Inspection on 25/06/09 for Ten Acre Respite

This is the latest available inspection report for this service, carried out on 25th June 2009.

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

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

Other inspections for this house

Ten Acre Respite 26/01/06

Ten Acre Respite 15/09/05

Ten Acre Respite 01/12/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Snydale Care Home

Whitwood Hall

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

Key inspection report Care homes for adults (18-65 years) Name: Address: Ten Acre Respite 89 Ten Acre Road Kimberworth Park Rotherham S61 3RW     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Shelagh Murphy     Date: 2 5 0 6 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 30 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 30 Information about the care home Name of care home: Address: Ten Acre Respite 89 Ten Acre Road Kimberworth Park Rotherham S61 3RW 01709375355 01709740525 528Manager@voyagecare.com www.milburycare.com Milbury Care Services Ltd care home 4 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: Date of last inspection Brief description of the care home Ten Acre Respite is a care home providing a respite care service for up to four adults with learning and physical disabilities and nursing needs. Service users who access the service have multiple complex needs. Ten Acre Respite is owned by Milbury Care Services. The home is located in the Kimberworth area of Rotherham, close to public transport and local shops. Ten Acre Respite is a modern single storey building with spacious accommodation. All bedrooms are single with en-suite lavatories. There is level access to the garden areas outside and the home has a small car park. The Statement of Purpose, Service User Guide and latest CQC inspection report were all displayed in the entrance. Referral to this service is via Rotherham Primary Care Trust who block book the beds for nursing care therefore no fees are involved. The registered manager supplied this information during the site visit. Care Homes for Adults (18-65 years) Page 4 of 30 4 4 Over 65 0 0 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is three star. This means that people who use the service experience excellent quality outcomes. Shelagh Murphy carried out this unannounced visit to the service over one day and the total time spent on site was 6 hours. In the report we make reference to, us and we. When we do this we are referring to the inspector and the Care Quality Commission. We used a variety of information as well as our findings from the visit to assess the quality of service offered to people who live at this home. Prior to our site visit the Annual Quality Assurance Assessment or AQAA report was sent to us. This report detailed what the home was doing well, what had improved Care Homes for Adults (18-65 years) Page 5 of 30 since the last inspection and any plans for improving the service in the next twelve months. Some information from the AQAA is included in the main body of the report. Some time was spent with the people who use the service. It was difficult to conduct conventional interviews with some people, due to their learning difficulties. However, we observed two people who had communication difficulties, to gauge how staff at the home supported them. It gave us some insight into how staff interacted with people, how people are supported by the staff and also an indication of peoples well being. We spoke to three people who live at the home. Three staff attended interviews with us, two relatives were sent surveys to us on behalf of their relatives to give us their views of the service. We also recieved surveys from two health professionals. Comments and feedback from these stakeholders have been included in this report. On the day of the site visit opportunity was taken to make a partial tour of the premises, inspect a sample of care records, check records relating to the running of the home and check the homes policies and procedures. The inspector checked all key standards and the standards relating to the requirements outstanding from the homes last key inspection. The progress made has been reported on under the relevant standard in this report. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The scale of charges are £1600 per week or £228.57 per night. The inspector wishes to thank the people staying at the home, staff, managers and relatives for their time and co-operation throughout the inspection process. Care Homes for Adults (18-65 years) Page 6 of 30 What the care home does well: This service has demonstrated that it has consistently complied with our regulations and takes steps to continue to develop and improve the services for people. They offer people excellent support and care services. People who use the service have their needs assessed by both care managers and staff at the home, to try to ensure that the staff can meet their needs before they are admitted to the service. The staff told us they encouraged people to make as many decisions about their lifestyles as possible, from what they chose to eat and drink, to what activities they wished to do, to what clothing they wished to wear and to how they chose to spend their money. During our visit we observed staff practices to be empowering, friendly and informal and that people were encouraged to make choices. This was really positive as it protects peoples rights and encourages independence. Relatives told us that staff were really good at, Giving her attention and allowing her relaxation when she needs it. Overall, we found that people had opportunities to take appropriate risks associated with leading everyday lifestyles. People who use the service were supported to maintain and develop relationships. The service organises a coffee morning for relatives and people every other month and find that this has been welcomed by relatives and has been