Inspection on 28/10/09 for Vicarage Road (1&3)

This is the latest available inspection report for this service, carried out on 28th October 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Vicarage Road (1&3) 06/12/06

Vicarage Road (1&3) 21/09/05

Vicarage Road (1&3) 05/08/05

Vicarage Road (1&3) 22/02/05

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Vicarage Road (1&3) 1&3 Vicarage Road Dagenham RM10 9SX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Harbinder Ghir     Date: 0 5 1 1 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 31 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 31 Information about the care home Name of care home: Address: Vicarage Road (1&3) 1&3 Vicarage Road Dagenham RM10 9SX 02085928734 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): vicarageroad@theavenuestrust.co.uk glebe.house@theavenuestrust.co.uk Avenues Support Services Name of registered manager (if applicable) Mr Edwine Allo Tembong Type of registration: Number of places registered: care home 8 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 1 to 3 Vicarage Road is a purpose built 8 bedded unit comprising two connected bungalows set on a housing development. The home is registered to provide care for individuals with learning disabilities and physical disabilities. Current residents have very high care needs; staff use their knowledge of residents as a means of communication to effectively understand their needs, as the range of verbal communication that residents are able to use is limited. The home is operated by the Avenues Trust, which is a registered charity. All the bedrooms are en-suite, there are two large dining/sitting areas, two kitchens, two laundry rooms and two garden areas. The home also has its own custom built vehicle, which staff drive to take residents out on outings. At the time of the inspection there were two vacancies. The fees currently charged by the service is £1,480.44 per week. Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 0 8 8 Brief description of the care home Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection undertaken by Regulation Inspector Harbinder Ghir. The inspection took place over two days, on the 28th October and on the 2nd November 2009 and a third day on the 5th November 2009 was spent contacting relatives and representatives by telephone, seeking their views on the service. Their feedback has been included in the report. During the inspection the inspector was unable to talk to the residents residing at the home due to their complex communication needs. However, the inspector was able to talk to staff and their comments have been included in the report. As part of the inspection the inspector toured the home, read records of people who use the service and examined documents in relation to the management of the home. The inspector would like to thank everyone involved in the inspection process. Care Homes for Adults (18-65 years) Page 6 of 31 The Care Quality Commission received a completed Annual Quality Assurance Assessment prior to the inspection. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 31 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 31 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. At this inspection we looked at standards 2, 3, and 4. The service completes comprehensive pre-admission assessments, to ensure they can fully meet the needs of prospective residents. Trial visits are offered to all prospective residents, to ensure residents have information on the services and facilities provided at the home. Evidence: There have been no new admissions to the home and the six residents living at the home have resided together for a number of years. The Annual Quality Assurance Assessment informs us that Full assessments are carried out with the help of service users, carers and relatives and that the service has an admission policy in place. It was evident that this is statement would be practised for all new admissions as the the service has a comprehensive pre-admission policy and procedure in place and admissions would not be made to the home until a full needs assessment has been Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: undertaken. The policies and procedures highlighted that admissions to the home would only take place if the service is confident that staff have the skills, ability and qualifications to meet the assessed needs of prospective residents. New prospective residents would be able to visit the home as many times as they like and have an opportunity to stay overnight. Relatives and family would also be invited to visit the home. Care Homes for Adults (18-65 years) Page 11 of 31 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. At this inspection we looked at standards 6, 7, 8, 9. There is a comprehensive care planning system in place, which provides staff with the information needed, to meet the needs of residents. The right for residents to exercise choice and control is promoted by the service and they are actively consulted on, and participate in, all aspects of life in the home. Risk assessments are undertaken routinely, to ensure residents are supported to take risks as part of an independent lifestyle, and are always updated according to residents changing needs. Service users financial interests are safeguarded and records of residents outgoings and incomings of money were recorded correctly. Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: Two care plans were closely examined. Care plans seen evidenced that the service involves individuals in the planning of care that affects their lifestyle and quality of life. Care plans were comprehensive, person centred and clearly set out residents health, personal and social care needs. Information was found specific to the religious, cultural and social care needs of residents and how the service was to meet these needs. For example residents were supported to attend the local church once a week. The information provided in care plans was very detailed and individualised, and clearly recorded and described how residents wanted their needs met. For example one residents care plan informed how they would like to be communicated to. Their care plan stated, Y will take the persons hand to communicate what he wants and will gesture. All care plans included a document which was named after each resident capturing a day in their life, which included information on the things they enjoyed and things they didnt like, how they liked to interact and communicate and how they wanted their needs met. This document was very person centred and was also provided in picture format and provided an excellent summery of each residents personality and needs. A key worker system and monthly key worker meetings with each resident also allows staff to work on a one-to-one basis and contribute to the care plan for the individual. Care plans were working documents and are reviewed on