Inspection on 06/11/08 for 62 Cheltenham Road

This inspection was carried out on 6th November 2008.

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

62 Cheltenham Road 06/11/07

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Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

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Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 62 Cheltenham Road 62 Cheltenham Road Evesham Worcester WR11 2LQ     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: Emily White     Date: 0 6 1 1 2 0 0 8 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. the things that people have said are important to them: They reflect 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 32 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.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: 62 Cheltenham Road 62 Cheltenham Road Evesham Worcester WR11 2LQ 01386442783 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Martin William Crookston Type of registration: Number of places registered: Noble Care Ltd care home 3 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 3. The registered person may provide personal care and accommodation for service users of both sexes between the ages of 18 and 65 years whose primary care needs on admission to the home are within the following categories: Learning Disability (LD) 3 Date of last inspection Brief description of the care home 62 Cheltenham Road is residential care home in Evesham, which provides specialist support for up to three people with a learning disability. It has was registered to a new provider in May 2007. The house is a semi-detached property in a residential area, which offers single bedroom accommodation. It is on a main road close to Evesham town centre as well as the park, Abbey and river Avon. Limited parking is available upon the drive. The registered provider is Noble Care Limited. The registered manager is Mr Martyn Crookstone who also manages another care home owned by the same provider in Evesham. Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 3 Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: People using the service sent us some surveys before we visited them. The manager also sent us an Annual Quality Assurance Assessment which tells us what the service has been doing to improve. We looked at these before we visited. We visited on a weekday and met people using the service who showed us round their home. The manager and staff were also there to help us. We spoke to everyone we met and looked at some file such as care plans and staff files. Care Homes for Adults (18-65 years) Page 6 of 32 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 Care Homes for Adults (18-65 years) Page 7 of 32 240 7535. Care Homes for Adults (18-65 years) Page 8 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have information about the service and have a detailed assessment so that the service can be sure it can meet their needs. Evidence: People using this service have lived at the house for some time and there are no current plans for new people to move there. We looked at peoples care files which had the service guide and statement of purpose in them. These provide all the required information about the service that people might need. We were sent three surveys by people using the service who said that they were all asked if they wanted to move to the home and had enough information about it to help them make a decision. The Annual Quality Assurance Assessment sent to us by the service tells us that if new people planned to move to the house, information would be provided. A full and detailed assessment would be carried out by a member of staff and meetings would be made with other professionals and next of kin. The assessment would look into the suitability of the house, taking into account the wishes and needs of the person Care Homes for Adults (18-65 years) Page 10 of 32 Evidence: concerned. A staff meeting would be held to discuss any issues and maintaining a safe environment. The home has a policy for this process. The Annual Quality Assurance Assessment also tells us that people would be able to visit the service on a date that suits them best. This would be a chance for the the person to meet with staff and other people using the service. People already living at the home would also have their say as to suitability. After an initial introduction to the home an invitation to visit again would be made. Visits would last longer each time until a long weekend stay at the home and overnight stays are possible. This shows us that should a vacancy arise, the service is well prepared to assist new people in making a decision to move there. Care Homes for Adults (18-65 years) Page 11 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have detailed individual care plans which support them in taking risks and making decisions. Staff support people to make choices and ensure their needs are met. Evidence: During our visit we looked at peoples care files. We looked at one persons in detail and we looked at parts of other peoples care plans. People have an essential lifestyle plan which they have been involved in making. They also have a staff management plan which helps staff know what support to give people, and they have a health action plan for their health needs. Peoples essential lifestyle plans use some simple text and a lot of photographs to show what support they need, what is important in their lives and what they have been doing. The plans describe my positive reputation, what people like, communication, and people in my life, what is essential to me, things I can do and preferred daily routine. Everyone has a key worker who is a staff member more familiar with their needs. Pictures of peoples key workers are up on the dining Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: room notice board which helps people know who their key worker is. One person was able to show us his essential lifestyle plan and talk