnasium, office and an Occupational Therapy specific kitchen. The Annual Quality Assurance Assessment [AQAA] identifies that ‘The building was designed specifically to be accessible to people with mobility problems, there are no thresholds and all the doors are wide enough to allow good clear access for people using mobility aids. The building has been built with extremely high specifications. Service users are encouraged to bring personal items to decorate and furnish their rooms to their taste. The lay out and design of the building ensures that service users maintain maximum privacy and independence.’ Quality Respite Care DS0000073080.V376341.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported by a supervised and effective staff team. EVIDENCE: The Manager advised that the staff team commenced employment during the second week of December in 2008 and during this time they received induction and training until the first service user moved into the home in early February 2009. Care staffing levels were reported as being a minimum of two support workers and the Manager on shift. It was identified that another service user was to be admitted later in the week and care staffing levels would be increased to three. That staffing levels would increase and be drafted in according to the needs of service users. The home use their own team of bank staff who it was reported covered shifts during periods of illness or holiday of the regular staff team. There is one waking and one sleep-in staff member on duty each night. The Manager reported working Monday-Friday between 9am-5pm and being on-call. The rota was viewed; the Manager and designations of staff were not reflected on the rota. The Manager agreed to add this information. Quality Respite Care DS0000073080.V376341.R01.S.doc Version 5.2 Page 21 The home employs an activities co-ordinator three days a week who undertakes two hour activity sessions with service users followed by preparing and cooking the main meal. Two staff recruitment files were examined. There was evidence of documentation and checks that had been undertaken. However, it was raised with the Manager that for a staff member, one reference was obtained sometime after the person had commenced employment and it was not entirely clear or easy to track in determining the date of when this person had started employment. In another staff member’s file; one of the references was undated and the section in the application form under the Rehabilitation of Offenders was left blank. Staff training information is contained with staffs individual files and it was confirmed that all staff had received mandatory training. It was suggested to the Manager to consider for the future developing additional and centralised systems to document and monitor staff training and development to support staff in keeping abreast with future and refresher training. Information taken from the home’s Annual Quality Assurance Assessment [AQAA] identifies that five staff are currently studying National Vocational Qualifications at level 2 or above in care. That staff attend monthly staff meetings and all staff have supervision sessions at least every 6 weeks. The home intends to continually recruit for more staff. Quality Respite Care DS0000073080.V376341.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are living in a home that is developing, evolving and growing. Their health, safety and welfare is promoted. EVIDENCE: The Manager has experience of being a registered Manager in other care settings prior to taking on this post and over ten years experience of working in the care field. The Manager advised that due to ill health the deputy Manager’s position had been replaced by senior carers. Information taken from the home’s Annual Quality Assurance Assessment [AQAA] identifies that the registered Manager has a National Vocational Qualification at level 4, has achieved other relevant qualifications, is current with all mandatory training and undertaken the Leadership and Management award. Quality Respite Care DS0000073080.V376341.R01.S.doc Version 5.2 Page 23 In respect of quality assurance systems in the home. There is a need to further develop this area. Available for examination were two quality assurance questionnaires completed by a service user and a visitor dated 5/3/09. Both ticked excellent to all areas. It was identified with the Manager how more research of quality assurance practices and systems should be pursued including seeking the views of a range of interested parties and following this up by evaluating, recording and actioning feedback received. There is a need to develop and build upon quality assurance systems more extensively in relation to the daily running and overall monitoring of the home. It was evidenced that Regulation 26 visits and reports undertaken by the Responsible Individual took place. However some aspects audited within these reports were brief for example in respect of a care plan a comment was made about a service user ‘benefiting from hydrotherapy’. It was discussed with the Manager to consider exploring ways with the Responsible Individual to develop this is in more depth alongside the home’s quality assurance programme. The Annual Quality Assurance Assessment [AQAA] identifies that health, safety and fire matters receive attention, with checks and maintenance matters in order. Quality Respite Care DS0000073080.V376341.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 3 12 2 13 2 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 X Version 5.2 Page 25 Quality Respite Care DS0000073080.V376341.R01.S.doc N/A Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA6 YA9 Good Practice Recommendations The Registered Person should consider and review whether the care plans and risk assessments devised for service users adequately and sufficiently match assessment information in terms of covering all areas relating to service users daily living requirements. The Registered Person should give consideration to the composition and sequencing of information held within service users records so that it accurately reflects what the home say they do and provides clear evidence. The Registered Person should consider and implement ways to monitor and review staffs future training and development. The Registered Person should expand upon quality assurance practices and monitoring systems as well as obtaining, collating and evaluating feedback received from all interested parties. 2 YA9 YA6 YA35 3 4 YA39 Quality Respite Care DS0000073080.V376341.R01.S.doc Version 5.2 Page 26 Care Quality Commission The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT National Enquiry Line: 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. 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