Inspection on 15/10/09 for The Cherries

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

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Cherries 10/10/07

The Cherries 26/06/06

The Cherries 07/12/05

The Cherries 07/07/05

The Cherries 23/11/04

The Cherries 05/05/04

The Cherries 03/02/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 26/11/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: The Cherries 30 Julian Road Folkestone Kent CT19 5HW     The quality rating for this care home is:   one star adequate 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: Kim Rogers     Date: 1 5 1 0 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 32 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 32 Information about the care home Name of care home: Address: The Cherries 30 Julian Road Folkestone Kent CT19 5HW 01303259561 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): the.cherries@craegmoor.co.uk Craegmoor Homes Ltd Name of registered manager (if applicable) Mr Robert Andrew Mycroft Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The home may only accommodate service users between the ages of sixteen to twenty five years of age. The maximum number of service users to be accommodated is 6. 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 Disabilities (LD). Date of last inspection Brief description of the care home The Cherries is registered to provide care and support for 6 young people with learning disabilities within the age range of 16 - 25 years. The home is a large detached building with communal space and single bedrooms. There is limited parking to the front drive but parking in the road outside. A large, well Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 6 3 0 0 1 2 0 0 9 Brief description of the care home maintained garden to the rear is accessible to the residents. There is no lift or access for a person with physical disabilities. The home is situated close to the centre of the seaside town of Folkestone with its varied amenities and public transport. The current fee range for this service is about £1478 to £2015 per week. For further information please contact the provider. Care Homes for Adults (18-65 years) Page 5 of 32 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced Key inspection of the service. This means that we assessed the Key Minimum Standards. The last Key inspection of this service was 30/01/09. Copies of this report are available from the Provider or can be viewed on our website. Following the last inspection we held a management review meeting and sent a warning letter to the provider to ask them to ensure that outcomes for people are improved. The provider responded to this and sent us an improvement plan for the home. We spent nearly five hours at the home. We spoke to and observed the people who use the service. We spoke to and observed staff and the manager and sampled various records. We made observations and had a look around the home. We talked briefly to the area manager. Care Homes for Adults (18-65 years) Page 6 of 32 We looked at the Annual Quality Assurance Assessment or AQAA. The manager completed this and it gives information about how the home has improved and how they intend to improve further. The manager returned the AQAA to us on time. We looked at any notifications from the home about accidents and incidents. We listened to what people have told us about the service. We sent surveys to staff. We received 2 surveys back from staff. Both made positive comments about the service. We made 7 requirements at the last inspection. We found that most of the requirements have been met. One requirement relating to risk assessments was not met. We served a Code B notice which we have to do if we suspect a breach of a Regulation. It details peoples rights and responsibilities. The new manager acted quickly to remedy this and sent us evidence after the visit that the requirement is met. There have been two safeguarding investigations, ongoing since the last inspection. One safeguarding alert has been made by the manager recently and this is closed. This means that the manager suspected abuse or harm and reported it to social services safeguarding coordinator to investigate. For more information please contact the provider. One staff has been referred to the Protection of Vulnerable Adults List by the provider since the last inspection. This means that the provider suspected that the staff member caused harm or abuse to one or more service users. For more information please contact the provider. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: The manager must ensure that all potential risks to people are assessed and managed so that people are safe. The manager agreed to do this. The manager agreed to review the length of shifts that staff work currently up to 14.5 hours. He agreed that it is service users best interests that staff are not tired or stressed. The manager must ensure that declared health needs by staff are risk assessed so poeple have the support they need to remain safe. The review of care plans must be regular and effective so that any change in needs can be identified and acted on. This will also ensure that staff are offering the right support. The manager agreed to do this. Care Homes for Adults (18-65 years) Page 8 of 32 To increase peoples skills and opportunities skill development plans are being written. To fully maximise this, staff will need training and support to know how to teach people skills so we made a recommendation that staff have training in person centred active support. Health action plans should have an action plan completed so staff know what support people need to remain well and healthy. 