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Inspection on 24/03/09 for Warwick House

Also see our care home review for Warwick House for more information

This is the latest available inspection report for this service, carried out on 24th March 2009.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Warwick House 12 Grosvenor Road Paignton Devon TQ4 5AY two star good service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rachel Proctor Date: 2 4 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement 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 Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Internet address www.cqc.org.uk Information about the care home Name of care home: Address: Warwick House 12 Grosvenor Road Paignton Devon TQ4 5AY 01803663421 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): admin@moduscare.com Modus Care Limited Name of registered manager (if applicable) Miss Kim Sylvia Underwood Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 7 0 care home 7 learning disability Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC to service users of wither gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) The maximum number of service users who can be accommodated is 7. Date of last inspection A bit about the care home Warwick House is a large detached house in Paignton which has easy access to shops, public transport and other community facilities. The home provides services for up to seven adults with a learning disability, in particular autistic spectrum disorder. All the bedrooms are en-suite and the communal rooms are spacious and well decorated. The home also benefits from a large rear garden. Warwick House is owned by a company which has other care homes and hospitals specialising in the care of people with autistic spectrum disorders. Fees charged are based on the assessed needs of each Service User and the degree of staffing input required. The range of fees currently charged are 1500 - 2300 per week. 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 How we did our inspection: This is what the inspector did when they were at the care home This was a Key unannounced inspection which took place on 24/03/09 between 10 am and 4 pm. The acting manager was on duty and remained for the duration of the inspection. At the time of the inspection there were five people living in the home, completed questionnaires had been received from all, some with help from their key worker. Surveys were also received from two staff, and one visiting professional. Time was spent talking to two of people living at Warwick house. Some of the staff on duty during the inspection were spoken with individually. One person living at Warwick House had their care followed. This involved speaking to the person, visiting the room they occupied in the home, with their permission and viewing their care planning records. Other records relating to the management of the home were seen. Discussion with the acting manager regarding management of the home also took place. What the care home does well The people who completed surveys and those spoken with during the inspection were happy with the service provided at Warwick House. The people spoken with said that the staff provide them with support they need to take part in activities they enjoy. Staff are respectful and listen to what people they are caring for tell them. People asked indicated that staff act on what they say. People also indicated that they are involved in the running of the home and are given the help they need to complete household tasks. Warwick House remains a well run home for adults with autistic spectrum disorders. The acting manager clearly knows the people living at the home well. Observation showed that staff have good relationships with the acting manager. People were seen to be treated with respect and spoken to appropriately. Conversation between staff while providing care always involve people living at the home. Observation and records show that care and support was provided in an individual way with people being encouraged to be as independent as possible. Assessments care plans and risk assessments are detailed and clearly identify the support each person needs to achieve their goals. The acting manager has ensured that people living at the home continue to be encouraged to have access to a wide range of educational, social and leisure activities both in the home and in the local community. They are also encouraged to maintain family contact. The home operates a key worker system, which ensures that individual peoples needs are met. The home has a good relationship with health and social care professionals who provide support for people living at Warwick House. One comment received from a health care professional stated, I have generally been very impressed by my contact with Warwick House. There was a robust staff recruitment procedure in place and the staff training program remains comprehensive. This should protect people from unsuitable staff. Staff receive training to help them do their jobs well. Training was relevant to the care needs of the people living at Warwick House. This should ensure that people continue to be cared for by a knowledgeable staff team. What has got better from the last inspection What the care home could do better Not all staff have a formal training and development plan recorded, which was based on their training needs and the needs of the service. Providing this would ensure that the training arranged for staff will continue to meet their needs and the needs of the people they care for. Not all recruitment information was provided at the home for new staff. New staff records are held at head office until all recruitment checks are completed. This could mean the manager does not have all the information they need about the new staff member easily available before they start work at the home. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Rachel Proctor 4th Floor Colston 33 Colston Avenue Bristol BS1 4UA 0117 930 7110 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535 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 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living at Warwick House are given sufficient information for them to make an informed choice regarding whether the home can meet their needs. The assessment process adopted by the manager ensures people have comprehensive assessments completed for all their care needs. People are involved and encouraged to participate in the assessment and care planning process. This should ensure that people receive care in the way they need and expect. Evidence: The acting manager advised that she was in the process of updating the service users guide. She further commented that this would enable the information to be provided in a way that was easier for people to understand. The preinspection information indicated that, A statement of purpose and service user guide was available for all new people and provides information about the home and the organization. The statement of purpose and service uses guide was available for people living in the home and other interested people. Four of the five people living in the home who returned surveys indicated they were asked if they wanted to move into the home. Three of the five people indicated they were given enough information about the home before they moved in so they could decide if it was right for them. One said they couldnt remember and the other no information was given. One of the five people living in the home had their care followed as part of the inspection. They had clear comprehensive assessments completed, which identified their health, personal and social care needs. The acting manager advised that Evidence: assessments are completed with the individuals and their individual choices and wishes are recorded as part of the assessment. The assessment identified the persons selfcare ability and things that the staff should help and support them with. Three people who were spoken with during the inspection said staff had spoken with them about the help they needed. The acting manager advised that individual people living in the home had communication books My Views, which gave information about them and what was important to them in an easy read format. She further commented these are developed with the person and the contents agreed with them. It was noted that the person had signed these. 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 living at Warwick house can have confidence that their individuality will be respected and care will be planned with them around their personal choices where possible. Evidence: Comprehensive plans of care had been developed for the five people living at Warwick House. One person had their care followed and their plan of care was looked at in detail. Two other plans of care were looked at as part of the inspection. Care plans had been agreed with the individual who had signed the plan of care. Care plans included the persons personal, social support and health care needs. Self-care ability was recognized as part of the care plan. Care plans provided information about what the person needed help and support with and what they could do for themselves. The person whose care was followed had a plan of care that recognized their physical and mental health care needs. Mental Capacity assessments had been completed for the person as part of the risk assessment process. These showed what the person could do and what they needed help with to achieve the goal they had set in their care plan. For example, the person was being encouraged to participate in household chores. Working in the kitchen was an area the person needed support to complete tasks. The acting manager advised that she and the staff team encourage people to do things for themselves and be involved in the day to day tasks in the home. One person had chosen to sit in the quite lounge and look at photographs. They were being encouraged Evidence: by staff to look at their photographs and talk about who the people were in the pictures. Three peoples individual rooms were entered with their permission. Each had an activity sheet for the week in their rooms, which showed the activities, arranged for them. One person spoken to said they had talked to staff about the type of things they enjoyed doing. And the activities for the week had been coordinated around the things they had chosen to do. Each person living in the home had an identified key workers who worked with them on an individual basis to help them with the goals they had agreed or assist with their day to day care and support. Their plans of care seen had been reviewed six monthly with the person, their care manager, staff at the home and family if this was the persons wish. Reviews identified what the person had achieved since their last review and the goals for the next six months. The acting manager advised that reviews take place sooner if the persons care needs change. The involvement of the multidisciplinary team including health professionals was clearly recorded in the reviews looked at during the inspection. The plans of care clearly showed how individual choices had been made and any restrictions had been agreed with the person. Risk management assessments had been completed for all the activities the person whose care was followed took part in. These showed the persons self care ability and how staff should minimize the risk to the person. The acting manager advised that people are encouraged to manage their own finances where possible. One person living in the home had been out with a member of staff shopping on the morning of the inspection. They had chosen what they wanted to buy with the support of the staff member. There care plan identified that they enjoyed shopping. Three of the people living at Warwick House spoken with said they liked living there. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living at Warwick House are encouraged and enabled to take part in activities of their choice outside the home. This means their personal preferences and choices are promoted and facilitated by the staff team where possible. Evidence: The following information was provided prior to this inspection. Service users are enabled to take a full part in the running of their own home and in accessing their local community. Whilst each service user has their individual preferences in how much they get involved in their community or in the running of the home, each service user has the opportunity to participate fully should they wish to. Service users are all supported and expected to get involved in the running of the home e.g. domestic tasks, cooking, shopping, gardening. This was found to be the case during the inspection. People living in the home were being encouraged to participate in household tasks. One person said they had dusted the communal lounge that morning. Another person said they were