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Inspection on 13/02/09 for 2 Ling Crescent

Also see our care home review for 2 Ling Crescent for more information

This inspection was carried out on 13th February 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: 2 Ling Crescent 2 Ling Crescent Headley Down Bordon Hampshire GU35 8AY     The quality rating for this care home is:   two star good service 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: Christine Bowman     Date: 1 3 0 2 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. 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. 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. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 03000 616161 (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. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: 2 Ling Crescent 2 Ling Crescent Headley Down Bordon Hampshire GU35 8AY 01428713014 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): ling@robinia.co.uk Robinia Care Ltd Name of registered manager (if applicable) Miss Donna Sebastian-Todd Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: 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 disability (LD). Date of last inspection Brief description of the care home 2-4 Ling Crescent is a care home for 6 younger adults with learning disabilities. The home is similar in appearance to neighbouring properties and is situated on a small housing estate in Headley Down, Hampshire. All residents are accommodated in single rooms and have the use of two communal lounges and a separate dining room. The home has a large enclosed rear garden that is accessible to the residents. The home is owned and operated by Robinia Care Limited, an organisation that has been a care provider since 1995. The fees range from #1,018.75 to #1801.75 per week. Care Homes for Adults (18-65 years) Page 4 of 29 care home 6 Over 65 0 6 Care Homes for Adults (18-65 years) Page 5 of 29 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 inspection report includes information gathered about the service since the previous site visit on 7th March 2007 under the Commissions Inspecting for Better Lives (ILB) process. An Annual Quality Assurance Assessment (AQAA) was completed, giving up to date factual evidence about the running of the home and informing us of what they think they are doing well, how they have improved the service and of their plans for further improvements. No surveys were returned on behalf of the service users, and they were not at home on the day of the site visit, so outcomes have been assessed on their behalf on other evidence provided. One staff member and one healthcare professional, each returned a survey, giving their views on the service. An unannounced site visit was conducted on 13th February 2009, to assess the outcomes of the key inspection standards for younger adults with respect to the service users Care Homes for Adults (18-65 years) Page 6 of 29 living at the homes. The registered manager, Miss Donna Sebastian-Todd, was on annual leave, but kindly changed her schedule to make herself available to assist with the inspection process, by making service user and staff files and other documents available to be sampled. A tour of the home was undertaken and some of the service users bedrooms and the communal areas were viewed. The staff on duty were accompanying the service users on a trip to an activity centre in Southampton, so their views could not be sought or their practise observed. Service user and staff records, maintenance certificates, complaints and compliments logs were sampled and some policies and procedures were viewed. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get Care Homes for Adults (18-65 years) Page 8 of 29 printed copies from enquiries@cqc.org.uk or by telephoning our order line –03000 616161. Care Homes for Adults (18-65 years) Page 9 of 29 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 29 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 can be assured that this home will only accept them if their needs can be met, will ensure their full involvement in the assessment process, and collate the appropriate information into an individual support plan, which is meaningful and accessible to them. Evidence: The service user guide was in the process of being up-dated at the time of the site visit to be more accessible to future prospective service users, to give them more information about the local services available in the area, in addition to relevant information about the home, and to help them to decide if this home was right for them. There had been no admissions since the previous site visit, and one discharge had meant that there was a possibility of a new service user being introduced to the home. The manager stated, No admission would occur if we were unable to meet the needs of an individual. The home caters for the needs of adults on the Autistic Spectrum with learning disabilities, who may display challenging behaviour, and, as we specialise in this field, I ensure that the staff receive training to support these Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: needs, which is updated and reviewed on a regular basis. Assessment documentation sampled, confirmed that a thorough assessment of the service users needs had been carried out prior to moving into the home. This covered health and sensory needs, medication, specific conditions, physical abilities including fine and gross motor skills, psychological and mental health, behaviour, lifestyle and risks to a healthy lifestyle. Information with respect to the individuals ethnic background, religious belief, family and other social involvement, and cultural needs had been recorded for consideration in