about all the photographs in it. However he was not able to read all of the information is his essential lifestyle plan. The people who live at 62 Cheltenham Road have different communication needs, some have basic reading skills and others may know what their plan is for but might not be able to understand all the information that is in it. As a small service, it would be good practice to consider working with individuals to personalise their essential lifestyle plans even further, using words that can be read or other forms of communication such as audio or picture formats. Some people enjoy drawing, other people showed us that they are good at monitoring some aspects of their own health care. The senior support staff is working with one person on a communication book using pictures and this could be considered in relation to the essential lifestyle plan. The plans are reviewed at least twice a year, the last key worker reviews for everyone took place in April and October this year. The service aims to review plans every two months. This would be good practice and an opportunity for essential lifestyle plans to be developed using the individual skills and preferences of the people who use the service. Outside of key worker review meetings, people have a lot of opportunity to make their opinions known and make decisions. People have a daily debrief with staff every evening where they are asked about how their day has been and how the staff can help. There are also monthly meetings for all the people who use the service, where people speak freely. Minutes from these meetings show us that people have requested more fruit, photos on the walls, and the weather forecast on the notice board, which have been put in place or are in the process of being put in place. People have activity planning twice a week when they are supported by a staff member to plan for the next few days ahead. We observed two people doing their activity planning with a staff member and observed decisions being fully supported. We also received three surveys from people using the service who told us that they always make decsions about what they do each day, and are able to do what they want to do in the day, evenings and at weekends. The Annual Quality Assurance Assessment tells us that people are supported in taking responsible risks in their daily lives. Risk assessments are carried out and strategies are put into place. The service tries to empower people to be more independent, for example two people are now enabled to go for short visits unsupported by staff. The service tells us that restrictions are only put into place with the consent and agreement of the person. We looked at peoples risk assessments which are in their files. They show that the service responds well to peoples requests for more independence and acts appropriately to make sure they are safe. Dates show that risk Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: assessments are regularly reviewed. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service have an active lifestyle according to their choice, they are supported to take a full part in meaningful activities, daily routines and mealtimes. Evidence: During our visit we spoke to people using the service about their lifestyle and looked at activity plans, notes from reviews and care plans. Records show that peoples interests are being encouraged by the service, and that they have opportunity for personal development leisure and occupation if they want it. For example, people regularly go to an art group and do volunteer work in local shops, and go to college. Peoples personal interests in animals, art or music are encouraged and people keep pets or attend concerts according to their own individual interest. One person told us about a recent concert he had been to and was observed to be planning a weekend trip away to see more music. Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: The Annual Quality Assurance Assessment tells us that the service encourages people to play a full part in the local community and to use community resources for example leisure centres, and local restaurants. People tell us that they take part in swimming, group activities such as pub and cinema, meals out, cooking, and visits to friends at another service. One person is actively involved in their church and with a church group. We observed two people doing their activity planning with a staff member which showed us that staff support people to be involved in their community. Most people using the service have regular contact with family as they wish. For example one person was preparing to have a long weekend away with his family on the day of our visit. The service supports people to develop personal relationships outside of the house and develop a social life. For example we observed one person being supported to telephone a friend and invite them for lunch. People who do not have regular contact with family participate in regular outings, however one person with little family contact often chooses to do writing and drawing in their room. While their choices are respected, consideration of use of a volunteer or befriender might be good practice to provide companionship for those without family or who are less active outside the house. We spoke to all people living at the house who tell us that as well as activities they get involved in all the house chores such as laundry, cleaning the bathroom and cleaning their rooms. There is a chores schedule in the kitchen which staff tell us is flexible so that people can choose and do what they prefer on a day. The Annual Quality Assurance Assessment tells us that the service plans to assess individuals in whether they can carry out their own shopping for their own needs with the aim of improving choice, budgeting skills and having opportunities to cook for the people they live with. This would be good practice in supporting independence. People tell us that they take part in menu planning and go shopping every