asked about any changes that were being considered. People living at the home are expected to assist in the running of the home. With support they keep their own rooms clean and are encouraged to help with other household tasks such as cleaning and washing up. During the inspection the three people spoken with said how much they appreciated the support provided by the staff. People living at the home were accessing local amenities and going out to shops during Evidence: the inspection with staff members. The deputy manager advised that people are enabled to take part in activities of their choice with the support of staff when ever possible. And weekly discussions take place with people living at the home regarding activities they would like to take part in. Two of the people living at the home were going out for a walk along the coast with a member of staff during the afternoon of the inspection. When they returned one person said they regularly go out for walks with a staff member when the weather allows. Peoples records show that they are all encouraged to participate in a wide range of activities both in the home and in the local community. People had an activities sheet showing their program for the week. The acting manager advised that this could be changed if the person wants to do something different on the day. One person said they enjoyed horse riding and were pleased that a new riding school had been found to enable them to go horse riding. Their activity plan in their room had a record of this. A newsletter was seen in the peoples care plan information. The acting manager advised that this was also sent to parents every three months giving information about what their relative has been doing and where they have been and includes photographs. A response from a relative to the newsletter was seen in one persons plan of care. The staff have access to cars, which can be used to take people to appointments and to attend college or social events. Staff records show that staff have copies of driving license and insurance information. The acting manager advised that a gateway club for people with learning difficulties was available for those who wanted to attend. One person asked said they were looking forward to attending this later that day. The acting manager advised that annual holidays are organized for the people living at the home on a group basis at present. She also advised that people are able to choose where they spend their holiday. One person spoken with said how much they enjoyed the holiday last year and were looking forward to this years holiday, which was probably going to be in Wales. Peoples preferences for food are recorded in their plan of care. The acting manager advised that menus are developed with people living in the home and are reviewed regularly. The menu was available during the inspection. One person told us they were pleased with the progress they had made loosing weight when they returned from a slimming club during the inspection. The acting manager advised that staff had encouraged them and provided information about different types of food to help them loose weight. People living at Warwick House are able to make their own drinks under supervision and work alongside staff preparing some food if they have been assessed as able. The lunchtime meal was shared with the people living at Warwick House. This was unhurried with people eating their meals at their own pace. Staff advised that they always share meals times with the people living at the home. Lively conversations about the days events and other topics were discussed at lunchtime with staff and people living at the home taking part. 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 . Staff provide sensitive and flexible personal support and care to maximize peoples rights to privacy, dignity, independence and choice over their own life. Staff also have a good awareness regarding peoples health and emotional needs which has allowed them to provide care for people in a way that supports their individuality and meets their care needs. Evidence: One of the five people living at Warwick House had their care followed as part of this inspection. The individual plan of care had been up dated and reviewed at least six monthly. Involvement of the individual was clearly stated. The persons individual preferences and choices were an integral part of the plan of care. The person whose care was followed had clear information about the household tasks they help with and what they could and couldnt do. Risk assessments were an integral part of the care planning process. This included risk assessments for the activities the person had chosen to participate in such as going on holidays, gardening and visits outside the home to local facilities. A record of input from health care professionals was clearly recorded in the plan of care. This included consultants, community nurses, physiotherapists and occupational therapists. A record of health professional visits was being kept with individual care plans. This included GP visits and the treatment recommended. Letters from local NHS advising of appointments were also being kept with the persons care plan. The person whose care was followed was identified as lacking capacity to manage some tasks independently. A clear risk assessment had been completed for each task the person took part in. This had been followed up in the care plan to identify what actions staff Evidence: should take to reduce risk and maintain the persons autonomy as far as possible. Comments received from a health professional included. Provides excellent personal care to severely affected younger people of various kinds. I have generally been very impressed by my contact with Warwick house. The acting manager advised that the home operates a key worker system, which ensures that each persons individual needs are met. Support required with personal care was recorded in the peoples individual care plans including how that support should be provided. For example what assistance was required with bathing, whether the member of staff remains in the bathroom or in the vicinity. Prompts regarding aspects of personal care are given as required and recorded in the daily records. The person care plan whose care was followed provided evidence that were involved in managing their own health care and that health care professionals are accessed as required. Two other plans of care for people living in the home seen during the inspection