the drawing up of the care plan. The manager recorded in the AQAA, any new potential service users will undergo a full assessment with the input of their family, friends, the community learning disability team, care management and an independent advocate if necessary, and this will be undertaken using the correct communication method for the potential service user, as it is important that we listen to their views and opinions, as they are potentially going to be living here. The transition process will also include compatibility with others living in the home and involve visits to the home and overnight stays. Care Homes for Adults (18-65 years) Page 12 of 29 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. Person-centred planning promotes the involvement of the service users in decisionmaking about their lives with appropriate support and independence is promoted. Service users are enabled to take risks and positive strategies are in place to guide the staff to support them and keep them safe. Evidence: The manager stated that she was in the process of updating all the service users care plans, which are now entitled support plans and outline the needs and associated risks involved in the receiving of support for personal care, and nature of the support required by each individual, whilst promoting their independence. The extent of the individuals ability to complete personal care tasks independently was recorded in the support plans sampled and the support required, taking into consideration the preferences and likes and dislikes of the service user to inform the staff, and to ensure the tasks were carried out with the co-operation of the individual and not done to them. Service users method of communication was recorded and included non-verbal Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: communication, gestures, signs, sounds, some key words relating to a number of different things and some Maketon signs. In one support plan staff were instructed not to talk too fast. The manager stated in the AQAA that, the service users and families have had as much involvement as possible with the support planning, and where specialist support is needed, the local community learning disability team has had input in the process of putting these plans into place. The manager had attended training on the Mental Capacity Act and relevant information with respect to what to do in circumstances where consent was required was recorded. Records confirmed that support plans were kept up to date and flexible to the needs of the service users with six monthly reviews. The manager wrote in the AQAA that, as a result of listening to the people who use the service, we have highlighted a need to improve individual service users communication to empower them to make their own decisions, and have purchased a communication and print package for the computer to promote this. A service users recent review of their care plan had been completed in a personcentred way to facilitate their understanding and to show how they had been involved in decision-making. Photographs and colourful symbols were used to illustrate the document, which gave a full picture of what they had done over the previous year. This service user had planned their own birthday celebration and been involved in the recruitment of a new member of staff to provide their one to one support. They had helped to design the job specific profile and interviewed the applicants with the manager, the manager stated. Risks were identified with respect to the environment and support plans included care actions to reduce risks. In the event of a service user displaying behaviours described as challenging, warning signs and situational triggers were described and proactive or positive strategies were used, with clear instructions recorded, giving the staff steps to follow on how to respond at each stage to keep the situation calm and reduce risks. Risk assessments viewed had been reviewed in a timely manner and the manager was in the process of making them more accessible to the service users by using the new computer software to provide symbols and writing them in a person-centred way. Care Homes for Adults (18-65 years) Page 14 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users take part in appropriate activities that take account of their needs and preferences, they are supported to maintain personal relationships and to be part of the local community. Service users rights are recognised and they are offered a healthy diet that reflects their individual tastes and dietary needs. Evidence: On the day of the site visit, all the service users were attending an activity centre in Southampton. As they were leaving in the minibus, provided by the organisation, a staff member stated that the service users would be canoeing if the weather was fine or alternatively doing archery. The AQAA recorded that, the service users access an activity centre every Friday, where activities include archery, motor boating, canoeing, rambling, farm visits and a zip wire and a ropes course and service users can choose to participate on the day. The home also had the use of a car to access the Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: community, but the manager stated that, the Service users at Ling Crescent are also encouraged to use public transport with the support of staff. They have annual bus passes, which are renewed each year, and these allow free bus travel. Service users support plans showed that The Grove Day Centre provided education and training for the service users, but the manager stated that, external education had been sought for one service user, that music sessions were being arranged at the home, and that horseriding was now being