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 9 of 32 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 10 of 32 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. Prospective service users know their need will be assessed. There is information available about the home so people know what the service has to offer. Evidence: There is information available about what the service offers. This is produced in text with symbols and pictures to make it user friendly. This means that prospective service users will have some information about the service to help then make a decision about moving in. The company has improved the assessment tool. This means that more information can be gathered about a persons needs and goals. The manager can then make a decision, based on the information gathered, if the home can meet the persons needs and support their personal goals. The AQAA says they continue to carry out assessments involving service users and stakeholders and offer trial stays. No one has moved in since the last inspection. Care Homes for Adults (18-65 years) Page 11 of 32 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 know that their needs will be recorded and supported. Work has started to identify, record and support individual goals. The manager is in the process of ensuring that all potential risks are assessed. Communication needs are recorded and supported. Evidence: We found that each person has a service user plan or care plan. We found that peoples needs are recorded. We found that the manager is working with staff and service users to identify and record peoples personal goals for the future. This is at an early stage as no goals were identified and recorded in the plan we sampled. The manager is updating plans so they have more detailed information. This means that staff will have the information they need to give people the right support. The manager showed us some work with one person to identify and record their goals for the future. This service user plan said, I want to cook more often, go to college and meet more friends. We found no time bound plan identifying who is going to do Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: what and by when to support this. This means that the person may not achieve these goals. The manager said he will ensure that plans of support are included so staff know what to do and by when. The manager said that the staff have attended a one day course in person centred thinking. He said that no service user has had a person centred planning meeting yet but he has been talking to staff and families about developing peoples care plans. This means that staff and family members who know service users well can have a say about what they think the person may want out of life, especially important if the person has communication needs. We found some contradictory information in the service user plan sampled. For example one part said that the person does not have the skills for a bedroom door key and another page said he has the skills for a key. The manager confirmed that some of this information is not right and he will change it. In the plan we sampled we found a review and evaluation sheet. This has two dates on it for this year. One date 14.05.09 says entire care plan re written and 18.09.09 no change. We found some parts of the care plan written over two years ago dated June 2007 and some parts of this plan are blank. As mentioned we found incorrect and contradictory information. This means that this review may not be effective and frequent enough. Without effective frequent evaluation changes in needs may not be picked up and acted on. The manager agreed to ensure that plans are reviewed more effectively. The manager said he is in the process of reviewing the risk assessments. We found that not all risks have been assessed as we required at the last inspection. For example one person has been assessed at being at risk of choking but no risk assessment has been carried out stating how they intend to keep the person safe. The manager said he would sort this out the same day and later informed us that he had completed a risk assessment. The manager must ensure that all potentials risks are identified and assessed to ensure that people are safe. We found that the way people prefer to communicate is recorded in individual plans. The manager said he has plans to improve communication support by making referrals to the local speech and language department for additional support. We found that there is some meaningful information to aid communication around the home. For example there is a board in the lounge showing pictures of activity choices. Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: Staff said they or service users point to things they might want to do. We found nothing on display showing who is on duty. This means people will not know who will be supporting them from one day to the next and will have to rely on staff to tell them rather than being able to find out for themselves. The manager said he plans to make information more accessible to service users. He said he plans to show who is on duty so people know who will be supporting them. We found that staff have attended training in alternative communication like using signs and symbols. This means that staff are more knowledgeable about alternative forms of communication. We found that sensitive information about people with their full names is put in one file for staff to read and sign before it goes into individual care plans. This means that all this sensitive information is in one place and so not held in line with the Data Protection Act. If people want to see information about them they may be able to read information about other people. The manager agreed to rectify this. Care Homes for Adults (18-65 years) Page 14 of 32 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 have the opportunity to take part in a range of activities. Relationships with family and friends are supported. Food is wholesome and nutritious and people are more involved in planning and preparing meals. There is still a lack of opportunity to learn and develop skills. Evidence: We found that each person has a weekly activity plan in their care plan. The plan we sampled showed the person attends a music session at another company home on a Thursday morning. The manager said this session was not on so the person spent time in the garden and then went into town with staff instead. The manager said that people go to local discos, clubs and into town. The AQAA says they plan to increase the variety of activities on offer. On the day of the visit everyone went to out during the morning. Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: As found at the last inspection skill development plans are not in place for everyone. This means that staff may not have the guidance and information they need to teach people new skills and develop existing skills and so opportunities to learn new skills are limited. The manager said neither he nor the staff team have had training in active support. This technique teaches staff to give just the right amount of support to enable the person to do things for themselves. The manager said he will look into active support training for staff. In one plan sampled we found information dated 22.08.09 about What I do now and What I would like to do. What I do now in the areas of Day care, spirituality, cultural, employment and learning the plan said None at present. What I would like to do in the future for the areas Day care, spirituality, cultural, employment and learning the plan was blank. The manager agreed that people will not increase and develop their skills and experiences unless there are support plans in place. We found that the contact details of family and friends are recorded. The manager said that family members are welcome to visit the home at reasonable times. Service uses have support to keep in touch with family and friends. We found that access to the kitchen has increased. We observed two service users in the kitchen with staff. One person was having support to make their breakfast. We observed staff encouraging the person to be involved in preparing their breakfast. The manager said he plans to increase access to the kitchen for everyone and is looking at the least restrictive options to ensure that people can come into the kitchen and be involved and remain safe. He has been trialling cupboard door locks so that individual cupboards instead of the whole kitchen can be locked. The manager said he plans to change the way the home gets the food supplies. He said he plans to support people to go to the supermarket rather than shop on line and have it delivered. This means that service users will have the opportunity to experience the sights and sounds of the supermarket and be more involved. The manager said he plans to have a weekly menu that service users are involved in. This means that service users can have a say about what is on the menu. We found that fresh fruit and vegetables are available and people can access cold drinks freely from a water dispenser in the dining area. We found that needs about Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: eating and drinking are recorded in care plans. Care Homes for Adults (18-65 years) Page 17 of 32 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 know their health and personal needs will be supported. Medication practice is safe. Evidence: We found that peoples personal care needs are recorded in individual plans. The manager has been updating this information and adding more detail to ensure that people get the support they need in the way they prefer. The AQAA says they have plans to support people to be more independent in their personal care. They plan to support people to choose and buy their own toiletries. Two bedrooms have en suite facilities. There is a ground floor shower room and a bathroom on the first floor. Service users also have use of the staff shower room if the other bathrooms are being used. We found that peoples health needs are recorded. We found that there are health action plan booklets in service user plans but not all are complete. The one we sampled was incomplete and the plan part was blank. This means that there is no plan Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: of action for staff to follow. Each person has a second smaller file where details and outcomes of attended health related appointments are recorded. We found that everyone is registered with a doctor and the manager said referrals to health professionals have been made when necessary. We looked at the storage of medication and found this to be safe. Records are in order and show the receipt and administration of medication. Staff currently control medication at the home. The manager said that staff attend training before they can administer medication to service users. They then have a competency assessment by the manager to check they are safe to give medication. Staff confirmed this. The manager said that systems are in place for ordering and checking in medication so they always have the stocks they need. We observed staff administering medication to service users and this was person lead in that staff took the medication safely to the person rather than the person having to come to the office. We found that staff have covertly administered medication to one person in the past. The manager said the family was involved in this decision but no work has been done to establish peoples individual wishes with regard to the requirements of covertly administering medication and the Mental Capacity Act. The manager agreed to consider this in the future if anyone needs to have their medication given covertly. Care Homes for Adults (18-65 years) Page 19 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a complaints procedure in place. Staff know how to recognise and respond to abuse. Any plans to support problem behaviour must be agreed and developed with the individual concerned so they have the opportunity to agree, have a say and give their consent to any restrictive physical intervention. Evidence: There is a written complaints procedure and a user friendly version with large print and symbols. There is a book for recording complaints. Since the last inspection some staff have had training in how to use alternative forms of communication. This means they may have more skills in communicating with service users and so recognising complaints. The AQAA says they have dealt with two complaints in the last year and both complaints were upheld. The Commission received some concerns about the home in March this year by e mail. These concerns