important in ensuring better communication between families and the service. The staff confirmed that people are always offered a choice of meals and drinks to meet their needs. Staff told us people can choose from a pictorial menu to identify which is their choice. The health care professionals we surveyed told us, Communication between professionals is of a high standard, The service attempts to meet individual clients needs. Another health professional told us, Staff liaise really well with other services and this ensures continuity of care for clients. We asked staff whether people knew how to make a complaint. They told us some of our guests do. Other people would need support from their carers or us to advocate on their behalf. People are protected by the safeguarding policies and procedures as the staff know how to respond to allegations of abuse. Care Homes for Adults (18-65 years) Page 7 of 30 The home was really very clean and tidy, homely and safe. The environment is decorated and furnished to a high standard and it is clear the environment was really well maintained and cared for. The rooms are spacious, with adequate dining and lounge areas. The kitchen was also clean and tidy. We asked staff about what they thought the service did well and all of the staff agreed their biggest success was the fact that all staff worked well together as a team to ensure peoples needs are met. Their comments included, We have a fantastic manager who puts systems and standards in place and we know we must meet them. And, They, the managers, lead by example. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have their needs assessed by both care managers and staff at the home, to try to ensure that the staff can meet their needs before they are admitted to the service. Evidence: We checked two peoples needs assessments. These has been completed by local authority case managers. The needs assessments were all appropriately detailed to ensure the service could assess whether peoples needs could be met at the home. The staff at the home also went out to assess people who had been referred to the service. The staff told us that usually a nurse and a support worker would visit the person in their own homes to carry out the assessment to, introduce themselves, and to agree a plan of how to introduce the person in to the service to meet their individual needs. Such introductions would be done at the pace and style requested by the person or their carers. This was excellent as both assessments were detailed and ensured that peoples needs Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: were assessed to ensure the staff cold meet peoples needs and introduce people in to the service in a way which met their individual needs. Care Homes for Adults (18-65 years) Page 11 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to be involved in making decisions about their lives, and can play a part in planning the care and support they need and want and the risks associated with the support plans. Evidence: We checked two peoples care plan files and found that overall they contained very comprehensive information for staff to support people appropriately and safely. Two peoples files showed the support and care staff were offering to people. This was in line with what staff told us about how they supported people. From our observations staff were following the guidelines and putting in to practice the care plans appropriately. For example risk assessments and information on daily activities etc. Staff told us and we saw evidence that peoples plans were regularly reviewed and that people and their relatives were invited to attend review meetings as appropriate to their needs. Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: Staff told us that currently new care plan formats were being introduced in to the service for all of the people who use the respite service. They said the plans were designed to be very detailed and designed to be person centred in their approach. From our observations these plans were very good in covering all of the areas of a persons lifestyle, their wants, needs and aspirations. However, the staff found the system cumbersome and the amount of information overwhelming. We would recommend that the system be reviewed and or staff receive further training on how to use the new system as the care plan system needs to be accessible to people and to aid staff in supporting people. We asked how people are supported to make decisions about their lifestyles. The staff told us they encouraged people to make as many day to day decisions about their lifestyles as possible, from what they chose to eat and drink, to what activities they wished to do, to what clothing they wished to wear and to how they chose to spend their money. During our visit we observed staff practices to be empowering, friendly and informal and that people were encouraged to make choices. This was really positive as it protects peoples rights and encourages independence. Relatives told us that staff were really good at, Giving her attention and allowing her relaxation when she needs it. Another parent said their relative, Does not seem at all distressed by going to the staff. They are really happy to come here and this is such a relief to us as parents. It was also clear that the staff knew people very well and were able to communicate with people who had communication needs and to interpret their needs and wants appropriately. This was excellent as the staff had the experience and ability to understand peoples needs who had very complex needs including communication needs. Overall, people had comprehensive risk assessments, which covered issues such as risks associated with people being moved in hoists, managing behaviour, which may challenge and outings from the home for people who are wheelchair users. Two peoples risk assessments we sampled and we found these had been completed by registered nurses and had been reviewed