Inspection on 04/12/09 for Ryde Cottage

This is the latest available inspection report for this service, carried out on 4th December 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.

Other inspections for this house

Ryde Cottage 05/01/06

Ryde Cottage 13/12/05

Ryde Cottage 04/08/05

Ryde Cottage 10/01/05

Ryde Cottage 29/09/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Ryde Cottage Binstead Road Ryde Isle Of Wight PO33 3NF     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: Nick Morrison     Date: 0 4 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 28 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 28 Information about the care home Name of care home: Address: Ryde Cottage Binstead Road Ryde Isle Of Wight PO33 3NF 01983614892 01983564008 daverobinson@rydehouse.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr John Raymond Clewley,Mrs Miranda Cruz Clewley Name of registered manager (if applicable) Mrs Joanna Lisa Smith Type of registration: Number of places registered: care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 7 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD Date of last inspection Brief description of the care home Ryde Cottage is a residential home providing care and accommodation for up to seven younger adults with learning disabilities. It is managed by Joanna Smith on behalf of the proprietors Mr and Mrs Clewley. The home is approached via an extended private drive off the main Binstead to Ryde road, which provides easy access to Ryde and bus routes to other parts of the Island. The house is located within the extensive private grounds of Ryde House with access to a private beach. Accommodation within the Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 7 1 2 1 2 2 0 0 8 Brief description of the care home cottage is arranged on two floors providing seven single bedrooms and a range of communal facilities and bathrooms. There is a patio area at the rear with seating available for use by the residents. The home does not have a lift. Care Homes for Adults (18-65 years) Page 5 of 28 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 report represents a review of all the evidence and information gathered about the service since the previous inspection. This included a site visit that occurred on 4 December 2009 between 14:15 and 18:45. During this time we toured the premises, looked at the files of three service users, met with five service users and had detailed discussions with three of them. We also observed the support they were receiving. We met with the Manager and Deputy Manager and spoke with one other member of staff and observed interaction between staff and service users. All records and relevant documentation referred to in the report was seen on the day of the inspection visit. We also referred to services own self-assessment of the home. We had sent out written surveys to staff, service users and other professionals but received no replies. Care Homes for Adults (18-65 years) Page 6 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 28 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 8 of 28 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. Service users benefit from having their needs and aspirations assessed prior to moving into the home. Evidence: The home requires a full assessment for each person before they move into the home. Assessments are carried out by the Manager jointly with the service making the referral and involve relevant professionals, the service user and their family. Assessments include the identification of any religious or cultural needs the service user may have. Records showed that all assessments were in place prior to the person moving in and that service users and their families had been involved in the assessment process. There is a clear transition period in the home where potential new residents have the opportunity to join in with meals and other activities on a gradual basis before deciding to move in. Other people already living in the home also have the opportunity to express their views about the potential new resident before a decision is made. Care Homes for Adults (18-65 years) Page 9 of 28 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. Service users benefit from having clear care plans and risk assessments in place and from being supported to make their own decisions. Evidence: We looked at the files of three people who live in the home. They all contained up-todate care plans that had been reviewed on a regular basis. Plans were person centered and staff had received training in working with person centered planning. The plans were comprehensive and covered a full range of need areas such as personal care, education/occupation, household skills, social networking and relationships, emotional health, social/leisure/community living, financial and health needs. In each section there were different prompts, against which were recorded the present situation, the aim, the action plan and who was responsible for addressing each part of the plan. Along with this were records of who wrote the care plan, when it was last reviewed and when it is next due to be reviewed. Each plan is reviewed monthly by the service user and their keyworker. These reviews are recorded and, since the previous inspection, now benefit from having pictures contained in them to make them Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: more accessible to service users. Each section of the plan is reviewed and recorded against. There were also prompts on the form for recording the views of relatives and of professionals as well as the views of the service user. The reviews also contained a section for plans for the coming month. From reading the reviews it was clear to see how service users had identified plans for themselves for the coming month and, from reading the subsequent review, how these plans had been actioned and what the outcomes were. As well as care plans, the files contained good background information