a regular basis or as and when required. In addition to this key workers also write a monthly key worker report. Evidence was seen of reviews taking place with care managers also involving the resident and their representatives. Reviews focused on asking what has worked for the individual, where progress is being made, achievements, and concerns and identified action points. Evidence was seen of reviews being arranged to fit in with the availability of family so that they could be involved in the process. Residents were involved in the daily running of the home as far as their abilities allowed. Each resident has a weekly activities plan which also includes participating in daily living tasks. Residents were possible were supported to bring their laundry down and place it in the washing machine, choose their meals and where they would like to go out each day. Care plans also included pictures of residents going out on day trips and visiting family members. Residents rights to make choices were actively promoted. The service is responsible for the finances of residents. Two residents records of money held were checked with the money held in safekeeping. All records and accounts were in good working order. Relatives and representatives of residents were spoken to as part of the inspection Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: and very positive feedback was received regarding the home. We have been delighted with the home. He knows everybody and all his needs are met there. They do what ever they can for him and the staff are really caring, and the home is a lovely and homely place. We cant fault the service. Care Homes for Adults (18-65 years) Page 14 of 31 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. At this inspection we looked at standards 11, 12, 13, 14, 15, 16 and 17. Residents are provided with support to maintain their independence and in areas of personal development according to their needs and wishes. Residents are engaged in community life, promoting their opportunities to be part of the local community. Residents are offered meals that promote their choices and respect their individual preferences. Residents are supported to maintain family links and relationships inside and outside the home. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: The service has a strong commitment to enabling residents to develop and maintain their skills, including social, emotional, communication, and independent living skills. Individuals are supported to identify their goals, and work to achieve them. Residents are supported in community participation by staff supporting residents to go out on days trips, visit local restaurants, leisure centres and visit family and friends. One resident was recently supported to visit their loved one in Norfolk for a week with the support of staff. Another resident is supported to visit the local supermarket restaurant at his request, which he enjoys. During the inspection staff were seen supporting residents to visit the local park and local shops. The home also has their own mini bus which facilitates residents community participation. Some residents also attend local day centres. The home also provides a music and movement class once a week. Residents are also given a choice of visiting church once a week and are also given the opportunity to participate in festivals and celebrations throughout the year. It was evident that there was a range of activities residents could participate in and had the freedom and choice to wander around the home as they liked. The home provides meals, which are varied and nutritious and meet the dietary needs of residents. There was plenty of fresh fruit and vegetables at the home. Residents were joined by the inspector at lunch time and all residents were eating different varieties of foods. Staff were aware of residents special dietary needs. Two residents are currently being PEG fed. Staff had received the specialist training to ensure residents were safeguarded at all times. Staff were calm and relaxed with residents helping them to eat at their pace. Residents were supported to choose their meals from an extensive folder of pictures of foods, meals and ingredients and staff supported residents to devise the weekly menu. Residents can also refuse their choice of meal on the menu on the day and staff prepared alternative meals specified by the resident. Care Homes for Adults (18-65 years) Page 16 of 31 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. At this inspection we looked at standards 18, 19, 20 and 21. Residents receive personal support and care in the way they prefer and require. Medication practises do not always ensure the safety of people who use the service. The ageing, illness and death of service users are handled with respect and as the individual would wish. Evidence: Residents at the home receive personal care and health care support using a person centred approach with support provided based upon the rights of dignity, equality, fairness, autonomy and respect. Each resident has a devised health action plan which identifies the health care needs of residents including specialist health, nursing and dietary requirements, which are clearly recorded and act as an indicator of change in health requirements. The plan also identified residents daily routines including the type of support they need in relation to personal hygiene and according to their level of care needs. For example whether residents prefer a shower or bath. All this Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: information was also summarised into a document called My hospital passport which accompanied residents if they were admitted to hospital. This document was very detailed and would provide any external professional with the information to meet each residents needs in a person centred way. Residents are supported by staff to attend appointments with health care professionals and their health is closely monitored and prompt referrals are made. There was evidence of the involvement of multi-disciplinary health care professionals where required were made to dentists, chiropodists, general practitioners and community psychiatric nurses. During the inspection the physiotherapist was spoken to who was visiting the home at the time. She informed The staff do take my instructions on board and they have become more accommodating. The home has settled down since Edwin (the registered manager) has come along. The staff do their best and I have no concerns about the service. There is currently an exercise programme in place which is definitely benefiting residents. The residents are always kept clean and they look good. I cant say anything bad about the service. The home itself is also always kept clean. There are no bad smells or anything. The community learning disabilities nurse was also spoken to as part of the inspection, she said I do go to the home once in a while to