Inspection on 12/03/09 for 44 Massetts Road

This inspection was carried out on 12th 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.

Other inspections for this house

44 Massetts Road 13/02/07

44 Massetts Road 04/10/05

44 Massetts Road 05/05/05

44 Massetts Road 09/12/04

44 Massetts Road 08/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 44 Massetts Road 44 Massetts Road Horley Surrey RH6 7DS     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: Jane Jewell     Date: 1 2 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. 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 34 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. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: 44 Massetts Road 44 Massetts Road Horley Surrey RH6 7DS 01293822161 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): massetts@prospectha.org.uk Prospect Housing and Support Services Name of registered manager (if applicable) Mr Stephen Tidey Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 7. 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: Mental disorder, excluding learning disability or dementia (MD). Date of last inspection Brief description of the care home The premises are a large detached domestic house converted over the years for residential accommodation. The home is managed by Prospect Housing a registered charity who also have other registered care homes. The home has been operating for thirteen years and is registered to provide care and accommodation for up to seven people who have a past or present mental health condition. The home aims to provided programmes of rehabilitation with a view to some residents moving to a more Care Homes for Adults (18-65 years) Page 4 of 34 care home 7 Over 65 0 7 Brief description of the care home independent lifestyle. The home is located within walking distance of Horley town centre with bus links close by. Residents accommodation is for single occupancy arranged over two floors with stairs providing access to the first floor. There are communal toilets and bathing facilities. The communal areas include a lounge, dining room, kitchen and conservatory which opens out onto a large garden. Care Homes for Adults (18-65 years) Page 5 of 34 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: The information contained in this report has been comprised from an unannounced inspection undertaken over seven hours and information gathered about the home before and after the inspection. The manager had comprehensively completed an Annual Quality Assurance Assessment (AQAA) form prior to the inspection and the information contained in this document has been used to inform the inspection process. The inspection was facilitated in part by the registered manager (Stephen Tidy) Deputy Manager and Assistant Director of learning disabilities. The inspection consisted of a tour of the premises, examination of the homes documentation and in depth discussion with four residents and four staff. Two relatives were also consulted about their Care Homes for Adults (18-65 years) Page 6 of 34 experiences at the home. Feedback surveys were sent to the home for distribution in order to obtain the views on the quality of the services and facilities being provided. Twelve were returned in total, four from residents, six from staff one from a health care professional and one from a relative. Their feedback is included in this report. There were five residents living at the home at the time of the inspection. What the care home does well: The home submitted an application to deregister from a care home in late 2008 with the intention of the premises them providing supported accommodation to other individuals. This application was subsequently put on hold by the provider who stated that their decision was based on a resident who had been assessed as requiring residential care. Residents have submitted a legal challenge regarding the closure of the home. It is commendable that despite the uncertainty over the future of the home and staffs employment, that management and staff continue to show much commitment to residents achieving their individual goals and the aims of the service with a clear business as usual ethos evident. Residents live in a clean, homely environment, which has been decorated and furnished to a good standard with their bedrooms furnished and decorated according to their individual lifestyles. Comments about the environment included environment clean and comfortable good facilities and clean lovely encouraging atmosphere nice location pleasant garden right next to a bus stop shops nearby, perfect really. The home is able to identify and meet the needs of residents with enduring complex mental health needs in a relaxing and gentle environment with all consulted speaking positively about their day to day experiences at the home. Comments include the staff at the care home provide very good environment atmosphere with supportive interactions with my son Looking after me very well provide a relaxed warm caring supportive environment for the residents best thing about the home is that it is comfortable it is like my family that is why I like it so much and t is s a wonderful place best place ever comfortable relaxed and quiet. Residents benefit from an experienced well qualified management team whos expertise is central to the homes effectiveness and range of residents needs able to be accommodated and met by the home. Management provide a clear ethos and values enabling staff to provide good quality support to residents. Comments about the manager included manager excellent listens very good very encouraging manager good he does good things here and manager brilliant very good and helpful great respect for both of them they may be so busy but they will always give you time. Residents lives are enriched by the promotion of independence and being enabled to live their chosen lifestyle. A residents said you need to be up at a certain time for morning medication but I can do what I like go back to bed and go out whenever I want. A relative said the staff all work hard at positive interactions with the residents and provide a variety of experiences and outings to the local area community which without their support my son would not have the courage to do. Residents are supported to maintain relationships with their families and friends. A relative said I can stay as long as I like. The staff group includes a stable core group who have worked at the home for many years. Their experience, together with supervision and training indicates that they have a good level of competence and understood the aims and objectives of the home and residents individual goals. A staff member said I feel I have the right support through Care