week, which they enjoy. Some people also enjoy doing the cooking. All tell us they like the food they have. Once a month the senior support worker asks people for comments on the food and records this which helps to inform decisions and offer choice. We were visiting over a lunch time and observed lunch as a very informal relaxed time with people eating at a time to suit them. When people met in the kitchen we observed a lot of conversation and relaxed interaction with staff. The menu schedule in the kitchen shows a variety of foods. Some people using the service may be able to be more involved with the menu planning as suggested above, this could be assisted by having the menu in an easier type to read or by use of pictures. Care Homes for Adults (18-65 years) Page 16 of 32 Care Homes for Adults (18-65 years) Page 17 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive the personal support they need through detailed care plans. Peoples health and medication needs are met and safe practices are observed. Evidence: We looked at peoples personal files and other records to find out about their personal support. Everyone has a care file which gives details for staff about a persons care needs. This is called a care management strategy. People also have their essential lifestyle plan, and a health action plan. This information is supported by key worker reviews, risk assessments, a daily diary for each person completed twice daily, daily checklists, mood and behaviour monitoring sheets and a daily debrief sheet. The care plan is reviewed annually and covers the persons needs, the aims of the care plan, and the staff intervention needed to support the person. The plans look at maintaining a safe environment, behaviour, communication, personal hygiene, physical health, mental and emotional health, daily living skills, eating and drinking, continence, sleeping, personal relationships, family and friends, activities and future and last wishes. The Annual Quality Assurance Assessment tells us that a registered mental health nurse works for Noble Care and works alongside the staff and people using the Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: service to develop plans for support. Peoples care plans show us that this has been very useful and effective at challenging times. We received three surveys from staff who all told us that they always receive up to date information about the needs of people they support. Within the plan there are links to risk assessments and behaviour monitoring sheets, so that staff can easily find the information they need. The notes in peoples daily diary show they are being supported according to their care plan and appropriate supportive language is used. The daily debrief is carried out at the end of each day with each person privately. Staff ask whether the person has had a good or bad day, what made it good or bad, has the person been sad or angry and if so why, and whether there is anything to be done to make them feel better. The records from these debriefs over the past few months show that people are usually happy and are able to tell staff when something has upset them. The key worker meetings have not been as regular as the service intends however there are lots of opportunities for staff to observe and monitor peoples support needs. Regular key worker meetings could be a way for staff to review the information that is being recorded about people using the service, to monitor any patterns that may arise in behaviour or peoples needs and wishes that may not be being met. Peoples health action plans are written in pictures and writing and cover emergency information, communication, what I understand, looking after myself, health, teeth, eyes, skin, and feet. The health action plans show details of all appointments that have been kept and the persons next appointment. People are having appropriate and regular meetings with relevant health professionals such as consultants, doctors and dentists. Staff use a daily checklist which looks at personal care, daily living, and activities. This is a useful guide to see what people are doing regularly, and shows us that their support needs are being met. Where relevant peoples emotional well being is monitored, with appropriate records being kept. People are also being encouraged to take responsibility for their own health, for example recording in their own fluid intake charts if they are able to. A discussion with one person using the service shows people are aware of some risks to their health and why recording is necessary. The health action plans and care plans record medications correctly and the medications that have been given to people are recorded accurately. The medications file contains a medications procedure, a photo of the person, a list of medications and the prescription information. Medications store and administered appropriately, and people have signed to agree to have their medications administered. We discussed with the senior support worker the needs of people using the service as they get older. She has identified some training that the staff may be able to attend Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: and personally has good past experience in this area. The Annual Quality Assurance Assessment tells us that an area for improvement will be for the service to be aware and monitor specific needs of people as they get older and involve community health professionals as necessary. Care Homes for Adults (18-65 years) Page 20 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are kept safe by procedures operated by the service. People know how to complain and there are lots of opportunities for them to make their views heard. Evidence: The service has a complaints policy and details of this are found in the guide for people using the service. The service keeps a complaints file but no complaints have been made, and no complaints have been reported to us since the last inspection. We received three surveys from people using the