Inspection on 27/04/09 for 72a Broad Street House 1

This inspection was carried out on 27th April 2009.

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

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

Other inspections for this house

72a Broad Street House 1 25/04/07

72a Broad Street House 1 16/08/06

72a Broad Street House 1 19/01/06

72a Broad Street House 1 06/06/05

72a Broad Street House 1 20/12/04

72a Broad Street House 1 08/07/04

72a Broad Street House 1 13/01/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 72a Broad Street House 1 Ash And Birch Units Clifton Shefford Bedfordshire SG17 5RP     The quality rating for this care home is:   one star adequate 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: Angela Dalton     Date: 2 7 0 4 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 31 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 31 Information about the care home Name of care home: Address: 72a Broad Street House 1 Ash And Birch Units Clifton Shefford Bedfordshire SG17 5RP 01462814196 01462850689 Kathryn.chainey@hft.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Home Farm Trust Ltd Name of registered manager (if applicable) Ms Ruth Paterson Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home 72A Broad Street (Ash and Birch) was a purpose built house owned by Home Farm Trust situated in a site recessed from the main street in the village of Clifton. On the same site was a second house provided by HFT for eight people with learning disabilities and the two houses shared a common paddock in addition to their individual gardens. The house was divided into two units namely Ash and Birch, each with a lounge, dining room and kitchen. One unit catered for people with Prader-Willi syndrome and the other for people with complex communication needs. Each service user had a single bedroom. In each unit were two bathrooms and a shower room with a total of seven toilets between the two units. Staff were provided with a room with en-suite facilities, which were also used as the main office. This room was situated between the two units and formed the link on the first floor between both units. The ground floor link was the communal laundry. The fees payable do not include Care Homes for Adults (18-65 years) Page 4 of 31 care home 8 Over 65 0 8 Brief description of the care home newspapers, hairdressers, personal telephone, toiletries, or private chiropodist; these services would incur an additional charge. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support peterchart Concerns, complaints and protection Environment Staffing Conduct and management of the home Poor Adequate Good Excellent How we did our inspection: One inspector conducted this unannounced site visit on 27th April 2009 between 10.15am and 6.30pm. Two people were case tracked. We followed the care of people who use the service to ensure the care they receive is reflected in the care plan and meets their individual requirements. The case tracking process cross references all the information gathered to confirm that what we are told is happening is actually occurring, and, reflects the Statement of Purpose, which contains the aims and objectives for the service. We spoke to the people who use the service, their relatives, members of the staff team and the manager. We were present for lunch and observed interaction between staff and people who use the service. We toured the building and examined documentation to check that what Care Homes for Adults (18-65 years) Page 6 of 31 was happening in the service was being recorded. The services weekly fees are under review but currently range from 1022 pounds to 1525 pounds. This does not include toiletries and private chiropody and other personal expenses. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 31 Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Evidence reflected that individual needs are assessed to ensure that they can be met by the service. Evidence: The service currently has three vacancies but there have been no new admissions since the previous key inspection in April 2007. The manager has reviewed contracts and devised a more user friendly format in a pictorial and large type format. These will include individual fees and any additional charges. The service user guide is in a similar user friendly format and is made available to each individual. There are several people currently visiting the service for meals as part of the assessment process with a view to moving in. The manager is working with people who live at Ash and Birch to ensure that they involved in meeting people who who may move in and that they feel that everyone will get on together. The manager writes a report at the end of the assessment process to determine whether the needs of a new person can be met and how any potential challenges can be overcome. There is a Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: cabinet in the front entrance of each service displaying useful information. People we spoke to understood that this is locked to ensure that documents do not go missing and that they could access information by asking staff. People had a copy of most of the information displayed such as the service user guide and complaints policy. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are the focus of the service and care plans illustrate how social care needs are monitored, managed and met. Evidence: Each person has a support plan detailing their individual needs. People are very involved in devising their plan of care and are passionate about contributing to the information that is written about them. Where possible staff work alongside people and this can be done jointly on one of the four computers shared by staff and people who use the service. People we spoke to confirmed that they had worked with staff in writing about the way that they wished to be cared for and how they wanted staff to work with them. The focus of the service is upon enabling people to do things for themselves and being supported to make choices. Home Farm Trust use a specific system for care plans called SPARS - Support, Planning, Assessment and Recording system. Staff enter information electronically and ensure a paper copy is available. A user friendly format is currently being developed. The service also has software to Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: enable text to be translated into pictorial or symbol forms. Existing information can be scanned into the system so that information is not lost. We inspected the care plans of two people and found them to be extremely detailed and informative. There were some gaps with regard to health needs but this will be expanded upon in the next section. Comprehensive risk