Inspection on 09/12/09 for Rose Belle

This is the latest available inspection report for this service, carried out on 9th December 2009.

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

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

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Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Rose Belle 37 Cross Road Witham Essex CM8 2NA 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: Ray Finney Date: 0 9 1 2 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 36 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 36 Information about the care home Name of care home: Address: Rose Belle 37 Cross Road Witham Essex CM8 2NA 01376512438 01376501145 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): AGL Care Ltd Name of registered manager (if applicable) Mr Justinath Beekram Ludhor Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 6 0 care home 6 learning disability Additional conditions: The maximum number of service users who may be accommodated is 6 The registered person may provide the following categories 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: Learning Disability - Code LD Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 36 A bit about the care home Rose Belle is in Witham. It is a home for six people with Learning Disabilities. The home has a car that people can use. This means that people who live there can get out and about easily. Everyone has their own bedroom. Care Homes for Adults (18-65 years) Page 5 of 36 There is a Service Users Guide that the home can let you have. It costs about £800 a week to live there, but it depends on what you need. Care Homes for Adults (18-65 years) Page 6 of 36 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 Care Homes for Adults (18-65 years) Page 7 of 36 How we did our inspection: This is what the inspector did when they were at the care home We looked at lots of different evidence for this report. We looked at paperwork like care plans, staff files and menus. The manager sent us information called an Annual Quality Assurance Assessment or AQAA. This told us about how they run the home. We got some surveys from people telling us what they think about Rose Belle. Care Homes for Adults (18-65 years) Page 8 of 36 We visited the home on 9th December 2009. We looked around the home. We talked to people living in the home and staff. We looked to see if people were happy with what goes on in the home. Care Homes for Adults (18-65 years) Page 9 of 36 What the care home does well Listens to people and helps them to do the things they want to do. Looks after people’s health and cares for them well. Helps people keep in touch with their families and friends. Care Homes for Adults (18-65 years) Page 10 of 36 Helps people get out do lots of activities that they enjoy. People have comfortable bedrooms with their own things in them. What has got better from the last inspection Care Homes for Adults (18-65 years) Page 11 of 36 There has been some redecorating. Staff get lots of training. What the care home could do better Care Homes for Adults (18-65 years) Page 12 of 36 Carry on making the paperwork better. Carry on making the decorating better. Get a better cupboard to keep peoples medicine safe. They could do more decorating and make the bathrooms better. Care Homes for Adults (18-65 years) Page 13 of 36 If you want to speak to the inspector please contact Ray Finney CQC Eastern Citygate Gallowgate Newcastle-upon-Tyne NE1 4PA Telephone 030000 61 61 61 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 14 of 36 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 15 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People choosing to live at Rose Belle can be confident they understand what the service provides and that their needs will be met. Evidence: The manager told us in the AQAA, The home has a service users guide that details its aims and objectives and philosophy. Details of the accommodation facilities are given as well as the support to be expected. The guide also includes details of the scale of fees charged and what they cover as well as cost of extras. Since the last inspection the home has gone through the registration process with the Commission to register a change of provider. As part of the registration process they submitted an updated Service User Guide and Statement of Purpose. The information in these documents informs people clearly of the service they can expect from Rose Belle. There are currently no vacancies in the home there is appropriate information about the service and this is available for prospective service users should a vacancy arise. The manager told us in the AQAA, There is a pre-admission assessment of any prospective service user that is carried out by a competent person whilst involving the Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: service user, relatives and friends and independent advocates as appropriate. A care management assessment is normally requested by the home from the referral team. All the people living in Rose Belle have lived there for a number of years. Although there have been no new admissions, there is an assessment process in place. As at the last inspection, individual records contain a comprehensive pre-admission assessment as well as well as a Com 5 assessment carried out by the local authority. The homes pre-admission assessment covers a range of areas including health, personal hygiene, diet, occupation and leisure, skills, money management, general behaviours, likes and dislikes, current identified needs and any other significant points to be noted. A relative