Homes for Adults (18-65 years) Page 8 of 34 lots of training and supervision. Residents comments about staff included staff very good help me out a lot all the staff are great we all get on and staff very kind and nice I can talk to them about how I am feeling and they help me sort out any problems I have. Relatives said staff really nice they seem to know what they are doing and Staff absolutely lovely the staff make the place what it is. The home has recently been awarded the Team of the Year by the organisation. The meals are good offering choice and variety. A relative commented Meal time hugely significant as staff sit down also, it is like a family. A resident said You can eat the meal provided which are nice or you can get a takeaway whichever you want staff cook every meal and its always good we can go into the kitchen anytime and make myself a drink or get a snack. Residents benefit from the provision of flexible and respectful personal and health care support that is individual, respects their privacy and dignity and encourages residents to remain as independent as possible. A resident said staff will call the GP if I am not feeling well which they have done very quickly and a relative said staff treat the residents with kindness respect and dignity. 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 Care Homes for Adults (18-65 years) Page 9 of 34 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. Care Homes for Adults (18-65 years) Page 10 of 34 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 11 of 34 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. The home provides both prospective and existing residents with a good range of accessible information about what services are provided and what to expect when living at the home. The home is able to identify and meet the needs of residents with enduring complex mental health needs. The way in which prospective residents are assessed ensures that the home admits only those residents whos needs can be met by living at the home. Evidence: There is a range of well documented and accessible information about the home and the services it provides, this includes a statement of purpose and service user guide which are available at the home and given to prospective residents, their representatives and any other interested parties. Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: There have not been any referrals to the home in six months due to the homes intended de registration. Documents seen for a recent admission showed that residents are accommodated following a comprehensive assessment of their needs. Information about their needs is gathered from a variety of sources including the resident, their representative and health care professionals. The needs assessment then forms the basis of their initial care plan. This helps ensure that staff are aware of the recorded needs of new residents prior to them moving into the home. The manager showed a clear understanding of the range of needs the home is able to safely meet and knowledgeable about admissions practices that help ensure a smooth transition to the home. Residents are all male and aged from forty three upwards. All residents are assessed as having enduring mental health issues including some who have complex mental health needs and one who has some physical needs. The home also admits residents who are under community treatment orders. The aims of the home is to provide long term rehabilitation with a view to some residents being able to move to a more independent lifestyle. A staff member described the aims of the home as we provide a service for people with long standing difficulties with complex needs, motivation can be of difficulty sometimes. Residents have been at the home from six months to twelve years with the vast majority having lived at the home for more than three years. The home also provides short term placements. Through observation, looking at records and speaking to residents it was clear that the home is meeting the needs of residents. Without exception all persons consulted regarding the home spoke positively about their day to day experiences. A sample of their comments include the staff at the care home provide very good environment atmosphere with supportive interactions with my son Looking after me very well although not living there permanently they have been very kind whilst he is staying with them and has settled in with no problems provide a relaxed warm caring supportive environment for the residents best thing about the home is that it is comfortable its like my family that is why I like it so much and It is s a wonderful place best place ever comfortable relaxed and quiet. The manager stated that prospective residents are provided with the opportunity to visit the home in advance to assess the quality, facilities and suitability of the home with their family and representative. The length and type of any visit would depend on the individuals needs and preferences. The first six weeks of residency is looked upon as a trial occupancy. Permanent residency is usually subject to a review of care needs Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: with the residents their representatives and placement authorities. . Residents are provided with assured tenancy agreements with additional terms and conditions attached depending upon the individuals needs. These make explicit the placement arrangements and clarify mutual expectations around rights and responsibilities. Care Homes for Adults (18-65 years) Page 14 of 34 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. Residents benefit from a good care planning process, which provides clear, up to date and accurate information about their needs and goals and the support needed to achieve them. The home balances well the rights of residents to take reasonable risks as part of an independent lifestyle. Residents rights to make decisions as part of their individual lifestyle is actively promoted on a daily basis, however residents felt that major decisions about their long term future they were not involved in. Evidence: Four individual plans of care were inspected and were found to contain comprehensive, detailed and up to date information on residents needs and the appropriate guidance for staff on how to support residents to meet these needs. In line with the Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: rehabilitation aims of the home care plans include clearly identifiable long term goals and the targets leading to their achievement. Regular notes on each resident are made, which recorded the actions and events that have occurred. These were written in a respectful, none judgmental style and were linked to residents individuals goals. This