were about the previous home manager and a relative of the manager working at the home. This has now been resolved. The manager said he has updated some behaviour guidelines and he showed us the guidelines on the computer as they are not yet in peoples plans. He said staff have been involved but the person they relate to has not been involved. Therefore they Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: have not had a say or agreed or given their consent and restraint is involved. The manager said he will be sharing the guidelines with the individual. The manager said that no one is subject to a Deprivation of Liberties Safeguarding authorisation. This means that the manager does not feel that peoples liberty is compromised in any way so has not applied for an authorisation. Due to the restrictions on the front door, kitchen and the fact that some people are subject to restraint he may wish to consider making an application. The AQAA shows there have been five incidents when restraint was used in the last twelve months. The home has policies and procedures in place to safeguard people from harm and abuse. This means that staff have some guidance to follow if they suspect people are at risk of harm or abuse. This procedure was followed by the manager recently when he made an alert to the safeguarding coordinator at social services. A short investigation was carried out by social services and the alert closed. There are currently two open safeguarding investigations. This means that the safeguarding coordinator at social services is looking into allegations of suspected abuse or harm to people. For more information please contact the Provider. We found that staff attend training in how to recognise and respond to abuse. Since the last inspection one staff member has been referred to the Protection of Vulnerable Adults List by the provider. This means that the staff member was suspected of abuse and so referred to the list as a safeguard to other vulnerable people in the future. This staff member no longer works for the organisation. For more information please contact the Provider. We found that there are systems in place to safeguard service users money. Staff have control of peoples money, which is held safely. We found that the balance is checked daily and two staff check and sign every transaction. This protects service users. Care Homes for Adults (18-65 years) Page 21 of 32 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. The home is cleaned and generally well maintained Evidence: We found that the home is generally well maintained and clean. There has been some redecoration including some peoples bedrooms and communal areas. There is a newly fitted kitchen and new television in the lounge. There are some new carpets. People can get out into the garden when they wish to get fresh air. The manager said that service users enjoy spending time in the garden. The laundry and front door are kept locked. The kitchen is now more accessible as it is not locked so much. The manager is trialing kitchen cupboard locks rather than locking the whole kitchen off to everyone. Each bedroom is single and two bedrooms have en suite facilities. There are shared toilets and bathrooms and communal space including a large lounge diner and separate smaller lounge. The AQAA says there are plans to update a persons en suite shower room. The front windows also need attention as the paint is peeling away. The manager said that there are plans to improve the windows next year. Care Homes for Adults (18-65 years) Page 22 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough staff to meet peoples needs. Recruitment checks are carried out before a person starts work at the home. Staff have had some training related to peoples needs. Evidence: We found that there are enough staff on duty during the day and at night to meet peoples needs. One staff survey returned to us they usually have enough staff and the other said they sometimes have enough staff. The manager said three new staff have been employed so the home is now fully staffed. Two staff returned surveys to us and told us that they had recruitment checks carried out and an induction. A member of staff told us that they had induction training when they started work at the home about a year ago. Both staff surveys said that they feel they have the training they need and that they have enough support from the manager. The manager said that prospective staff come to the home to meet service users before they start working with them. The AQAA says they plan to involve service users more in recruiting new staff so they can have a say about who may potentially support them. Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: We sampled two staff files and found that for one new staff two references have been requested and obtained. One reference was from a friend and the other from a previous employer. This second reference was basic and gives only the dates the person was employed. No further reference has been requested even though another care home was given as another previous employer on the persons application form. Although two references meet the Minimum Standard they should be satisfactory references. This also means that the manager has not got a reference about how the person performs at work. We found that one staff has a declared health need for which they take regular medication. We found that no risk assessment has been carried out even though the person works on a one to one basis with service users at the home and in the community. To protect the member of staff and service users we asked the manager to do this and he agreed. The manager said that staff have had training in alternate communication since the last inspection. He said that all staff are up to date with mandatory training. However we found some gaps on the compliance training record for some staff. The manager said where there are gaps courses have been booked. Most of the staff have attended a one day course about person centred thinking. The manager agreed that training in person centred planning and active support techniques would