provided individually and externally. Some of the sessions enjoyed by the service users at the centre, included drumming, communication and cookery and were recorded on their individual timetables. One service user, who attended an external day centre, also enjoyed art and craft, walking, helping in the post office and had made some new friends. The manager wrote in the AQAA, we actively promote social intergration within the local community and surrounding areas. Some of the service users have built up a circle of friends from people who live close by or work in the local ammenities, as they use these often. We ensure that time is scheduled in to access local ammenities such as pubs, resturants, hairdressers and local shops. Relatives were invited to review meetings and records confirmed that service users met relatives for meals, and spent short breaks with them. One service user recorded in their review notes that, at the disco for their birthday party, they had, invited their parents, and enjoyed a dance with their dad. Daily records were kept of service users meals and snacks to ensure they had accessed a balanced and nutritious diet. Special dietary requirements and preferences were recorded in service users support plans to inform the staff. A pictorial menu was used to help the service users to make their choices. It was evident from service users support plans that they were involved in home skills, food shopping and cooking to promote their independence. Care Homes for Adults (18-65 years) Page 16 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users personal and healthcare needs are met according to their preferences and safe procedures are in place to promote their access to medication. Evidence: Service Users individual support and person centred plans recorded their preferences. Any sensitive personal support was highlighted and the guidance to the staff promoted the service users dignity, independence, rights and privacy. Records confirmed that service users were supported to go shopping to buy personal items such as clothes and toiletries of their choice. The manager wrote in the AQAA, bath times and bedtimes are flexible according to the choice of individual service users. A staff member, who completed a survey, confirmed they always had the right support, experience and knowledge to meet the different needs of the service users with respect to equality and diversity issues. The key worker system provided consistency and continuity of care to the service users and good staff retention meant that those working with the service users knew them well. A social care professional commented, my client used to wear age inappropriate clothing, prior to living at Ling Crescent, they now dress in a very appropriate way. Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: Assessments sampled covered the service user healthcare needs including medical history, medication, special needs such as epilepsy, oral and dental care, and sensory needs, and support plans showed how the service supported the individuals to meet those assessed needs. Service users had healthcare plans written in a person-centred way and giving details of the professionals involved in their care such as the General Practitioners (GP), dentists, opticians and psychiatrists. The manager stated that the provider company had their own occupational therapist and physiotherapist, who readily offer advice and guidance, and a full time specialist in behaviour management and physical intervention was also available to offer support. Healthcare appointments were recorded, confirming that service users had undertaken annual medical examinations, and recent appointments with a GP and an optician informed the staff of the specialist advice given and prescribed medication. The community learning disability nurse, epilepsy nurse, speech and language therapist, dietician and psychiatrist were accessed through the GP, the manager stated. One service user had accessed Indian Head Massage, for relaxation and the home had a sensory room, which was in the process of redecoration. When completed, the manager stated, it will be provided with fibre-optics, coloured lights, bubble tubes, mobiles, music and other aids to relaxation. Medication was stored appropriately and was blister-packed at the local pharmacy for safety and convenience. Records were kept of medication received and returned to the pharmacy, and a sample of one service users medication, confirmed that the balance of medication recorded was correct. A controlled drug was recorded in the controlled drugs register and each entry was double signed for safety. The manager stated that updated medication training had been undertaken in December 2008 and that staff were only permitted to administer medication after training and confirmation of competence. The manager recorded in the AQAA, as a company we have started to have medication audits completed by an external company. We are reviewing our medication policy with them, and have started to audit medication each time it is administered. New internal medication assessments for staff have been introduced and these are to be completed annually. Care Homes for Adults (18-65 years) Page 18 of 29 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 endeavours to ensure that the communication needs of the residents are met to enable them to make their feelings, wishes and views know so they may be acted upon, and a full complaints procedure is provided. Service users are safeguarded from abuse, neglect and self-harm and the home takes action to follow up allegations. Evidence: A complaints procedure was displayed in the home and was included in the service user guide. All the service users had allocated key workers, all