see one resident there. They try to take my instructions on board. Residents are looked after and they do their best for them. Steps have been taken to find out the wishes of residents in the event of their death, including contacting relatives or representatives where the resident is unable to express their views. There are policies and procedures for staff to follow in the event of a death; to ensure the death of a resident is handled with respect and as the individual would wish. This information was included in each residents care plan document. Some residents had chosen the their own funeral directors and specified whether they wanted to be buried or cremated. Medication administration records (MAR) were closely examined. Medication records were not always correctly completed. There was evidence of signing errors taking place and staff had also made hand written entries without signing to evidence who made the entry and where they had received the instruction from. The medication file contained photographs of each individual, a medication pen picture and information about each medication. All of the residents have regular medication reviews conducted by the general practitioner, which is very good practise. However, the medication in each side of the home is stored in the managers office in each home which is a long walk to the lounge. The registered manager informed that staff take out each medication pill and put them into a pot and take them to the resident for administration and then come back to sign the medication administration record. This Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: practise is very time consuming and is not safe as one resident could be on numerous medication. On administering each medication the medication administration record should be signed straight away. Carrying medication around the home is not a safe practise in itself, as staff could become distracted by other residents, telephone calls or an emergency. Therefore to minimise the risks of medication administration it is a requirement that the current practise is reviewed and safer storage systems are found within the home. The homes Annual Quality Assurance Assessment does identify that safer storage of medication is required within the home. It states under what we could do better that we would like to Purchase medication trolleys for both houses to be used when dispensing and administering medication. This together with recent improvements will go further to reduce the possibility of medication errors or eliminate it altogether. The registered persons must also ensure that all hand written entries are signed and dated by staff to ensure the safety of residents and to validate the entry. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At this inspection we looked at standards 22 and 23. People who use the service can be assured their views are listened to and acted on. The service records all complaints and concerns to ensure any dissatisfaction with the service is recorded regardless of source. All staff have received up to date training in Safeguarding Adults, which ensures the protection of residents. Evidence: People who use the service are supplied with a complaints procedure that they can understand. The procedure is available in picture format and has also been provided in audio format. The service has received no formal complaints since the last inspection. All concerns and niggles are recorded by the service regardless of source and are actioned promptly. All staff had attended Safeguarding Adults training which is also covered in the induction programme. The service has comprehensive Safeguarding Adults procedures and protocols in place. There was also comprehensive guidance for staff on how to record incidents of abuse and preserving evidence. Staff on shift during the inspection were also spoken to. They were aware of the Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: safeguarding procedures and were knowledgeable on the actions to take if they suspected abuse going on in the home. Care Homes for Adults (18-65 years) Page 21 of 31 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. At this inspection we looked at standards 24, 25, 26, 27, 28, 29, 30. Residents live in a comfortable environment and decor is of a good standard and provides a homely and pleasant living environment enhancing residents comfort, but further environmental safety checks would minimise risks presented to residents. Evidence: During a tour of the building it was identified that residents live in a physical environment that is appropriate to the specific needs of the people who live there. The home provides ground floor accommodation for eight residents. The Annual Quality Assurance Assessment informs us, that since the last inspection the home has replaced the carpets and flooring in residents bedrooms, has replaced faulty equipment and has improved the garden furniture and both boilers in each house have been replaced. Residents bedrooms were provided with aids and adaptations to meet their required needs, for example grab rails and hoists. The bathrooms also provided specialist equipment such as a high low bath in one of the main bathrooms. Each resident had been supported to choose colours and furnishings for their room. Residents had also personalised their rooms with pictures, photographs, personal furnishings and belongings. All rooms were lockable and can be overridden by staff in an emergency. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: The main communal areas such as the lounge and dining area were clean and had furnishings that were homely and welcoming. These areas had also been personalised with photographs of residents. The kitchens were clean and were equipped with suitable cooking appliances and kitchen equipment. There was a wide range of fruit and vegetables and meats. Food was correctly labelled with the date of opening. Fridge, freezer and hot food temperatures had been taken consistently. as On touring the homes laundry room it was identified that washing detergent powder was openly stored which was a risk to residents who may consume this powder. One residents shoe rack was broken and had not been replaced. Open packets of food were also stored in the kitchen. These must be be stored in air tight containers to reduce the risks of pests. The registered persons must ensure that all parts of the home to which residents have access to must be so far reasonably practical made free from hazards to their safety and unnecessary risks to residents are identified and so far as possible eliminated, this will be stated as a requirement. Care Homes for Adults (18-65 years) Page 23 of 31 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. At this inspection we looked at standards 32, 33, 34, 35 and 36. Recruitment practises are robust and ensure residents are in safe hands at all times. Comprehensive staff training is provided to all care