on each person including a pen picture, religion, professional contacts, date of last medication review, dietary needs and dislikes and preferred form of address There was information on how the person spent their days and also a timetable of the activities they participated in at the day service in a pictorial format. A key section of the care plan was the persons plans for the future. This contained information on who was important in the persons life, what problems they had at present, what things they wanted to do in their life and what helps them feel good about themselves. This, along with the monthly care plan reviews, demonstrated how the service encouraged service users to be aspirational and how they supported people to achieve the things that were important to them. Throughout the inspection we were able to observe people living in the home being able to make decisions for themselves including what and how much to have to eat, how they were going to spend their time between coming home from the day service and having their meal and whether or not to go out to the pub in the evening. Staff induction training emphasised the importance of enabling people living in the home to make decisions for themselves. In discussion with staff it was clear that they understood this and understood how each person communicated decisions. For example, they were clear for one person that if they decided not to put their shoes on in the morning they were deciding not to go to the day service on that day. There was provision for people to stay at home if they chose not to go to the day service. Service users care plans also contained information how they made and expressed decisions about what they wanted and did not want to do. Service users were also supported to be involved in wider decision making about the home through individual meetings and group meetings. They chose where they wanted to go on holiday, made decisions about the menus and were involved in decisions about staff recruitment. Where potential risks to individuals had been identified there were risk assessments in place. These were comprehensive and detailed the name, date, identified hazard, who might be harmed and how, how the risk is controlled at present, what further action needs to be taken, by whom, by when, a numerical indication of the severity of the risk, who completed the risk assessment, the review frequency needed and the date of the last review. Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: All the risk assessment we saw had been reviewed at the necessary intervals. The risk assessments were aimed at promoting independence and supporting service users with their aspirations. Staff signed each risk assessment to say they had read and understood it. In addition to these, each person had a personal emergency evacuation plan in place detailing the support they would need in the event of having to evacuate the building. There were also individual procedures in place for each person in the event that they might go missing. These included a photograph and a description of the person. Care Homes for Adults (18-65 years) Page 12 of 28 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. Service users benefit from having their rights respected and from balanced and nutritious meals. They also benefit from having the opportunity to engage in a wide range of activities both inside and outside of the home. Evidence: The service is focused on personal development for people who live in the home. This is demonstrated through the setting of goals with service users and the identification of their aspirations and how this is followed through with action that is then reviewed with them. It is further demonstrated by the way that each person living in the home has a day with their keyworker each week on a one-to-one basis. This time is used to work on personal goals and activities that are important to the person. A service user spoken with on the day of the inspection explained what they had been doing on that day with their keyworker and was clearly pleased with what they had done in that time. Care plans contain recording of activities and progress and the service is able to Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: demonstrate ongoing development for each person. Although some activities provided by the home were group activities there was also evidence in care plans that activities are often planned on an individual basis and reflect individual interests and aspirations. The homes Annual Quality Assurance Assessment (AQAA) told us they were in the process of exploring options for people other than attending the day services. These included college and employment options. People living in the home have access to a wide range of individual and group activities in the community including eating out, shopping, using the local pub, hiking, art, games and bowling. People living in the home also told us they get invited to a lot of parties and that staff in the home support them to go to them. Peoples care plans contained information on their professional and social networks and also birthdays and addresses of people who were important to them so that staff could support them to send cards as appropriate. The homes AQAA told us that over the past year they have been concentrating on family involvement and have arranged social events in the home and encouraged families to attend. They also provide support for people to go and visit their relatives. People living in the home are supported to have visitors and this is arranged through discussion with their keyworker in order to ensure it will be convenient to other people living in the home. The home also supports people to stay in touch with their friends and relatives by telephone. People living in the home told us they enjoyed the food and thought they had sufficient to eat. The home has introduced a nutritional screening tool to identify specific, individual nutritional needs and is also working with service