who completed a survey told us, Rose Belle does meet the needs of my [relative]. Staff spoken with on the day of the inspection were able to demonstrate a good awareness of peoples assessed needs. Care Homes for Adults (18-65 years) Page 17 of 36 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. People using the service can be confident their individual needs are met as they would wish. Evidence: The manager told us in the AQAA, The home has individualised care plans for all service users which are devised following assessment of individual needs. The care plans provide the carers with guidelines on all aspects of service users personal, social and health care needs, including specialist requirements. A sample of two care plans was examined on the day of the inspection. The care plan starts with What you should know about x and gives details of what the persons preferences are in different areas of assessed needs. These include on getting up, bath time, meal times, likes and dislikes, occupation and night time preferences. There are details in the care plans about what assistance staff have to provide and what the person can do for themselves. The emphasis is on encouraging the person to maintain and develop skills. An example in one of the care plans stated, X is asked to Care Homes for Adults (18-65 years) Page 18 of 36 Evidence: check the bath water temperature after the staff has done so, to ensure that [they are] comfortable to get in. One care plan examined contained information for staff around communicating with the person. There were good details about the persons abilities in communicating through speech and communicating through behaviour and body language. Staff spoken with were able to demonstrate a good awareness of the information in peoples care plans around their needs, abilities, likes and dislikes. Records examined contained evidence of regular review of the care plans. There are also records of yearly review of the persons care by the local authority with input from relatives, key workers and the individual. The manager told us in the AQAA, the home encourages gender identity by facilitating service users to choose their own clothes, hairstyle and make up in a manner that reflects their identity. We noted in the care plans that there was information how to encourage people to make choices, whatever their abilities. One care plan stated, X is assisted to choose [their] clothes every morning and is able to point out what [they] prefer. Throughout the day of the inspection we noted good staff interactions with people living in the home, consulting with them and asking them what they wanted to do. Staff spoken with explained how they encourage people to make choices around food and we observed staff talking to people about the evening meal. The manager told us in the AQAA, The home supports service users to take responsible risks and guidelines are in place for carers to enable service users to do so as part of an independent lifestyle. Risk management strategies are agreed and recorded and actions are taken to cater for identified risks and hazards. Each person has a comprehensive risk assessment that covers a range of areas of identified risk and what actions are to be taken to minimise the risk. Risk assessments for one individual with complex needs covered areas including self harm, specific behaviours, knowledge about personal safety, choking, road safety and travel by car, accessing the kitchen and maintaining dignity. There are also identified risks to others from the persons behaviour. Information in the risk assessments records a good level of detail to ensure staff have clear guidelines of how they need to support the person to reduce the risk. Care Homes for Adults (18-65 years) Page 19 of 36 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. People living in Rose Belle enjoy a lifestyle that meets their wishes and needs. Evidence: As reported at the last inspection, people living in Rose Belle are unable to access paid employment because of their complex needs, but they are encouraged to continue their education and training by attending college courses. The weekly activity planner details the range of educational activities that people take part in. Many people living in the home access the local college or other venues for courses both in the morning and the afternoon on weekdays from Monday to Friday. The current courses that people are attending include Flower Arranging, Our World, Keep Safe, Drama, Sensory Art and Craft, Using Signs and Symbols, Computer Skills and Birds and Animals. On the day of the inspection people came back from their morning activity and talked to staff about what they had done. They had lunch and discussed what they were going to do in the afternoon. It was evident that people choose to be busy and were eager to go to their activities. Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: Staff spoken with said that in the evenings people choose what they want to do at home, including watching television, listening to music or doing puzzles. One person spoken with told us about what they like including programmes about antiques, visiting museums, old cars, food and personal shopping. They told us about visits they had made to places like museums and discussed with staff about other places they would like to go. A member of staff who completed a survey told us, clients love holidays. We observed that staffing levels are good and people are able to have appropriate support on a one-to-one basis to meet their challenging needs. A relative who completed a survey told us, There seems to be a happy, caring atmosphere in the home. Our relative seems happy to stay there. We never have a problem getting [them] to go back after we have taken [them] out. A member of staff who completed a survey told us that what the home does well is give the clients a good choice of activities and another said, the clients attend regular activities. The manager told us in the AQAA, Some service users have recently been contributing whilst the homes weekly shopping list is being planned and they have even written the items that they wish to be included in the home catering shopping. The complex behaviours of people living in the home make it difficult to encourage them to take part in the daily routines of the home or assisting with cooking safely. However, it is evident from our observations and from what people told us that their days are spent doing fulfilling activities that they enjoy. As we reported at the last inspection, people living in Rose Belle are supported to maintain links with family and friends. Staff spoken with told us that they always keep families informed. Records examined contained evidence that families attend reviews of their relatives care. Two relative who completed surveys told us they are always kept up to date with important issues affecting their relative. The manager told us in the AQAA, Service users are involved when planning and reviewing menus and they can express their views over what they want to eat. There is a four weekly rotational menu and staff explained that if people dont want what is planned they are asked what they would like as an alternative. We observed that one Care Homes for Adults (18-65 years) Page 21 of 36 Evidence: person told staff that they did not want bolognaise that evening and wanted chops instead. Staff spoken with knew people well and were very aware of their likes and dislikes around food. There was evidence in the kitchen of a variety of foods including fresh vegetables. Care Homes for Adults (18-65 years) Page 22 of 36 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. People living in Rose Belle are confident they are supported as they would wish with their personal and healthcare needs. Evidence: The manager told us in the AQAA, The home focuses on the service users abilities whilst recognising their disabilities and encourages them to use their self help skills to maintain their dignity and independence. Care plans clearly set out how people like their personal support to be provided, including what they can do for themselves and what staff need to do to help them. It was evident from discussions that staff have a good knowledge and awareness of peoples needs and preferences around personal care. Throughout the day of the inspection, we observed that people are treated with respect and any personal care needs are dealt with privately and discretely in a manner that maintains their dignity. A relative who completed a survey told us, They support and care for my [relative] very well. The manager told us in the AQAA, The home provides support for service users physical and emotional needs. They are supported to access NHS health care facilities and their Care Homes for Adults (18-65 years) Page 23 of 36 Evidence: health is monitored and potential complications are dealt with by referral to appropriate professionals like GP, Psychiatrist, District Nurse, Community Nurse, Chiropodist or Podiatrist, Optician and Dentist. Through discussions staff were able to demonstrate that peoples health care needs are well met. Records examined confirmed evidence of input from a range of health care professionals, including Consultant Psychiatrist, Doctor and Optician. Consultations with health care professionals are documented in individual care records. Care plans contain charts for recording health related issues including weight charts and body maps for a person who self harms. The manager told us in the AQAA, The home assists service users to administer their medications according to the homes policy. Medications are kept locked and all medicine administrations are as advised by Doctors and signed for by the person in charge. We examined processes around medication and the shift leader was able to demonstrate a very good awareness of peoples prescribed medication. Overall recording was appropriate and there were no missing signatures on Medicine Administration Record (MAR) sheets. However, the MAR sheets did not record the full details of the prescribers instructions as written on the medication label. The recording process could be improved if the format of the MAR sheets had more space to include this information. There were separate sheets to record medicines delivered and what stock remained so there was an audit trail of what was used and what was stored in the cupboard. Storage of medication is a wooden cupboard with a padlock. The medication cupboard is quite small for the amount of medication in use in the home and there is insufficient space to store oral medications separately from topical preparations such as ointments and creams. Although this is a solid cupboard it is not appropriate for the storage of controlled drugs. There were no controlled drugs in use at the time of the inspection, however appropriate storage facilities must be available should someone be prescribed medication that requires this level of secure storage. Records examined contained protocols for the use of medication prescribed on an as required basis (usually referred to as PRN medication). One of the protocols examined related to PRN medication prescribed for anxiety and behaviours that may be challenging. The protocol gave clear details of all the behaviours