increase staff skills and improve outcomes for service users. Some staff have attend an Autism awareness course and another course is planned. Staff continue to work long shifts of up to 14.5 hours. Because staff could get tired and stressed the manager agreed to review this. Staff have a handover every day so they are kept informed of events. The manager has held two staff meetings since coming to the home at the end of June this year. We found that the manager is in the process of meeting on a one to one basis with staff. The manager says he hopes to increase the frequency of one to one meetings with staff so staff have the opportunity to have at least 6 one to one meetings a year. This means that staff will have the opportunity to talk about training and development needs and get coaching and support. There is not currently an element of observation as part of the supervision process and the manager agreed to consider this. We observed a staff member encouraging a service user to be involved in preparing Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: his breakfast. Care Homes for Adults (18-65 years) Page 25 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a new manager in post and the home is adequately managed. There are systems in place to seek peoples views about the service. There are systems in place to audit and monitor practice. Evidence: There is a new manager at the home. He has been in post for about three and a half months. There was previously a temporary acting manager for a few months. The manager has the qualifications required by the Minimum Standard, that is, a National Vocational Qualification at level 4 in care and a Registered Managers Award. The manager said he would like to study in the future for a qualification in learning disabilities. The manager is not yet registered with us but has put in an application. This means that he has not yet passed the fit person process. He will be interviewed by us to asses if he is a fit person within the next couple of weeks. As the manager has only been in post for a short time he has no proven track record at the home and we have Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: little evidence of sustained improvement at this time. Two staff in surveys returned to us said they feel the manager is an improvement and has had a positive impact on the service. The manager spoke about the requirements from the last inspection and is addressing some of the issues. For example he has held two staff meetings and plans to meet with staff individually for supervision sessions. We found that improvements are needed to meet two requirements made previously, namely risk assessments and the effective reviewing of care plans. Because of these unmet requirements we served a Code B notice to the manager that outlines his rights when we have evidence that a regulation has been breached. The manager acted the same day to complete a risk assessment for one person. He must now ensure that all potential risks to people are assessed so people are safe. The manager agreed to ensure that the review of care plans is more frequent, more effective and involves service users. The manager is working on updating care plans and is doing this work in the office using the computer. We saw a lot of the work on the computer. We spoke to the manager and area manager about the importance and necessity of involving service users, staff and stakeholders in this process so that everyone gets together to have a say. The AQAA shows that the required health and safety checks of equipment and premises are carried out. The manager said he has reviewed the fire risk assessment as required at the last inspection and will have it checked at the next health and safety audit by the company. There has been a fire drill held recently. We found that staff who work on their own are first aid trained and have attended fire awareness training. The manager said that staff are up to date in mandatory training related to health and safety including fire awareness, food safety and first aid. We found some gaps on the training compliance record and the manager said where there are gaps courses have been arranged. Staff also attend training about equality and diversity. The AQAA says that service users views are sought through sending out surveys, the complaints procedure, quarterly area conferences, yearly review meetings and during Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: audits. The manager said service user meetings are held and they plan to try to include service users in staff meetings. The AQAA says they would like to have some one to one time for service users to talk to their key workers about how things are going. The manager said that a senior manager carries out monthly audits of the service. He said he has regular supervision meetings with a line manager to get some coaching, mentoring and support. The company carry out audits to check that practice is safe, The manager said he has an action plan from a recent company audit. Care Homes for Adults (18-65 years) Page 28 of 32 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 29 of 32 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 1 23 12 Any plans to support 31/12/2009 problem behaviour must be agreed and developed with the individual concerned so they have the opportunity to agree, have a say and give their consent to any restrictive physical intervention. To ensure that people are involved and protected from harm. 2 34 12 The manager must ensure that recruitment checks are satisfactory and that staff who need them have risk assessments. To make sure that staff and service users are safe. 31/12/2009 Care Homes for Adults (18-65 years) Page 30 of 32 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 32 To ensure that the staff team have the competencies to teach service users new skills staff should have training in person centred active support. Care Homes for Adults (18-65 years) Page 31 of 32 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 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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