assessments were in place which focused upon how individual risks were managed and the impact upon others e.g. with regard to behaviour. Again where possible, risk assessments are written with service users to ensure that they are aware of how needs can be managed. This is valuable to some people who have specific triggers to behaviour and understand how staff will work with them. The kitchen is locked but this is discussed when people move into the service and is agreed with professionals as part of peoples behavioural management. The manager plans to develop the protocol in line with the Deprivation of Liberty aspect of the Mental Capacity Act. Regular reviews take place to ensure that the care plan is still relevant and meets peoples needs. We observed the manager speaking with family members to coordinate a review and advocated that it was at the convenience of the service user and not the attendees. Each person has a person centred planning diary. This enables each person to record what they would like to do and plan it with staff. It also enables people to have hopes and aspirations that staff can assist in realising. Some people met with an Advocacy Alliance representative each month until they recently retired. This post has been temporarily filled until a permanent replacement is found. Home Farm Trust also runs a Speak Out group which enables people from across the organisation to meet together with senor managers and discuss issues. One person from the service was instrumental in encouraging others to join the group and was supported to issue a flyer. As a result there was an increase in members of the group and it has met regularly. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The leisure and occupational requirements of people who use the service are met in a flexible way. Evidence: The staff team work hard to ensure that service users have a varied leisure programme. This is devised in conjunction with people and changes as necessary. Service users have previously attended college but due to building work taking place are not currently attending. Home Farm Trust have a resource centre locally which is attended for occupational and recreational sessions. A peripatetic support worker has been employed to work in several services to promote individual interests. This has been successful at Broad Street and has provided opportunities for people to go swimming and play snooker. People are supported to attend community facilities. This has been very successful with one person who travels to a snooker club by public Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: transport. They are pursing the possibility of joining a local league to compete in as their playing has improved. The manager is keen to promote activities as it is recognised that it leads to increased confidence and improving daily living skills. Family members are also involved in some leisure activities: Two parents lead a hand bell ringing activity and involve service users and staff which everyone enjoys. Staff are creative and incorporate activities into daily routines to assist people in their exercise and weight loss goals. A lawn mower has been purchased to enable one person to mow the lawn and another person requested an exercise bike which was funded by Home Farm Trusts Extra Special Fund. Staff assist people to maintain the garden and outdoor furniture. The manager ensures that holidays are booked in January to ensure that people get to go away at a time they wish and enable staff to be given adequate notice. One person had left to go to Euro Disney on the morning of the inspection. Leisure files reflected how holiday choices had been made and why people chose to go to particular places. Two service users are going to Blackpool, one is going to stay in a chalet in Dorset and another who likes animals is going to stay on a working farm. Some people are supported to attend church and everyone goes out regularly to places of their choice. Service users are supported to go shopping for food and decorative items. During the inspection one person had been shopping for lights and lampshades. People contribute to planning the menus and the methods that are used are tailored to meet peoples needs. Some people have Prader-Willi syndrome and one aspect of the syndrome is an obsession with food. Staff are skilled and sensitive in managing potentially challenging situations and menu planning and meal times are dealt with in an appropriate low key way. Care Homes for Adults (18-65 years) Page 16 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The medication system does not ensure the safety of people who use the service. Evidence: People living in Ash and Birch receive support from a variety of health and social care professionals. The service is supported by Twinwoods and there was evidence to show that regular assistance was given by the psychology team. Because of the associated needs that people with Prader Willi syndrome have support is provide from the dietician and other professionals as required. Care plans detailed how dietary needs were being met and how weight loss plans were supported. One service user manages their own diabetes with staff overseeing the process. There was no evidence to reflect how competence was assessed and reviewed to ensure the safe administration of insulin. There was no evidence to support that staff had received training to support someone with diabetes in the administration of insulin and any associated complications. Two staff we spoke to confirmed that they had previously had training approximately two years ago when the diabetes was managed differently. Although there were guidelines about how to manage low blood sugar there was no Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: information informing staff how to manage high blood sugar. The ideal blood sugar range was recorded to be between 4 and 7. Blood sugar records reflected that bedtime readings were often higher than this and on occasion had been 18,14 and 12. Insulin was stored at a correct temperature on the day of inspection but 5 vials of insulin had previously been returned to the pharmacy because the storage temperature had been too high. There was no way of reducing the temperature in the medication storage room and records reflected that the temperature was regularly 25 degrees Celsius which is deemed the maximum safe storage temperature. Some diabetes information was in user friendly language and symbols on the wall of the medication storage room. When we asked how it was seen by the person with diabetes we were told that they came into the room. We were later told that people who use the service do not go into the room when we questioned the container of sterilising fluid with pots and oral syringes in. There were some sterilising tablets out of their box being kept in the desk pen tidy. The container and tablets were removed during the inspection. We raised our concerns as people with Prader Willi syndrome will often eat and drink non edible items. We checked Medication Administration Record (MAR) sheets for 2 people. 