staff should look out for to indicate that the person’s anxiety levels were rising, although it did not specify at what point the person would need the PRN medication. However, staff spoken with were able to demonstrate a good knowledge of how to use other tactics to try to diffuse the situation before administering medication. The protocols would benefit from being updated to reflect the good practices that are being used and to ensure that all staff are aware at what point the person needs to have the medication. Care Homes for Adults (18-65 years) Page 24 of 36 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. People using the service are confident that any concerns they may have are listened to and acted upon. Evidence: The manager told us in the AQAA, The home has a complaint procedure that details the process and time scales to deal with complaints and The home manager is aware of his responsibilities regarding complaints make by service users, relatives, staff and others and ensures that records are kept of the investigations and actions taken. The home continues to have an appropriate process in place for dealing with concerns and complaints. As at the last inspection, there have been no complaints made to us at the Commission or recorded by the service. Through discussions the manager and staff were able to demonstrate that they deal with minor concerns as and when they arise. This is particularly important as the people living in the home can become distressed if they have concerns and this in turn can affect their behaviour. We observed staff listening to people and dealing with things they brought up. Three relatives who completed surveys told us that they know how to make a complaint if they need to and the service has always responded appropriately if they have raised any concerns. The manager told us in the AQAA, Service users care plans and risk assessments Care Homes for Adults (18-65 years) Page 25 of 36 Evidence: provide guidelines to ensure service users safety and wellbeing. The home deals with any allegation or suspicion according to its policy on protection of vulnerable individual. Staff are offered training on the protection of vulnerable adults and abuse in the care home. The home ensures that the service users physical, financial, psychological and emotional needs are not neglected by deliberate intent and negligence. Since the last inspection there have been no issues raised relating to safeguarding. As reported then, there is a robust recruitment process in place that includes carrying out relevant checks as to the applicant’s suitability to work with vulnerable people. Staff spoken with were able to demonstrate an awareness of their responsibilities for keeping people safe and recognise what constitutes abuse or poor practice. Care Homes for Adults (18-65 years) Page 26 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can enjoy living in an environment that suits their lifestyle. Evidence: The manager told us in the AQAA, The home is well maintained and most areas have been re-decorated, bathrooms re-tiled, new flooring in bathroom and 3 bedrooms and all communal areas flooring are professionally cleaned twice a year. On the day of the inspection we carried out a tour of the premises that included all of the communal areas and some peoples bedrooms. There is a large lounge area with ample comfortable seating. Some of the furnishings are covered with throws to make them more homely, but we noted a few armchairs where the fabric on the arms had become quite grubby, which gave the room a somewhat jaded appearance. Some of the people living in Rose Belle have behaviours that can be challenging and this makes it difficult and unsafe to have items such as ornaments or flower vases. However, there were large, modern pictures on the walls in the lounge, which helped give the room a pleasant appearance. Individual bedrooms varied in the level of personal possessions, but again this related to some individuals behaviours. Each room was different and overall reflected the tastes or personality of the individual. Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: Overall the home was clean and there were no unpleasant odours. Rose Belle is a very busy home and staff support people very well, but as they do not employ a cleaner, care staff take on these responsibilities as part of their role. Some areas such as carpets on the stairs would benefit from deep cleaning. Similarly the main bathroom would benefit from deep cleaning around the toilet and de-scaling around the bath taps, as these areas can pose a cross infection risk. We also noted that some areas of maintenance needed to be addressed including a broken toilet seat, a crack in the basin and broken bath plug. Staff spoken with explained that the maintenance person had been off for some time. The manager told us that the maintenance person from their other home would be coming to assess what needed to be done and address some maintenance issues. The manager told us in the AQAA, There are measures in place to control spread of infection in accordance with legislation. Staff have had updated training on Infection Control recently. We observed that liquid soap and paper towels were available in toilets, bathrooms and kitchen and staff followed good practices around hand washing. Care Homes for Adults (18-65 years) Page 28 of 36 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. People living in the home can be confident they are cared for by a competent staff team who can meet their needs and keep them safe. Evidence: The manager told us in the AQAA, The home has a training and development