service who all say that they know how to make a complaint. The service has a complaints form called its good to talk which is kept in the hall and in peoples essential lifestyle plans. This is written with pictures and easy to read words. Everyone we spoke to said they know how to complain or who to speak to, but one person was not sure what the complaints form was for. There are opportunities for people using the service to make complaints verbally, through the daily debrief and through a monthly audit by the senior support worker when everyone is asked if there are any complaints and a record is made. More regular key worker meetings could be used to monitor issues which are not formal complaints but may be causing concern to people using the service. The Annual Quality Assurance Assessment tells us that a number of staff have received training in safeguarding adults. Staff records confirm that all staff have had refresher training in this area in 2008. The service has a copy of government policy relating to Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: protecting vulnerable adults, a Whistle Blowing policy and a paper copy of the Worcestershire Adults at risk policy documents. All staff employed at the service have undergone the pre-employment checks. The poster from Worcestershire Council (with West Mercia police) about what to do in cases of suspected abuse is prominently displayed on the staff room wall. We looked at records such as peoples daily diary, the daily debrief, mood and behaviour monitoring, incident and accident reports which document what happens in the home. These records show that any incidents are managed safely, and risks are assessed. We spoke to staff who know about how to keep the people they support safe, and what to do if they are concerned about the well being of someone who uses the service. Care Homes for Adults (18-65 years) Page 22 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely, clean and welcoming house which is kept safe by staff who follow the required practices. Evidence: The Annual Quality Assurance Assessment tells us that the service has started a maintenance matrix to keep up to date with work that needs doing around the house. A facilities manager has been appointed across the homes run by Noble Care. New sofas and a new fridge freezer have been bought, and one persons bedroom has been redecorated at their request. One person who uses the service showed us around their home. The house is very homely and peoples bedrooms are very personalised. One person has a small bedroom so has his own lounge which has many personal items in it. There is a spacious garden and people tell us they have had barbeques. The dining room has a large notice board which has a coloured rota of staff, the weather for the week, peoples activity sheet for the week, staff on duty that day with a photo, and photos of key workers. We observed that the communal areas of the house while very homely are not very personalised. We were told that people have requested photographs to be put up around the house which staff are in the process of setting up. Some of the people who live at the house are interested in art and it would be good practice for the service to consider whether they would like their art displayed in Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: bedrooms or around the house. The Annual Quality Assurance Assessment tells us that hygiene and infection control practices are up to date. The service provider visits regularly as required by law and makes sure these checks are carried out. Fire checks, water temperature checks, and legionella checks are recorded and filed. We saw that health and safety risk assessments all completed, and that people using the service help with keeping the house clean. All bathrooms and kitchen are clean. The three surveys returned by people using the service all say that the house is always fresh and clean. We checked staff files which show that all staff have had updated infection control training this year. Care Homes for Adults (18-65 years) Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive support from knowledgeable, caring staff who are well supported by their seniors. Staff are recruited safely and receive training. Evidence: The Annual Quality Assurance Assessment tells us that staff are well qualified to do their jobs. It tells us that the staff team are competent, caring and well motivated with varied qualifications such as NVQ2, NVQ3, LDAF, BTEC in health and social care, and a qualified learning disability nurse on the team. Staff have a good knowledge of the complex needs of people using the service and access to further expertise at anytime is on call. We checked some staff files which show that some staff have NVQ qualifications and others are being supported towards this. Senior staff have relevant background experience, and staff we spoke to or observed show that they have a good knowledge of person centred working and supporting people with independent skills. We discussed staffing with the senior support worker and the registered manager. There are currently five female staff, with two working to support people during the day. A male staff member is being recruited as one person using the service has expressed that he misses male support. Surveys returned by people using the service tell us that the staff always treat them well and always listen and act on what they Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: say. We checked two staff recruitment files which show that all pre employment checks are completed before staff start work, ensuring that people using the service are protected. The service uses a training matrix which keeps track of all the staff training. It shows that all staff have had updated training this year, which includes managing challenging behaviour, personal relationships, person centred care and adult abuse. The service uses DVDs to keep staff training up to date but recognises that external training is also