enabled a clear overview of the progress made towards achieving an individual assessed needs. Not all residents expressed an interest in the being involved in the development and review of their care plan but felt able to ask to see them at any time. Staff consulted were very knowledgeable about the individual needs and preferences of residents. Changes in residents needs and preferences were promptly identified through the regular review of care plans. Annual placement reviews are usually held with the placement authorities, residents and health care professional. This helps identify any changes in residents needs and confirms that the home can continue to meet their needs. The home has a developed system in place for enabling residents to take responsible risks as part of an independent lifestyle. For example the main risks faced and posed by residents are assessed and any measures to reduce or manage the risk is recorded in order for staff to follow. Respecting residents rights to make decisions about their lives is integral to the ethos of the home and the promotion of a independent lifestyle and it was clear that on a day to day level residents rights are strongly promoted. Consideration has also been given in residents care plans to new legislation (Mental Capacity Act) which affects residents rights to make decisions in their lives. Consistent feedback was however received from residents, staff and a relative that decisions regarding the deregistration of the home residents have not been actively involved in. This has resulted in residents increased anxiety over their future and frustration over their lack of involvement in major decisions about their lives. A resident said I am happy and settled here I do not want to leave here we are being made to move into another home there is no choice I am anxious at the thought of what is ahead all I want is to stay here. The provider stated in response to this feedback that there is evidence of adequate consultation with residents. Consistent feedback was also received by staff and residents regarding the inconsistent information being shared regarding the de registration process by the organisations representatives and management at the home, which sometimes added to the uncertainly over residents future. Residents spoke of now having an independent advocate appointed by the organisation in order to discuss their concerns regarding their future and legal advocates to ensure their rights are being protected during the process. Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: Residents participate in the day to day running of the home in accordance with the range of their individual preferences or if it is part of their individual goals, for example light domestic duties. One resident spoke of the chores they undertaken including some shopping and baking bread. Much importance is placed on preserving residents confidentiality as the nature of the assessment process means that a great deal of personal information is retained about residents. Staff demonstrated an awareness of good practice about confidentiality, ensuring that sensitive information is kept secure and knowledgeable about the circumstances under which information must be shared with management and others. Staff are also aware that residents have the right to ask that some information not be shared with family or others. Care Homes for Adults (18-65 years) Page 17 of 34 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. Residents lives are enriched by the promotion of independence and being enabled to live their chosen lifestyle. Resident benefit by being supported to maintain relationships with their families and friends. The meals are good offering choice and variety. Evidence: Central to the ethos of the home is the promotion of residents personal development with a view to enabling an independent lifestyle. Rehabilitation provided at the home is mainly long term. However the manager gave examples of fast track rehabilitation Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: being offered in the past to some residents who then moved onto supported accommodation. Care plans provided clear guidance on the personal goals for residents and the targets leading to their attainment as part of rehabilitation plans. A relative said There has been massive improvements since he has been at the home. As part of an enabling lifestyle residents are encouraged to organise their own leisure activities. One resident spoke of the support they need to access community resources including shops and leisure facilities due to their decreased mobility. Two residents spoke of not being well enough to currently access the community independently due to their mental health and relied on staff to support them. Staff spoke of the inventive ways they try to motivate residents to participate in the local community and leisure activities. One resident accesses local day services. Residents spoke of a pending overseas day trip and other holidays they have had. A relative said the staff all work hard at positive interactions with the residents and provide a variety of experiences and outings to the local area community which without their support my son would not have the courage to do. Relatives commented upon how welcomed they are made to feel when they visit, this included being offered beverages or meals and staff being friendly and approachable. Relatives commented I can stay as long as I like and the Care home staff always facilitated communication with myself and my son and are always very welcoming when I visit the care home. Residents consulted mentioned flexibility in the daily routines and respect for personal freedom and lifestyles being respected. A residents said you need to be up at a certain time for morning medication but I can do what I like go back to bed and go out whenever I want. Residents are able to help plan menus, shop for food and in some cases help prepare meals and snacks. The main meal is cooked by staff and menus showed that a varied and balanced diet is provided which includes fresh produce. Staff spoke of the flexibility in the menus if the group for example decided they wanted something different from the planned menu. It was clear that meal times are an important time of the day, with residents saying best bit about the home is the food having meals cooked for me as I would not eat otherwise food very good indeed and You can eat the meal provided which are nice or you can get a takeaway whichever you want staff cook every meal and its always good we can go into the kitchen anytime and make myself a drink or get a snack. A relative said meal time hugely significant as staff sit down also, it is like a family Care Homes for Adults (18-65 years) Page 