provided clear information regarding how their care should be provided and what supported they needed from the staff. The daily records completed for individuals showed that staff provided support as identified by the care plan or as requested by the person. Peoples medication was noted as being stored and administered correctly. The home manager and staff team continue to use a recognized monitored dosage system. The acting manager advised that a signing in and out book for peoples medication was still in use. This provided a clear audit trail when people needed medication when away from the home. Each person had a lockable box and medication was contained in blister packs. Two peoples medication records were inspected and the medication being stored for them seen. These had been recorded appropriately. A system was in place to record controlled drugs used by people living at the home. A record of medication disposal for medication no longer required was being kept. The staff member responsible had signed this record. Reference books relating to medication were provided for staff use. The manager confirmed that staff receive training for medication management. 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 . The home has a complaints procedure and arrangements for protecting people from abuse, which staff understand. This should ensure people are confident that the staff team who care for them will deal with any concerns they have sensitively. Evidence: The home has an appropriate complaints procedure, which was included in the service users guide. A copy of this complaint procedure was also available within the home. The Care Quality Commission has received no complaint about Warwick House since the last inspection. The anonymous surveys returned to the Commission from people living at Warwick House indicated: - 5 said they knew who to speak to it that we not happy. 3 said they knew how to make a complaint and two said they didnt. The pre inspection information had indicated that the homes staff team needed, To ensure that the service users are always aware of the complaints procedures within the home. This shows awareness of the feedback the Commission has received. And that they were working to try to ensure people living in the home knew how to make a complaint. The home has policies and procedures for adult protection, in line with the local multiagency code of practice. Reference information was also provided for staff in the office of the home. This included information about the Mental Capacity Act. The acting manager confirmed that all staff have received training in adult protection, this was documented in training records viewed during the inspection. Training included challenging behavior positive behavior management as well as protection of vulnerable adult training. The staff questionnaires returned indicated that they felt confident that the Vulnerable Adult policies were a means to protect very vulnerable people and that they also felt the policies informed and supported them in their work. Staff spoken with during the inspection confirmed this. One comment received from a staff member indicated. We have an official complaints procedure, in policy procedure files. Details of this are Evidence: available on display in the foyer of the home and offices. The information returned to the Commission by the manager prior to this inspection included the following statement. Staff are reminded of the procedures that are put into place about complaints. Managers reports are submitted monthly and complaints are highlighted and recorded in this report. 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 . Warwick House provides people with a homely, comfortable and safe environment in which to live. Evidence: A tour of the home was completed with the acting manager. All communal areas and were visited. The laundry room and kitchen were also viewed during the inspection. Three of the rooms people were using individually were entered during the inspection with the persons agreement. Their rooms had been personalized with items of the persons choice. This included soft furnishings, posters and pictures. The acting manager advised that people are encouraged to choose the decoration for their own rooms with support from staff. Two people spoken with in their own rooms confirmed they had been able to chose the colour scheme for their rooms. All those spoken to during the inspection said they liked the rooms they had. The manager prior to this inspection provided the following information. Maintenance checks are carried out on a weekly basis and maintenance request forms are completed and submitted to head office for work to be carried out. All staff are trained in health and safety, food hygiene, and all the mandatory training required to keep the environment safe. An environmental risk assessment is carried out on a yearly basis. Records were seen relating to maintenance and health and safety management of the home. Observation made during the inspection indicated that the home was well maintained and health and safety checks are carried out as stated. The laundry area was well organized. Hazardous substances such as cleaning materials are stored in a locked cupboard. All areas seen during the inspection were clean and hygienic and the home was free from offensive odour. Information received prior to this inspection stated that eighteen of the twenty-two staff had received infection control training and four were due to have refresher training for this. Evidence: 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 . Warwick House employs sufficient staff who have the skills, training and understanding to meet the needs of the people who live there. Evidence: Since our last inspection the registered manager has been promoted to a senior position within the organisation. At the time of the inspection an acting manager who had previously been a deputy was managing the home. The acting manager advised that she continues to be supported by the previous manager for the home. The information provided in the training matrix showed that the acting manager was working towards an NVQ level 3. Staff spoken with during the inspection said they felt supported to do their work. One comment received from a staff member indicated, Care plans are regularly reviewed and updated. Staff are encouraged to read service users plans on a regular basis. The acting manager provided a training matrix, which showed the training