of whom had been working at the home for more than two years. They spent time working closely with them and understood their needs well. Care documentation indicated to the staff, how the service users expressed their feelings, and suggested to them what non-verbal signs and body language might mean. A staff member confirmed, in the survey they completed, that they knew what to do if a service user, their relative or representative had concerns about the home. A social care professional, who completed a survey, recorded in the survey they returned, that the care service always responded appropriately if concerns had been raised about service users care. They commented, I have always had a prompt response to my enquiries. One complaint had been received since the previous site visit and records confirmed that this had been dealt with appropriately. As all the service users were commissioned by different local authorities, the Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: safeguarding information was recorded in the service users files to inform the staff of their referral details. The AQAA recorded that there had been two safeguarding referrals, one of which, had resulted the staff team being reduced by two for more than a year, and the second, which had led to the discharge of a service user, for whom the placement had become unsuitable. Correct procedures had been followed to protect the service users living at the home. The manager had completed the local authority safeguarding training and the staff accessed regular training refresher updates organised by the provider organisations training manager, which included Adult Abuse Awareness, whistle blowing, and the No Secrets guidance. The staff were also trained to work with people whose behaviour could be challenging. Care Homes for Adults (18-65 years) Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a comfortable, homely and safe environment, which meets their needs and is clean and hygienic. Evidence: The home was located in a residential area and was similar to the adjacent homes. It was made up of two semi-detached houses, which had been made into one, to accommodate six service users, and was within easy reach of local facilities. A social care professional commented on what they felt the care service does well, this service balances the offering of person-centred care, which reflects individual choice, with providing a safe and supportive environment, able to deal with behaviours that may cause service users injury. They also thought the care service could improve, by providing smaller units of two or three people. A tour of the premises was undertaken and the communal accommodation and some of the service users bedrooms were sampled. There were two sitting rooms at opposite ends of the home, both equipped with televisions and other musical entertainment equipment for the service users enjoyment. Comfortable seating and plants, gave the house a homely feel. One of the sitting rooms contained a fish tank and there were Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: framed photographs of service users engaging in a variety of activities displayed on the walls. In the conservatory, which was accessed through one of the sitting rooms, were some tables and art materials. A large painting was displayed on the wall along with photographs of the service users involved in creating the picture. The garden, which could be accessed from the conservatory, was mostly laid to lawn and contained a large trampoline and outdoor seating for use in the warmer weather, and a bird table to provide winter interest for the service users. The dining room, which was adjacent to the large modern fitted kitchen, contained two large solid tables, which could be moved together for celebrations. A small room, which was in the process of re-decoration, was the designated sensory room. Service users bedrooms were personalised with photographs, posters, pictures and objects of special interest. One service user was particularly interested in music, and had posters of pop stars and a large modern art picture, which they had chosen because of its texture and for the fact that it made a noise when touched. Another service user had a touch screen computer in their bedroom, a collection of large cushions, and soft toys, mobiles and photographs of themselves on the fastest rollercoaster ride at Thorpe Park. Bedrooms were well colour co-ordinated and the manager stated that the service users had chosen their bedroom furniture and soft furnishings. Bedrooms were fitted with hand basins, and bathrooms were equipped with specialist equipment required by individual service users. The utility room contained all the necessary equipment for laundering the service users clothes and bedding, and each service user had their own named laundry baskets for taking their soiled linen to be washed, and for returning the clean articles. Infection control facilities included a separate basin for hand washing, and one was also provided in the kitchen, along with disposable paper towels, and liquid soap. The Control of Substances Hazardous to Health (COSHH) cupboard was secure to safeguard the service users and the manager wrote in the AQAA, the staff attend infection control and health and safety training annually, and risk assessments are in place for infection control. The home was clean and hygienic on the day of the site visit. Care Homes for Adults (18-65 years) Page 22 of 29 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. Staff, who have been safely recruited, and receive the right training and support provide consistency and continuity of support to the service users. Evidence: A service user had recently been involved in the process of recruiting a