19 of 34 Care Homes for Adults (18-65 years) Page 20 of 34 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. Residents benefit from the provision of flexible and respectful personal and healthcare support that is individual, respects their privacy and dignity and encourages residents to remain as independent as possible. Evidence: All but one resident do not require any direct personal care. Instead, staff provide emotional and practical support that residents say is provided in ways that promote their dignity and independence. A resident said a lot of the time I do not need any support only when I go out, meals and having a bath instead they encourage me to do things for myself. A relative said staff treat the residents with kindness respect and dignity. Residents spoke of the support they receive to maintain their health care, this includes accessing GPs, specialist mental health nurses and psychiatrists. Residents said staff make any appointments I need to get the doctor if I am not feeling too good and staff will call the GP if I am not feeling well which they have done very quickly and he Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: checks my health. It was clear that when there are any health concerns prompt medical intervention has been sought. Residents are supported to maintain some control over their medication with some residents self medicating part of their medication regime while the home manages the rest. Staff spoke of the prompting and support they undertake to ensure that residents follow their medication regimes. The system for the administration of medication are good with clear and comprehensive arrangement being in place to ensure residents medication needs can be met. Good practices were noted in the additional instructions provided on the use of PRN Medication. This helps to ensure that staff are fully aware of the individual requirements for when these medications are prescribed. Care Homes for Adults (18-65 years) Page 22 of 34 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. An effective complaints procedure and appropriate adult protection policies protects the rights and interests of residents. Evidence: There is an accessible complaints procedure in place for residents, their representative and staff to follow should they be unhappy with any aspects of the service. All residents felt able to raise any concerns they may have with staff and where they have raised minor concerns records show that these have been addressed promptly. A resident said complaints no need to complain if I was not happy I would just tell the staff . A corporate complaint has been received in the last twelve months which has not been resolved at the time of inspection. The providers representative felt that the organisations complaints procedure had been followed, this may be examined at the next inspection. The home has written policies covering adult protection and whistle blowing. These make clear the vulnerability of people in residential care, and the duty of staff to report any concerns they may have to a responsible authority for investigation. Staff consulted with have received formal training in safeguarding adults and prevention of Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: abuse and showed a clear understanding of their roles and responsibilities under safeguarding adults guidelines. Care Homes for Adults (18-65 years) Page 24 of 34 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. Residents live in a clean, homely environment, which has been decorated and furnished to a good standard with their bedrooms furnished and decorated according to their individual lifestyles. Evidence: The home is located within walking distance of Horley town center and bus routes, which several residents said that being able to independently access these was very important to them. The building is leased to the provider and there was a rolling plan of redecoration and repair. Staff reported that maintenance issues are promptly addressed, with all reasonable steps taken to maintain a safe home. Standards of décor were good with much effort made to create a homely feel. Comments about the environment included environment clean and comfortable good facilities clean lovely encouraging atmosphere nice location pleasant garden right next to a bus stop shops nearby, perfect really and clean healthy environment. Communal space includes a lounge, dinning room, kitchen, conservatory which leads Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: out onto a long pleasant secure garden that has a patio and seating areas. A resident spoke of being involved in helping to maintain some of the potted plants. Residents bedrooms are individualised reflecting their tastes and preferences. Whilst respecting the privacy and choice of residents, the home recognises that a minimum standard of hygiene must be maintained, to ensure the well being and comfort of all with residents being actively encouraged to undertake their own cleaning of their bedrooms. Smoking is an important part of most residents lifestyle and suitable provisions has been made for them to be able to smoke at the home in comfort. There are a sufficient number of toilets and bathing facilities located around the building, including two standards baths with attached showers and each bedroom fitted with a wash hand basin. Generally residents do not require any adaptations or specialist equipment to help with mobility with the exception of a bath seat.. All areas inspected were observed to be cleaned to a good standards with a staff member commenting very clean home to work. Care Homes for Adults (18-65 years) Page 26 of 34 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. The staff group includes a stable core group who have worked at the home for many years. Their experience, together with supervision and training indicates that they have a good level of competence and despite uncertainly over their future employment remain motivated and committed to assisting residents moving towards their individual goals and the aims and objectives of the home. Residents are being protected by robust recruitment practices. Evidence: Residents, staff and relatives felt that there was always sufficient numbers of staff on duty for staff to undertake their roles in a timely manner and for residents to receive the support they needed, when they wanted it. It was observed through the inspection that staff understood their roles and had a good rapport with residents and planning skills. The tasks of the day appeared well organised and individual staff appeared confident in carrying them out. This helped ensure that residents knew who would be supporting them. Staff consulted with had a clear understanding