users towards healthier lifestyles, including healthier food choices. The Manager has plans to begin courses in the New Year about healthy eating and also doing individual work with people on their specific needs. They intend to support people living in the home to make the link between healthy living and healthy eating. Some of this work had already begun and two service users we spoke with demonstrating some understanding of the need to eat healthily. There is fresh fruit available throughout the day for people living in the home, which they are able to help themselves to. The home has a four week menu in place, which demonstrates a variety of nutritious meals. Staff told us they usually stick to the menu except when particular people do not want what is on the menu or when people have decided to have a meal while they are out. People living in the home are able to contribute ideas to the menu through individual meetings with keyworkers and through group meetings. Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: Records are kept in the daily diary of what each person has eaten on each day. Care Homes for Adults (18-65 years) Page 15 of 28 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. Service users benefit from having their healthcare needs met and are protected by the homes medication policies and practices. Evidence: The person centered care plans gave clear instructions of the personal support each person required and the way they preferred to receive their support. There were also clear records of the support given. There was a clear process in place from assessment, planning, delivery of care, recording and review of care given which resulted in people receiving the kind of support they needed in the way they wanted it. Records on peoples files showed that their healthcare needs were monitored regularly and that staff in the home maintained good links with GPs, opticians, dentists, chiropodists, Community Learning Disability Nurses, Community Psychiatric Nurses and psychologists in order to meet the health needs of people living in the home. The Annual Quality Assurance Assessment told us that everyone living in the home had received a thorough health review with their own GP in the last year. Medication reviews are also completed regularly according to the needs of each person. Clear Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: records were kept of all healthcare appointments and included any necessary follow up action The home has medication policies and procedures in place. All policies and procedures in the home had been reviewed in September 2009 and staff signed to say they had read and understood them. Copy of policies and procedures were kept in the medication records folder so that they are always available to staff when they need them. The medication records also contained photographs of service users and list of allergies for each person. Each person had a sheet in the medication file titled my medication. This gave details of each item of medication, the start date, the end date, doses and times to be administered, the reason for it being prescribed (which was specific to each person rather than just a description of the conditions the medication is generally prescribed for) and potential side effects. The home had devised these forms in consultation with the pharmacist. The records were also colour coded to match the colours used in the monitored dosage system used by the home. Medication was stored in a locked cupboard in the kitchen and was kept ordered and tidy. Each persons medication was clearly labelled and readily accessible. The medication in the home was checked twice each day in order to pick up any potential errors on the same day they were made. There were no records of any errors. All staff in the home received training in medication before they were able to administer medication to people living in the home. Records of training were seen on staff files. The home had previously used as required medication for calming people down during and after incidents of challenging behaviour in the home. Since the appointment of the Manager last year, and the introduction of good behavioural support plans, the home had stopped using the medication. It had recently been reviewed with service users GPs and decided there was no longer any need for this medication and it has all been sent back to the pharmacy. Care Homes for Adults (18-65 years) Page 17 of 28 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 living in the home are protected by safeguarding policies and practices and are able to complain if necessary. Evidence: The home has a complaints policy in place which had been reviewed in September 2009 and which all staff had signed to say they had read and understood. The policy was also available to all service users and was also produced in a Makaton format to make it more accessible to a wider range of people. One person we spoke with was aware of the policy and said they knew how to make a complaint if they wanted to. There had only been one recorded complaint in the past year. The Manager informed us this had not been raised as a formal complaint, but that she had recorded it as such to ensure that it was followed up and responded to appropriately. In discussion the Manager and staff also demonstrated an understanding and awareness of how people living in the home may not use the complaints procedure but may express dissatisfaction with the service through their behaviour. This was also acknowledged in the homes guidelines for responding to challenging behaviour. There had been a requirement at the previous inspection regarding the need to ensure the money the home looks after for service users is properly accounted for and that good records are kept. This was due to the fact that records did not match the amount of money people had and records were unclear due to scribbling out to the extent it was not possible to work out where mistakes had been made. Since then the