and updated on a monthly basis. From discussions with the staff team, we found staff had a good level of understanding about the use of risk assessments to keep people safe, whilst being aware of not Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: unnecessarily imposing on peoples liberty. Overall, we found that people had opportunities to take appropriate risks associated with leading everyday lifestyles. These included accessing the community for outings, peoples mobility around the home and use of the equipment in the kitchen. Care Homes for Adults (18-65 years) Page 14 of 30 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 who use the service were treated with dignity and respect. Staff support people to be able to make choices about their lifestyle, and people are supported to develop social, recreational and general life skills. The home provides people with suitable diets to meet their individual needs. Evidence: Throughout our visit we observed staff interactions with people, which were at all times respectful, empowering and friendly. People indicated to us that they liked the staff and had formed positive relationships with staff. All of the staff we saw and spoke to were positive and enthusiastic and there was a very calm and confident approach to their support of people. We wanted to see how people were supported to take part in age, peer and culturally appropriate activities. This is what we observed of people who were staying at the home. Two people went out to attend day service activities and staff supported them to get ready and access their transport arranged Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: for them. There was also evidence that people who stayed at the service during the day were involved in meaningful daytime activities of their own choice, which, had been planned in accordance with their wants, needs and capabilities. This included people supported to prepare drinks, and to eat their meals, to go on outings in the local community and to help to do domestic tasks in the home. The staff told us they planned activities for people and had recently taken people out on trips to the local park, to go shopping and to visit coastal resorts. People who use the service were supported to maintain and develop relationships. The service organises a coffee morning for relatives and people every other month and find that this has been welcomed by relatives and has been important in ensuring better communication between families and the service. One really positive outcome for one person was that a relative has been working with staff to help them speak to a person in their first language. The staff now have phrases in Portuguese to use with the person and this acknowledges the persons communication and cultural needs and has proved really useful in enabling the person to settle in to using the service. We asked staff and checked peoples care plans and found evidence that staff regularly supported people to make regular phone calls to relatives and also to offer support to have visits and to see relatives. From our observations and from some records we could see that mealtimes were arranged around peoples needs and wants. Some people had special diets and other people had swallowing assessments devised by speech and language therapists which guided staff on how to support people to eat safely. The staff confirmed that people are always offered a choice of meals and drinks to meet their needs. Staff told us people can choose from a pictorial menu to identify which is their choice. Staff told us that people are encouraged to go shopping with staff to buy food for meals. This encourages peoples choice and enables people to develop independence skills. We checked to see if people were offered a varied and nutritious diet and menus showed that this was the case. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive was based on meeting their individual needs. Evidence: We asked staff to tell us how they supported people with personal care tasks. This is what they said, People can choose the gender of the staff that support them. People choose when they go to bed and what they wear. Another person said, For people who cannot verbally communicate with us, we ask peoples carers to give us details of peoples preferences, such as baths or showers, morning routines and bedtime routines, whether people need prompts or actual support to wash and dress etc. In some peoples care plans it clearly advises whether staff need to prompt people or whether they need to help them to wash and bathe and dress themselves. All of the people who were staying at the service were observed to be well dressed and their Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: clothing was age appropriate. The nurse in charge told us that personal care support was offered to people on an individual basis and had to be flexible to meet peoples needs. For example, rising and retiring times were dependent on the individuals choice, as was the time when people were to be bathed or showered. From the care plans we checked it was clear that people attend regular health appointments on a regular basis. Other specialist health professionals were also supporting people who had more complex needs. There was evidence in the care plans that some people had attended appointments with specialist health professionals. For example community nurses. The health care professionals we surveyed told us, Communication between professionals is of a high standard. The service attempts to meet individual clients needs. Another health professional told us, Staff liaise really well with other services and this ensures continuity of care for clients. Ten Acres staff are, Flexible in their approach to people and offer support to carers. This was really positive and shows us that the staff work well with other health professionals to meet peoples needs. We checked to see if people had moving and handling