of the aims of the home and how their individual role contributed towards achieving this. Residents comments about staff included staff very good help me out a lot all the staff are great Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: we all get on and staff very kind and nice I can talk to them about how I am feeling and they help me sort out any problems I have. Relatives said staff really nice they seem to know what they are doing and staff absolutely lovely the staff make the place what it is. The home has recently been awarded the Team of the Year by the organisation. Most of the staff have worked at the home for a number of years and had a good understanding of residents assessed needs and how to support them in a consistent way. It is commendable that despite the uncertainty over staffs future employment, due to the possible deregistration of the home with some redundancies having a taken place, that staff continue to show much commitment to residents achieving their individual goals and the aims of the service. The home has been proactive in ensuring that staff receive a National Vocational Qualification (NVQ) in Care, with the deputy manager reporting that either all staff have completed this qualification or are working towards it. There has been a freeze on recruitment due to the uncertainty over the future of the home, with some known bank staff used to cover any vacancies. The personal files of two staff were inspected and these showed that the shortfalls in recruitment practises noted at the last inspection have been addressed. Recruitment files showed that the manager had satisfied themselves that all of the necessary checks had been undertaken by the organisation to ensure only staff who are suitable to work with vulnerable people are employed. There is a commitment to improving staff skills through an ongoing training programme both in practical matters and the broader aspects of working with people who have mental health conditions. Staff consulted with said that they had all undertaken the mandatory areas of training necessary for them to work safely with residents. Specialist training in areas of mental health are usually undertaken by the manager and deputy who are both experienced mental health nurses. The deputy manager felt that the skills for care induction, which is the industry recommended minimum inductions standards is incorporated into the organisations induction programme. Staff said that they receive regular supervision with the manager regarding their performance, conduct and training needs. All staff consulted said that they felt well supported by the management team to undertake their roles and felt able to approach them for advice and guidance. A staff member said I feel I have the right support through lots of training and supervision. Care Homes for Adults (18-65 years) Page 28 of 34 Care Homes for Adults (18-65 years) Page 29 of 34 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. Residents benefit from an experienced well qualified manager who ensures that the home is able to meet the needs of residents with enduring complex mental health needs and who provides a clear ethos and values enabling staff to provide good quality support to residents. Evidence: The manager has many years experience in managing services for people who have a mental health conditions and is well qualified as a Registered Mental Nurse and holds the recommended management qualifications. The manager demonstrated an in depth knowledge of good practices in the daily running of a service for people who have mental health conditions and keeps themselves updated in changes in good practice guidance and legislation through regular training. Without exception all persons consulted spoke positively about the manager with particular reference to their approachability and resident focus. A sample of comments made about them included manager excellent listens very good very encouraging manager good he does good Care Homes for Adults (18-65 years) Page 30 of 34 Evidence: things here and manager brilliant very good and helpful great respect for both of them they may be so busy but they will always give you time. The manager is supported by a deputy who also has considerable experience and expertise in working with people who have mental health conditions. It was clear that the management teams expertise was central to the home effectiveness and the service being able to meet the needs of residents with enduring complex mental health needs. There are several mechanisms in place for the manager to obtain feedback on the services of the home and whether it is achieving its aims and objectives. These include annual placement reviews, residents and staff meetings, internal quality audits, written feedback from residents, relatives and health care professionals. Examples were noted whereby improvements to practices and the environment have been made based on this feedback and audits. A staff member felt that what the home does really well is listening to staff suggestions of new ways of working and uses staffs knowledge of residents to help make their lives better. Written guidance is available on issues related to health and safety. Records submitted by the manager prior to the inspection stated that all of the necessary servicing and testing of health and safety equipment has been undertaken including regular internal health safety checks Systems are in place to support fire safety, which include regular fire alarms and emergency lighting checks, staff training and maintenance of fire equipment and fire drills were reported to have been undertaken. The deputy manager reported that a fire risk assessment has been completed which records significant findings and the actions taken to ensure adequate fire safety precautions in the home. The required monthly visits to monitor the services and facilities by the responsible individual is undertaken by their representative. It could not be ascertained why the records of these visits did not mention the pending de registration of the home and the effect on residents or whether the issue having been discussed with residents. This is despite this issue being raised freely by residents in all discussions the inspector had with them. Therefore it could not be established whether the Responsible Individual was effectively monitoring the situation and standards at the home and whether residents were being actively consulted during these visits. Care Homes for Adults (18-65 years) Page 31 of 34 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 32 of 34 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 33 of 34 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. 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