Manager Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: had introduced different procedures for the handling of service users money and access to the money was restricted to senior staff in the home. Records were much clearer and easier to follow and when we looked at the amount of money each person had it matched with the amount they should have had according to the records. The records were checked twice a week by the Manager or the Deputy Manager and also audited on a six monthly basis by someone else outside of the home. This requirement has been met. The Manager of the home works closely with the Isle of Wight adult protection team and also provides some training for them. She demonstrated a good understanding of protection issues and local reporting procedures. Training records showed that staff in the home receive regular training in adult protection. Incident and accident records were in place for any incidents that put people at risk, including incidents of challenging behaviour. These were also reported to the Care Quality Commission appropriately. There had been a significant decrease in the amount of challenging behaviour incidents over the last year. The Manager told us the reason for this was the implementation of good behavioural support plans along with staff training. The behavioural support plans we saw were clear and comprehensive. Staff are encouraged to respond to behaviour by assessing the situation and deciding whether the behaviour is a result of pain, being upset by someone or something in the immediate environment and asking questions in a gentle way to find out causes. After this, there were coping strategies and distraction techniques to implement depending on the person and the behaviour. Different behaviours were listed along with potential triggers and the kind of support the person might need in that situation. These support plans were individualised and the intervention depended entirely on the person and the situation. The effectiveness of theses plans and the approach of staff to supporting people is demonstrated by the dramatic decrease of incidents in the home, making it a safer and more enjoyable experience for the people who live there. Staff approach and direction from the manager in dealing with everyday occurrences in the home have also contributed to some incidents not even happening in the first place. This happens through staff understanding peoples communication and respecting their decision making, for example understanding the person expressing a choice not to go to day services by not putting their shoes on. Care Homes for Adults (18-65 years) Page 19 of 28 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. Service users benefit from living in a clean, comfortable and safe environment. Evidence: At the previous inspection we had made a requirement regarding the fact that unguarded radiators and pipework may present a risk to people living in the home. By the time of this inspection the radiators had been covered with guards and pipework had been lagged so that no risk remained. This requirement is met. The service provides a comfortable and homely atmosphere. Service users spoken with said they liked the building and had no complaints about it. The communal areas of the home consist of a main lounge with access to a dining area, which in turn has a hatchway to the kitchen. There is also a second lounge which serves as a quieter room. Individual rooms are individually decorated and furnished according to the taste of the person living there and each room has a lock for privacy. The doorways to communal areas have been painted red to enable people with poor eyesight to be able to make their way through safely. The home benefits from regular maintenance and health and safety audits of the building are carried out by the Manager and Deputy Manager twice a year. Procedures are in place to prevent the spread of infection and they were reviewed in September 2009. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: The home has introduced a new cleaning rota with a daily list of cleaning tasks. Specific staff are assigned to these specific tasks each day and the completion of tasks to the required standard is monitored by the Manager and Deputy Manager. There is liquid soap and paper towels in place throughout the building to help prevent the spread of infection and the laundry area was clean and tidy. Care Homes for Adults (18-65 years) Page 21 of 28 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. Service users benefit from being supported by adequate numbers of well trained staff and are protected by the homes recruitment policies and practices. Evidence: The home has a Manager, a Deputy Manager, two senior staff and three other staff. In addition there are two staff who have bank contracts. This is to ensure some consistency of care when the permanent staff are absent. The Deputy Manager post is a new post since the previous inspection. There is a rota in place in the home which matched with the staffing available on the day of the inspection visit. The rota showed that there were two care staff on duty throughout the day, in addition to the Manager and the Deputy. At night there was one member of staff sleeping in. In addition there was also provision in the rota for people living in the home to have one to one support at arranged times during the week. This was time they could spend with their keyworker doing things that were important to them. The home has a low turnover of staff, which benefits people living in the home by providing consistency of care from familiar people. The staff we observed on the day of the inspection visit interacted very positively with people living in the home and were skilled in communicating with them. It was clear from our observation that staff communicated with and supported people in accordance with Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: the guidance set out in care plans. Service users were obviously comfortable with the