good practice to maintain staff interest. We received three staff surveys which say that they all had an induction which covered everything very well. The surveys also tell us that the staff are getting training which is relevant, helps them meet peoples needs and keeps them up to date. The Annual Quality Assurance Assessment tells us that they have a comprehensive and updated staff handbook with updated policies, and staff supervisions and meetings occur regularly. Staff have their own communication book with details of appointments and other events. We discussed meetings and supervisions with the senior support worker. She tells us that meetings usually happen every two months and supervisions planned for every month which allows for some flexibility. The senior support worker is carrying out supervisions of the other staff which she states she feels competent to do. The staff surveys tell us that they meet with their manager regularly. Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has worked hard to improve management resources at the service. People are now supported by significant management time which makes sure the service is a well run and safe place for them to live. Evidence: The Annual Quality Assurance Assessment tells us that since the last inspection the registered manager has been given more dedicated management time to focus on the service. He is supported in this by a newly appointed area operations manager and the service provider. The registered manager is also registered manager for another service run by Noble care in Evesham. This larger service has a deputy manager which allows the registered manager freedom to work between the two services. We discussed the management arrangements with the registered manager who says that he is comfortable with the present set up and believes that the management roles are clear within the organisation. The registered manager visits 62 Cheltenham Road on a regular basis and we observed that he had a good rapport with people using the service. Surveys received from staff tell us that the ways of passing information Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: between managers and staff work well, and that there are enough staff to meet the needs of people using the service. An experienced senior support worker is responsible for many of the simpler management tasks such as rotas, supervision of junior staff and working closely with people using the service. We discussed the management arrangements with her and she says she feels able to manage these tasks and feels supported by the registered manager and the provider organisation. The three services run by Noble care in Evesham work together closely and there is a wealth of experience and support available to all staff. The provider has also recently carried out an audit of the management arrangements which show that at present the system is working. The service will need to regularly monitor the situation to ensure that all staff remain clear about who is responsible for different management tasks and to ensure that people using the service are not affected by the senior support worker having to spend time on administration tasks. The Annual Quality Assurance Assessment also tells us that a comprehensive quality assurance system has been established. This means that the service regularly looks at how it is run and asks people using the service for their opinions. This is done formally once a year through surveys. The service also carries out audits covering Medication, Food Safety, Health and Safety, Infection Control, and Service overview audits. We looked at some examples of these audits which are comprehensive. The Annual Quality Assurance Assessment has been completed in detail with many examples of good practice. Required monthly visits from the provider monitor health and safety. Fire checks, water temperature checks, and legionella checks are recorded and kept up to date. In the staff office there is a list of tasks that staff are responsible for, which includes all health and safety tasks, which ensures all checks are completed. Environmental risk assessments have also been carried out to ensure peoples safety. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 6 It would be good practice for the service to consider working with individuals to personalise their essential lifestyle plans even further, using words that can be read or other forms of communication such as audio or picture formats. Regular reviews with key workers would assist this. This could help people using the service to increase choice and control over their own care arrangements. Consideration of use of an advocate, volunteer or befriender might be good practice to provide companionship for those without family or who are less active outside the house. Some people using the service may be able to be more involved with the menu planning, shopping and cooking. This could be assisted by having the menu in an easier type to read or by use of pictures, or by people making the menu plan themselves. Regular key worker meetings could be a way for staff to review the information that is being recorded about people using the service, to monitor any patterns that may arise in behaviour or peoples needs and wishes to ensure all needs are met. It would be good practice for the service to consider asking people using the service how they could further personalise Page 30 of 32 2 15 3 17 4 18 5 24 Care Homes for Adults (18-65 years) their personal and communal space, for example by using peoples art works. 6 37 The service should regularly monitor the management arrangements to ensure that all staff remain clear about who is responsible for different management tasks and to ensure that people using the service are not affected by the senior support worker having to spend time on administration tasks. Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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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