assessments in place, they did and they been reviewed recently. The staff on duty told us that none of the people who came to stay at the home were able to administer their own medication. The nurses told us that they were responsible for administering medications and recording when this had been given. We checked two peoples drug sheets and found that a system was in place which identified the medication prescribed, the dosage, reason for use and review dates. The medication was stored in clean, lockable drug cabinets. This was good practice and helps to protect peoples health and welfare. Care Homes for Adults (18-65 years) Page 18 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by the safeguarding policies and procedures as the staff know how to respond to allegations of abuse. Peoples rights were protected as there are procedures to ensure all allegations of abuse are thoroughly investigated. People or their representatives have access to a complaints procedure. Evidence: The home has a complaints procedure for people. This is in accessible formats, it was called, `letting us know what you think. We asked staff whether people knew how to make a complaints. They told us some of our guests do. Other people would need support from their carers or us to advocate on their behalf. From the AQAA report we can see that one complaint had been made at the home since the last inspection. There was evidence in the homes complaint log book that this was resolved within the services timescale. All of the staff we spoke to said they were aware of the adult safeguarding procedures and they had completed training on this subject. The AQAA report confirmed this. We spoke to three staff who were all aware of their responsibilities in relation to reporting abuse or suspected abuse. Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: We saw evidence of the new local area safeguarding adults procedure was kept in the hallway of the home and was accessible to all staff at all times. This helps staff to protect people. We spoke to a member of staff who had used the whistle blowing procedure, in order to report unsafe practices some years ago. They told us they were supported well by their line managers and the issue was addressed appropriately. They said they would not hesitate to use it again. This was very positive and will help to safeguard peoples safety and welfare. The nurse in charge informed us that over the last year no adult safeguarding referrals have been made to the local safeguarding adults team. And no safeguarding investigations had been instigated for anyone staying at the service. The inspector discussed with the nurse in charge how peoples finances were managed. The system was easy to follow and gave a clear account of their deposits and withdrawals and receipts for goods and services purchased. Care Homes for Adults (18-65 years) Page 20 of 30 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. Overall, the accommodation offered to people was of a good standard. People were encouraged to personalise the rooms they stay in and the staff try to make the house homely in order to meet peoples specific needs. Evidence: At the time of the visit four people were staying at the respite service. The staff are responsible for cleaning and laundry tasks within the home and it was clear the team work really well together in ensuring the respite service offers a comfortable and homely environment for all their guests. The home was really very clean and tidy, homely and safe. The environment is decorated and furnished to a high standard and it is clear the environment was really well maintained and cared for. The rooms are spacious, with adequate dining and lounge areas. The kitchen was also clean and tidy. We checked two bedrooms, which were both well decorated and furnished to a high standard. People are encouraged to bring personal belongings to help personalise the rooms and make their stay more comfortable. Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: The bathrooms checked clean and were appropriately adapted to meet peoples needs. We checked the hot water tap temperatures and found these were within the appropriate range to prevent people from being scalded. Outside there communal garden areas with patio furniture. The garden was well maintained and attractive. Staff who work at the home told us there were adequate washing and drying facilities in the home to keep peoples laundry clean. There was evidence that staff had completed infection control training and that measures were in place to wash soiled laundry safely. Care Homes for Adults (18-65 years) Page 22 of 30 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. Overall people were supported by a staff team who were appropriately trained, skilled and experienced to meet their needs. People were supported by the homes recruitment practices. Evidence: On the day of our visit there were two support workers on duty and the nurse in charge to support two people who were staying at the home during our visit. There was also a student nurse who was completing a practice placement at the service. This staffing level was observed to be adequate to meet peoples needs on the day of the visit. Two member of staff told us, they had received regular training from the service. They confirmed they had completed all of the following training at the required frequencies, fire safety, moving and handling, food hygiene, first aid and infection control. They also told us they had been on specialist training courses including PCP training, epilepsy, LDQ, challenging behaviour, etc. They said they felt suitably trained to carry out their responsibilities safely and thought the quality of the training was generally good. Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: We asked staff about what they thought the service did well and all of the staff agreed their biggest success was the fact that all staff worked well together as a team to ensure peoples needs are met. Their comments included, We have a fantastic manager who puts systems and standards in place and we know we must meet them. They, the managers, lead by example. Someone else said, This service gets involved with families, we work well together, staff are open minded and we are persistent, we never give up on people. The nurse in charge told us that currently 3 out of 14 care staff had completed an NVQ2 in care award. They said the manager was currently putting in place a system to ensure that all of the other staff can begin this award. The AQAA report confirms the service has highlighted this as an area for improvement over the next year, and that a regional training and development manager has been employed recently to ensure this is implemented. We recommend that more staff are supported to complete this award to ensure they have the ncessary basic skills to meet peoples needs. Another member of staff told us, they were offered frequent supervision and always feel able to take any concerns or problems they had to the management team. We checked a sample of supervision records and found people see their line managers on average 4 to 6 times per year. The staff interviewed told us, the relationship with managers was really good. Staff also told us they have regular staff meetings and feel managers and nurses are approachable and will listen to them. From our observations we saw a lot of good staff practice. For example staff were very tuned in to peoples communication styles, they were aids in place to support them to move people appropriately using individuals aids and hoists. And they were supporting people with very complex needs in a professional and safe manner. We also observed the relationships between staff and people who lived at the home. This showed that staff had positive regard for all of the people who were staying at the home. They were informal but respectful in the way they spoke to and of people. This was very positive to see as the people who stayed at the home responded positively to the staffs approaches. Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: Three staff recruitment records were checked. We found these all contained the information required including CRBs, application forms, proof of I.D, two references. This helps to protect peoples welfare. Care Homes for Adults (18-65 years) Page 25 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were good relationships between the managers and staff team and it was clear this had a beneficial effect on the excellent services offered to people. Evidence: The manager of the home was registered. And is appropriately qualified as a registered nurse for the role. She has also told us she has completed the Registered Managers Award. The staff reported that the manager was supportive and listens to them. One member of staff we interviewed told us that, The manager is very approachable, professional, is a nice person, she is fantastic with people who use the service. This member of staff told us, The deputy manager is also excellent and has a real rapport with people, who always ask if he is on duty. From observations and discussions with staff, we found that their opinions are sought and listened to via supervision sessions, team meetings and on an everyday basis by speaking to the nurses and managers as required. Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: People who use the service can take part in many activities in the home and from observations it was clear the staff were supporting people to lead fulfilling lifestyles as this was the way the manager directed the team to operate. The AQAA report from the home detailed the way in which peoples views underpin, the reviews and self monitoring of the service through service users meetings, monthly and annual internal service reviews which involve people. The AQAA report also stated that the organisation had recently appointed a regional QA manager to improve the quality monitoring of the services. The service had comprehensive health and safety policies and procedures in place. This ensures peoples safety and welfare. Staff told us they knew of these and could access them if required. One member of staff told us they were responsible to ensure all of the COSHH requirements were kept up to date and another staff told us they were responsible for checking fire safety in the building. This ensures staff are fully involved in the health and safety practices within the home. The nurse in charge said the regional operations manager visits the home to carry out regulation 26 visits, and records of these were shown to the inspector. As part of the site visit we examined a sample of the maintenance and servicing records, these included a premises electrical circuits test certificate dated 5.2.09. A fire detection and fighting equipment check was carried out on 4.2.09, Fire drills were undertaken 6 monthly and the last one was on 4.2.09, Fire alarm tests were done on a weekly basis. The water temperatures had been checked on a weekly basis and the specialist baths and hoists had been checked by a specialist on 3.2.09. This shows that the management of the home are carrying out health and safety checks on a regular basis which can help to protect people from harm. Care Homes for Adults (18-65 years) Page 27 of 30 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 28 of 30 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 1 6 The registered person should discuss with the staff team the introduction of the new care plan model and what their concerns are. To ensure the system is appropriate and enables staff to meet peoples needs and is accessible to people who use the service. The registered person should ensure more staff have the opportunity to complete the NVQ2 care award. To enhance their skills when working with people. 2 32 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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