member of staff to provide their one-to-one support. The planning of this process and the eventual outcome were recorded in a person-centred way in the service users review. However, the new staff member had not yet taken up the post, as recruitment checks had not been received, and the file was with the personnel department of the provider company. No other staff had been recruited since the previous site visit and the last report confirmed that the staff had been safely recruited. A staff member, who completed a survey, also confirmed that their employer had carried out checks, such as Criminal Record Bureau and references before they started work. The AQAA recorded that 60 of the permanent staff had achieved a National Vocational Qualification (NVQ) at level 2 or 3 in Health and Social Care, also that one was working towards a level 3, and another had completed an NVQ at level 4, in addition to the manager. All staff had a record of their professional development and the manager confirmed this was reviewed regularly at supervision meetings. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: Staff records sampled, confirmed that the staff had accessed mandatory training including Moving and Handling, Food Hygiene, Health and Safety, Infection Control, the Protection of Vulnerable Adults, Medication, Fire Safety and First Aid. Other training accessed by the staff included Communication, Disability Awareness, Personal Care, Safeguarding Adults (provided by the local authority), Equality and Diversity, Autism, Epilepsy, Behaviour Management and Physical Intervention, and Visual Impairment and Learning Disability. Workbooks had been completed and Certificates for working with People with Learning Disabilities had been achieved. A staff member, who completed a survey recorded that their induction covered everything they needed to know to do the job when they started, very well, and that they were being given training, which is relevant to their role, helps them understand and meet the needs of the service users with respect to equality and diversity issues, and keeps them up with new ways of working. Care Homes for Adults (18-65 years) Page 24 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported to make their views known and to influence the way the home is run, ensuring it is managed in their best interests. Their health, safety and welfare are promoted. Evidence: Since the previous site visit the acting managers application to register with the CSCI, as registered manager for the home, had been accepted. The manager had already achieved a National Vocational Qualification at level 4 in care, has had ten years experience in the care profession, including three and a half years of management experience, and had recently submitted the Registered Managers Award for approval. Over the last twelve months, she had completed the Mental Capacity Act training, and training to proactively work with service users, whose behaviour may be challenging. She had undertaken the appointed person and First Aid at work training and attended the local authority Safeguarding, train the trainer training. She also had plans to complete the Deprivation of Liberty training, provided by the local authority. Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: The AQAA recorded that, annual questionnaires are sent out to families, service users, and staff and the feedback recorded and acted upon. Service user files confirmed that annual reviews had been held. A recent review showed that a service user had been supported to present a person-centred report on their achievements and development over the previous year, and their aspirations for the forthcoming year. The manager stated that, care management, relatives, and other important people, service users would like to attend reviews, are invited. To ensure that the views of people who use the service are promoted and incorporated into the development of the service, each service user is assigned a key worker of their choice to work with them on a one to one basis. As a result of listening to people who use our service, the manager wrote in the AQAA, one service user has been to look at an external day centre, has shown interest in attending this on a weekly basis, and we are currently in the process of transferring them, we have highlighted a need to improve individuals communication to empower them to make their own decisions, and have purchased a communication and print package for the computer to promote this, a service user is in the process of choosing new designs for flooring and wall coverings in their bedroom, and evening activities have increased including an outing to a local pub for an open microphone night. The AQAA recorded that equipment had been serviced or tested as recommended by the manufacturer or other regulatory body, and certificates for the gas appliances and fire alarm system sampled, confirmed they had been serviced within the last twelve months. Records confirmed that fire training had been conducted at the home on 28th January 2009 and staff training and development logs included certificates for food hygiene, first aid, health and safety, moving and handling and infection control training. Records were kept of accidents and other serious incidences and the home kept the Commission for Social Care Inspection appropriately informed of such events. There was an ongoing programme of maintenance and repair. Care Homes for Adults (18-65 years) Page 26 of 29 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 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 28 of 29 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. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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