staff had completed. The training included specific specialist training relating to the needs of the people living Warwick house. The matrix showed which staff have achieved an NVQ level 2 or above in care. And those working towards this qualification. The preinspection information provided for the Commission prior to this inspection indicated that eight of the twenty two care workers employed had already achieved an NVQ level 2 or above in care. And a further six staff were working towards this qualification. One staff member commented in an anonymous survey, Modus have an excellent training schedule. Any ideas for new training that staff feel would be beneficial is looked into and can be arranged if managers feel it is relevant. People living at home spoken with during the inspection were complimentary about the way staff supported them and understood their needs. Two staff files were reviewed during the inspection. These showed that pre- Evidence: employment checks are carried out prior to any new member of staff starting work. Each file had an application form, proof of identity, two references and proof of the police check are being completed. The recruitment practices in place should protect people from unsuitable staff. However one new member of staff didnt have all their recruitment details at the home. The manager advised that until the recruitment process was completed staff information was kept at head office. During the inspection the acting manager was able to confirm that all pre-employment recruitment checks had been completed by contacting the head office. The acting manager advised that the training staff need was discussed with them during supervision sessions. Examples of completed supervision sessions are available for inspection. The staff who responded to the anonymous survey indicated that their manager met with them every six to twelve weeks one commenting, our manager operates an open door policy. The training matrix showed the type of training staff have access to. The manager advised that the training staff receive was linked to the needs of the people living at the home. The home caters for people with autism, the training record show that all staff have received training in this area and refresher training was organised every three years. Information available showed that the induction program used by the acting home manager covers skills for care guidelines. Staff who responded to the anonymous survey indicated that the induction covered what they needed to know. The acting manager showed how supervision was coordinated and managed for staff working in the home. A calendar on the wall in the office showed when staff supervision was due and the date it was planned. Staff who responded to the anonymous survey indicated that they receive supervision on a regular basis from the line manager. The acting manager advised that an appraisal system was being developed, which would include training and development plan for staff working at the home. This was in addition to the supervision was already taking place. 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 . People living at Warwick House can be confidant that the home is well run and that their views will be taken into consideration in the plans for the home. Evidence: Warwick House is part of a larger company Modus, which provides a supportive structure to enable the manager to run the home. Since the last inspection there has been a change of manager. The registered manager had been promoted to a senior position with in the company. The acting manager advised that the previous registered manager had continued to support their management of the home. In discussion the acting manager showed a good understanding of the needs of the people living at Warwick House, their behavior and how this should be managed. They were also aware of the training the staff needed in order to fulfill their role. The three people living at the home who were spoken with during the inspection said how much they liked living at Warwick House. They said that they were able to speak to staff about things that concerned them and staff listen to what they said. A quality monitoring system was in place. Information relating to care practice and maintenance checks were available in the quality-monitoring file kept in the office of the home. The acting manager advised that that three relatives surveys had been returned in January. The acting manager also stated that regular staff meetings and senior and management meetings regularly take place. Copies of Regulation 26 reports were also being kept in this file. The results of quality assurance carried out are discussed with people living at the home at weekly meetings. Any issues or plans to up date the environment are agreed with the people living in the home. One person living in the home said they had been involved in the choices that had been made regarding Evidence: redecoration of the lounge as well as their own room. The manager provided the following information prior to the inspection. A yearly development plan has been implemented within the unit, which integrates various documents, to ensure that action points from these documents are followed up within the agreed timescale. This was provided during the inspection and clearly showed plans for the unit. Risk assessments were seen to be an integral part of the management processes for Warwick house. These had been reviewed regularly as required and actions taken to address identified risks. The fire logbook was up to date and health and safety checks had been completed. The manager advised that policies and procedures were currently being reviewed. Information in the staff files and training matrix shows that staff training includes first aid, infection control and food hygiene. Accidents and incidents had been recorded including action to be taken to reduce the likelihood of a reoccurrence. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 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 34 Information relating to new staff recruitment, application forms, references and police checks should be available at the home prior to the person starting work and not just at head office. A record of staff annual appraisals with their line manager, which includes agreed career development plans should be provided for all staff who work in the home. 2 36 Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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