30 Calcit sachets had been received on 31/3/09 and the latest MAR sheet commenced on 13/4/09 but the amount had not been carried forward. 15 sachets had been given and 15 should have remained but there were only 13 leaving 2 sachets unaccounted for. 28 Fybogel sachets had been received on 31/3/09 and 3 had been added to the total equalling 31. 15 had been given and 16 should have been left but 18 remained. The second person had a gap on their MAR sheet so the administration of eye drops was not recorded. 60 Andropatches were recorded on 31/3/09 15 doses were given and 33 patches should have been used leaving a balance of 27 but 30 patches were left. Records reflect that people receive too much or too little medication. There is a designated person responsible for checking in and reviewing medication and another person who covers their absence. The manager is aware that they need to be more involved in the medication process and that issues should be identified through more frequent audits taking place. Amounts of medication are recorded when leaving and returning to the home but no records are completed during the time people spend with their families. The manager confirmed that there is an issue that has previously been identified with regard to medication no tallying. No process had been implemented to deal with this situation. Copies of prescriptions are kept and this ensures that there is a receipt for the medication that has been prescribed. There are currently no controlled drugs prescribed but the storage facility exists if necessary. The service does not have the current guidance in place from the Royal Pharmaceutical Society relating to administration of medication in care home and the Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: manager plans to obtain a copy. Each person has a health action plan detailing how individual needs are managed. Several people receive treatment from the district nurse at a clinic to treat leg ulcers. There are no skin care assessments or specific care plans to assist staff in monitoring any changes in symptoms but clearly, regular clinic visits take place. There is no District Nurse care plan kept in the home because individuals attend clinic appointments so a record is required. A service users family nominated the home for an award with the Coeliac Society to reflect the hard work that staff had done to assist with managing coeliac disease. The home won the Supporting a family member with coeliac disease award and this is the first time a care home has been nominated or won the award. The manager is sourcing a display cabinet so that the award can be displayed. We spoke with the family who were highly complimentary about the support that they had received. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has a clear system in place to enable people to express their concerns. Evidence: There is a complaints policy in place. Each person has a user friendly version and this is displayed in the cabinet in the hallway. The people we spoke to confirmed that they knew who to raise any concerns with informing us that they would talk to their keyworker or the manager. A member of staff from Advocacy Alliance visits each month and acts as an independent representative for people who use the service. This post is being filled by a temporary member of staff due to retirement. Records reflected that staff had attended Safeguarding training. An incident occurred earlier in the year between two service users and this was appropriately dealt with under the local SOVA (Safeguarding of Vulnerable People) policy. A finger touch keypad is being costed as a result of the outcome of the strategy meeting to enable an individual to lock their room as they find using a key difficult. The manager keeps copies of compliments and is planning to expand the complaints procedure to illustrate how concerns or allegations are dealt with effectively and they do not escalate into complaints. This will also ensure that the process of any investigation or process that takes place is recorded. The manager has also led in house SOVA workshops for both staff and people who use the service to ensure that it is a subject that everyone is familiar with and discuss any questions. Training on the Mental Capacity Act has commenced and the manager plans to incorporate this into peoples care plans. Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: We checked two peoples financial records and there were no issues. The service uses a specialised system (Versapak) which has a separate number for a lockable tag. Each time finances are checked a new tag is issued with a corresponding number. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some improvements are needed to better meet the needs of people who use the service. Evidence: The majority of the the home was clean and tidy and odour free. The manager has recently submitted a list to the Area Manager identifying the work that requires completing. Some areas require attention as they are worn and do not complement the homely style and atmosphere in Ash and Birch. One of the bathroom floors was stained and worn. A chest of drawers in the bathroom had been affected by the damp and was warped and the varnish was faded and cracked. There was no toilet roll, soap or bin. The extractor fan had a build up of dirt. A shower room had stained flooring and the shower tap was leaking. It was not possible to tell which direction to turn the tap for hot or cold water as the cover had come off making it difficult for people to use the shower independently. A toilet had no toilet roll holder or bin and hand towels were not available. Radiator covers had paint peeing from them. A vacant bedroom had a stained carpet. The manager explained that toilet rolls and hand towels were not available due to the behavioural needs of one person. There was no evidence that specialist advice had been sought to research alternative methods of storing toilet rolls and paper towels. The bathroom walls were bare and the manager stated that she Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: hoped to improve their appearance and make them more homely. There is a distinct difference between the communal rooms downstairs and upstairs. Downstairs is warm and friendly and clearly reflects the personalities and choices of people who use the service, whereas upstairs is more stark and has few personal touches. There was evidence to reflect that items had been purchased to improve a persons bedroom but unfortunately, due to their complex needs the improvements had been short lived. The dining room in Ash was being decorated during the inspection and one person had been shopping for lights and lampshades. The manager reported that service users had spent time repainting the garden furniture and a lawn mower had been purchased for one person as part of their exercise plans and desire to help manage the garden. The laundry meets the needs of people who use the service and there was adequate protective clothing available. There are dissolvable alginate bags for use with soiled laundry if needed. All service users have access to a computer as there are 3 at fixed locations and one lap top. Staff and service users discuss when availability is required to ensure access when needed. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are supported by an effective staff team. Evidence: There have been some new staff since the previous inspection in April 2007 but only one remains. We checked recruitment records and found them to be satisfactory. As the service has 3 service user vacancies the staffing level currently meets peoples needs (there is a waking night vacancy) but levels will be increased following new admissions. A comprehensive training programme is completed by staff. Although staff do not complete the Learning Disability Qualification they obtain the companys equivalent and complete a 3 day induction. All staff have obtained or are working towards NVQ Level 2 and 3. In addition to mandatory training staff attend specific training relating to Autism,Dementia, Person Centred Planning, Safeguarding and The Mental Capacity Act. Two staff are planning to attend a four day course on first aid. Many of the staff have worked in the service for a number of years and stated that they enjoyed their job. Staff receive supervision every six weeks which enables staff to set their goals with regard to training and performance. The service currently has 1 manager, 1 senior and 10 support workers and 2 waking night staff. Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: People who use the service were complimentary about the staff and said that they knew who their keyworker was and who they could talk to regarding any concerns. We were told staff are nice and friendly and that I wouldnt change anything. We spoke to 2 parents who spoke highly of the staff there is a positive ethos and atmosphere and no feeling that X is a burden even if they are. It doesnt matter day or night, theres no problem and staff are very very caring. Were so grateful, its all encompassing, everything is under one umbrella. They keep in touch with telephone calls and email when something happens - its very reassuring. Always the same staff, they know X well, weve been very lucky with the staff and set up. Theyre caring and have common sense - we wouldnt change anything. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The views of people who use the service are incorporated into the running of the home. Evidence: The manager has worked at 1 Broad Street since October 2007. They are currently awaiting their final evaluation from the Internal Verifier and will have achieved an NVQ 4 and Registered Manager Award. We discussed that the manager needed to be more involved in delegated tasks. The manager told us that they are being more involved in medication and plan to be more involved in Health and Safety to ensure that standards are being met. The AQAA (Annual Quality Assurance Assessment) was completed prior to the inspection by the manager to demonstrate how the service had reviewed the care they delivered and identified any improvements required. We inspected fire records and found them to be in good order and the manager plans Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: to update the fire plan in line with guidance provided by the local fire service. Health and safety records are maintained and reflected that necessary safety checks were being conducted. Hot water checks are conducted monthly and we found the hot water in a bathroom to run hot but then cool to a comfortable temperature. The manager stated that people who live at Birch receive support to bathe and stated more regular checks would occur to identify any potential risks. We were told that dishcloths are left to soak in sterilising solution in the kitchen. This poses a risk to people who use the service and staff removed them during the inspection. Fire drills were taking place and the manager has plans to conduct a late night drill to ensure sleep in staff know how to respond. The service sends out a quality assurance questionnaire to families, people who use the service and to professionals. A report is published and sent out to all participants and reflects what action will be taken. The manager plans to incorporate the findings into the statement of purpose as this is reviewed annually. This will ensure that the statement of purpose illustrates how the service is responding to comments that are made by people who use the service and their relatives. The company meets with the Family and Friends Association quarterly, which enables the management team to address any concerns and provide an update of any developments within the service. The manager also attends these meetings. Regular house meetings are held to ensure peoples views are considered and implemented. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 24 23 The service must ensure 30/06/2009 that specialist needs can be met specifically with regard to the provision of toilet roll, toilet roll holders, soap and hand towels. A maintenance plan must reflect the schedule of works to reflect when improvements are scheduled. The service must meet the needs of people who live there. 2 19 12 Records must reflect how individual health needs are assessed, monitored and managed, specifically leg ulcers and diabetes. Staff must receive appropriate training to ensure these needs can be met and people are appropriately referred. This will ensure staff to identify any improvement or deterioration and report to 30/06/2009 Care Homes for Adults (18-65 years) Page 29 of 31 identified professionals to ensure appropriate treatment. 3 20 13 The medication system must 30/06/2009 reflect that regular audits occur. If a person self medicates records must reflect how their competency has been assessed and reviewed. This will ensure that amounts of medication reconcile, and that people are safe to self-administer medication. 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 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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