plan that starts from induction period onwards. As reported at the last inspection, the home has a robust process in place for recruiting staff. Personnel files are well organised and had a checklist on the front. Personnel records contained all the documentation required by regulation including two written references and proofs of identity. The service continues to provide new staff with a structured induction process. Because of the complex needs and behaviours of people living in the home, new staff work alongside established members of the team to familiarise themselves with peoples individual needs. A recently recruited member of staff spoken with was able to demonstrate a good knowledge of peoples care plans, needs, likes and dislikes. Staff have received a range of training relating to their role. This includes Effective Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: Communication, Role of the Worker, Basic Food Hygiene, Managing Challenging Behaviour, Adult Protection, Infection Control, Health and Safety, Manual Handling, Fire Drills and Evacuation and Safe Administration of Medicines. The manager explained that all staff have received training around the Mental Capacity Act. The manager also discussed the homes membership of a training consortium of local homes that will help smaller homes to arrange staff training more effectively. Staff spoken with on the day of the inspection were knowledgeable about their role and demonstrated an awareness of their responsibilities. Members of staff who completed surveys made positive comments about the training they receive. One person told us that what the home does well is offers support to new staff and staff who are training for qualifications. Another person said, relevant training is offered. Care Homes for Adults (18-65 years) Page 30 of 36 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 appropriately managed in the best interests of people living there. Evidence: The manager told us in the AQAA, The Home Manager is a qualified nurse in Learning Disability (RNLD) and competent to run the home and meet its aims and objectives. He ensures that the home complies with the Care Standards Act and Regulations. As at the last inspection, the manager has the appropriate qualifications, knowledge and skills to run the service. We further noted that information provided about the service in the homes Annual Quality Assurance Assessment (AQAA) was accurate and supported by the evidence we examined at the inspection. Some of the information provided in the AQAA, however, was somewhat general and did not truly reflect some of the good practices we observed. The information in the document could be improved if it contained practical information about what happens on a day to day basis, which would give a picture of what it is like to live in the home. Care Homes for Adults (18-65 years) Page 31 of 36 Evidence: The manager told us in the AQAA, We hold regular house meetings when staff as well as service users are encouraged to join in and voice out their views and concerns. Service users meetings also take place to enable service users and their key workers to discuss individual choices, interests and suggestions of changes in view to improve the service. The manager further told us, The home has an annual Quality Assurance and Quality Monitoring through the process of providing forms to service users, relatives, friends, staff and other professionals involved with the service the home provides. A Quality Assurance Report is compiled from the information gathered from the surveys. As previously reported the home has a system for monitoring the quality of the service they provide, which includes collecting information from surveys. The manager also explained that they have regular meetings with service users to discuss any issues they may have and to seek their opinions about the service. It is evident that the home continues to listen to people using the service and takes their opinions and wishes into account. The home continues to ensure that checks relating to Health and Safety are carried out. Information provided in the AQAA dataset confirms that the home has had maintenance checks carried out in the past year on the homes electrical installations, Portable Appliance Testing (PAT), fire alarm, fire equipment and emergency lighting, gas appliance and the heating system. Care Homes for Adults (18-65 years) Page 32 of 36 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 33 of 36 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 20 13 31/01/2010 Medicines must be stored securely at all times and in line with legal requirements and they must be stored under suitable environmental conditions. This will ensure medicines are not accessible to unauthorised people and also ensure the quality of medicines in use. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 24 Taking the behaviours of people living in the home into account, consideration should be given as to how to ensure the environment remains homely. Consideration should be given as to how to improve the homes programme of maintenance so that areas were there is damage to the fixtures and fittings are addressed Page 34 of 36 2 30 Care Homes for Adults (18-65 years) 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 so that good infection control is maintained and people living in the home benefit from a well maintained environment. Particular attention should be given to the upstairs bathroom. Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 36 of 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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