staff, to ensure they are equipped with the skills and are competent to do their jobs. The service has a good skill mix of staff, ensuring adequate numbers of staff are on duty to meet the needs of residents. Staff are supervised at least six times year to ensure they are equipped with the skills and knowledge to meet the needs of people who use the service. Evidence: Three staff files were closely examined, which included two staff files of two newly recruited members of staff. Staff files were in good order. References and Criminals Records Bureau checks had been obtained, application forms had been completed in full and two references had been obtained. All new staff complete comprehensive induction programmes and the service sees this as vital to the success of staff Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: recruitment and retention. The service has made a commitment to staff training that is focused on delivering improved outcomes for people who use the service. The Avenues Trust has a very comprehensive training programme in place and management prioritise training and facilitate staff members to undertake external qualifications beyond basic requirements. The service also has internal development training, to complement formal training as part of an ongoing training plan. Staff training included training in first aid, food hygiene, manual handling, health and safety, fire training, safeguarding adults, medication, person centred planning, understanding challenging behaviour, epilepsy and autism. The registered manager had also recently received training in the Deprivation Of Liberty which was also going to be rolled out to front line care staff. Over fifty per cent of the staff team have a National Vocational qualification. The staff rota included all the members of staff on duty. The service has a permanent staff team and uses its internal system of bank staff to cover shifts when required. There are sufficient numbers of staff on duty per shift which supports the needs of residents, activities and aspirations of residents in an individualised and person centred way. The latest supervision records were viewed for all staff. A supervision programme is in place and staff files evidenced that staff members are supervised formally on a regular basis (at least six times a year). This ensures that staff are provided with the skills, training and knowledge to perform the tasks required by their employment role. During the inspection two members of staff were spoken to who spoke very positively about the manager and working at the home. Staff were also observed positively interacting with residents and were able to communicate with residents freely and using each residents preferred method of communication. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At this inspection we looked at standards 37, 39, 42. Residents benefit from an experienced manager who recognises their needs and adequately manages the home. The systems for service user consultation ensure the home is run in the best interests of residents. The welfare of staff and residents is promoted by the homes policies and procedures. Evidence: The registered manager joined the home in June 2008 and has registered with the Commission. Staff and relatives spoken to during the inspection also spoke very positively about the manager, informing That he is supportive and always listens to staff. The manager is commended for his organisational skills as all documentation required Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: for inspection purposes was easily accessible. The manger also demonstrates through his formal qualifications, robust operational systems and his professional experience and ability that he is knowledgeable and highly competent in a range of areas, which included good practise areas, understanding current legislation, and the importance and purpose of having effective quality assurance systems in place. Quality assurance systems have been developed which are completed annually and the results of surveys are analysed and incorporated into the homes annual stakeholder survey report. The home works to clear health and safety policy. Health and Safety records were inspected. All documentation was in order and appropriately completed. Certificates viewed included certificates verifying up to date portable appliance testing, electrical installation, gas safety, employers liability insurance and records of fire drills and fire alarm testing and water temperature testing. Motor insurance certificates were also seen for the homes mini bus, which were all in god working order. Currently fire drills are completed monthly. This can be both traumatic and stressful for residents and staff. It is therefore recommended that fire drills are completed three monthly. Regulation 26 visit reports were examined during the inspection which are undertaken by a number of senior managers within the organisation. These reports were completed monthly and were very comprehensive and also included action points where any areas for improvement had been identified and were reviewed to check for compliance. The accident and incident records were closely examined which evidenced that all accidents and incidents were comprehensively recorded and further follow up checks were also completed by the manager of the home to ensure residents did not have any further health associated risks posed to them. A completed Annual Quality Assurance Assessment was received before the inspection and was supported by a wide range of evidence. It informed of the changes the service has made and where they still need to make improvements. Care Homes for Adults (18-65 years) Page 27 of 31 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 31 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 20 13 The registered persons must 31/12/2009 also ensure that all hand written entries are signed and dated by staff to ensure safety of residents and to validate the entry. . 2 20 13 The Registered Persons must ensure that to minimise the risks of medication administration it is a requirement that the current practise is reviewed and safer storage systems are found within the home. . 31/12/2009 3 24 23 The registered persons must 31/12/2009 ensure that all parts of the home to which residents have access to must be so far reasonably practical be made free from hazards to their safety and unnecessary risks to residents are Care Homes for Adults (18-65 years) Page 29 of 31 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 identified and so far as possible eliminated, . 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 42 It is recommended that fire drills are completed at least three monthly and not monthly to reduce any unnecessary stress to residents. Care Homes for Adults (18-65 years) Page 30 of 31 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. 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