staff supporting them and happy to voice opinions or to ask staff to do things for them. We looked at the recruitment records of three staff working in the home, including the most recently appointed person. These records showed that staff recruitment followed the homes policies and procedures and that all necessary pre-employment checks were undertaken before people could begin work in the home. People living in the home were also involved in the recruitment process and had the opportunity to meet each applicant and give the Manager their thoughts prior to decisions being made. All staff working in the home have a National Vocational Qualification (NVQ) at level two as a minimum and other staff have, or are working towards and NVQ at level three. Staff files showed the training that each person had undertaken and each member of staff had their own training matrix listing the training they had received and when updates were due. At the time of the inspection there were no outstanding training needs. Induction training for new staff covered all areas they needed to know about when beginning their job. Training for staff in the home includes health and safety, moving and positioning, food safety, safeguarding, infection control, fire, training in supporting people with challenging behaviour, medication, effective communication and peg feeding. As well as the individual training matrices there was a training plan in place for the organisation and a person responsible for arranging the delivery of training to all staff. All staff working in the home had regular support and supervision sessions with the Manager or the Deputy Manager. The records on each persons file showed that these sessions concentrated on the needs of people living in the home as well as the developmental needs of the member of staff. The records also showed that issues highlighted in these sessions were followed up with action where necessary and reviewed at the next session. Care Homes for Adults (18-65 years) Page 23 of 28 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. Service users benefit from living in a well managed home that is safe and responsive to their needs. Evidence: The Manager of the home is registered and has demonstrated that she has the skills, knowledge, qualifications and experience to manage the service. She is also a qualified moving and handling instructor, qualified to deliver Health and Safety training, Safeguarding Vulnerable Adults training and Infection control training. She is an NVQ Assessor and a PROACT-SCIPr-UK(R) instructor (this is training aimed at supporting people whose behaviour can cause problems for themselves and others). The quality assurance system in the home is based on seeking the views of people who live there and ensuring that these are responded to in the process of developing the service. As well as people living in the home, views are sought from relatives, staff and other professionals. The responses are analysed and actions formulated in respect of each of them. The responses are collated very well and a report is produced in both narrative and graphic formats. This report tells those involved what people said about Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: the service and what the service is going to do about any issues that need addressing. The following years report also contains feedback on how the service managed with the action plan from the previous year. Letters are sent out to everyone who had been involved in the process thanking them for their input. An example of how the quality assurance process works was that last year people living in the home did not appear to be clear about the home complaints procedure. In response to this staff introduced the procedure at a residents meeting and explained it in a variety of formats by relating it to example situations. The development of the service is also influenced by the individual care plans and needs of people living in the home and by feedback received from service user meetings and staff meetings. The effectiveness of service user meetings is demonstrated by the changes made as a result of issues raised within them. For example, this year it was proposed by people living in the home that they would go somewhere different for their holidays and this was acted upon. General workplace risk assessments were in place covering the environment and activities taking place within the home. The home uses an external health and safety consultant to formulate these and the Manager has input to ensure they are relevant to the issues in the home. The consultant also provides advice to the home on health and safety matters. The assessment records showed that they were up-to-date and kept under regular review. Other records demonstrated that equipment in the home was regularly serviced Each person living I the home has a personal emergency evacuation plan in place detailing what support they may need in the event of the home needing to be evacuated. Along with these was a photograph of the assembly point. There was also an individual procedure in place for each person in the event that they should go missing. These included a description and a photograph of the person. The home has recently purchased night time alarms for specific people so that, in the event of them falling in the night, they are able to press a personal button which attracts the attention of the member of staff sleeping in. The Manager is planning to improve the management of health and safety in the home by providing learning sessions for people living in the home covering areas such as health and safety, first aid, food safety and healthy living. No health and safety concerns highlighted during the inspection. Care Homes for Adults (18-65 years) Page 25 of 28 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 26 of 28 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 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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