Inspection on 21/07/09 for Allan House

This inspection was carried out on 21st July 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Allan House 09/11/09

Allan House 13/06/08

Allan House 02/10/06

Allan House 12/11/05

Allan House 13/06/05

Allan House 01/11/04

Allan House 18/05/04

Allan House 29/07/03

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

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 12/10/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Allan House 53 Uttoxeter Road Blythe Bridge Stoke On Trent Staffordshire ST11 9JG     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Linda Clowes     Date: 2 1 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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: Allan House 53 Uttoxeter Road Blythe Bridge Stoke On Trent Staffordshire ST11 9JG 01782397018 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: allan@jeffriesgroup.com Mrs Grace Jeffries,Mr Ronald Jeffries care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 8 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Learning Disability (LD) 8 Date of last inspection Brief description of the care home Allan House is registered to provide care and accommodation for eight people who have a learning disability. The home is one of two homes owned by Mrs Jeffries and her son. The home is located on the main road in Blythe Bridge and blends in with the surrounding properties. The home is a two-storey large family type house although all bedrooms and lounges are on the ground floor. The home provides six single bedrooms and one double bedroom. The environment internally is of a good standard and outside at the front is a car park and at the rear a large garden. The people who live at Allan House access local health resources and local attend colleges, day centres or day Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 8 Brief description of the care home services. The people who use the service generally have low to moderate needs although the home is able to respond to some challenging behaviour. The aim of the home is to promote and develop the independence skills of the people who use the service and, if appropriate, to support them to move to a more independent living environment. The Service User Guide states that current fees range from four hundred and fifty to one thousand pounds a week. Anyone interested in moving to Allan House is advised to contact the home directly to obtain information about current fees and admission procedures. 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: one star adequate 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: One inspector carried out this unannounced Key Inspection. We inspected against the National Minimum Standards for Care Homes for Younger Adults and the Care Homes Regulations 2001. The objective of the inspection is to evaluate whether people who use the service and their family carers experience services of good quality that offer and promote independence. On the day of this inspection the Registered Manager, Alison Nicklin was in the home and assisted us throughout the day. This inspection took place over a period of 8.5 hours. We looked at peoples assessments and care plans, personnel files, complaints files, medication records, health and safety records and gave feedback throughout. Care Homes for Adults (18-65 years) Page 6 of 34 Prior to the inspection visit the providers were asked to complete a self-assessment tool which is know as the Annual Quality Assurance Assessment (AQAA). Completion of the AQAA is a legal requirement and it enables the service to undertake a selfassessment which focuses on how well outcomes are met for people using the service. Information from this AQAA is used to plan the inspection visit and references to it have been made in this report. The AQAA was returned on time and gave us a reasonable picture of the current situation with the service. We received five surveys from people who use the service. The home had forwarded these to the day services attended by people who use the service so that they could be completed confidentially. All gave positive feedback. Two relatives/carers who returned surveys told us that they are very satisfied with the services provided by Allan House. We received four surveys from staff who tell us that they receive training and information from the service so that they can provide effective and individual care. All feel they have enough support, experience and knowledge to meet the different needs of people who live at the home. We have included comments made in surveys in the body of this report . In the main we identified that Allan House provides a satisfactory service. We have, however, identified concerns with medication that we have asked the manager to address without delay. We have received no complaints about the services provided by Allan House since the last Key Inspection held on 13 June 2008. We have made one requirement and three recomendations following this visit. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: The storage of insulin was poor and may place people at risk. Monitoring arrangements for medication must include treatments/medication stored in peoples own rooms. Care Homes for Adults (18-65 years) Page 8 of 34 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 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 9 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 10 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. People who wish to use the service are provided with the information they and their families need to make an informed choice about whether the home will suit them. No person moves into the home without first having a full assessment of their needs to enable the home to determine whether it is able to meet their individual needs. Evidence: One requirement was made in this outcome area in the last Key Inspection report for the home to develop a suitable Service User Guide. We looked at the current Service User Guide and Statement of Purpose and found that these documents had been reviewed and updated and contained all information required by regulations. This requirement is, therefore, met. Allan House Statement of Purpose and Service User Guide are service specific. The documents are available in various formats as required. The documents are informative and current and give clear information to help people understand what specialist services the home can provide. Each person has received a copy of the Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: Service User Guide which gives detailed information about the accommodation available and the staff team who will provide their care. Allan House was fully occupied on the day of this inspection. One person had been admitted very recently and one was due to move on to more independent living in the near future. The home was already carrying out the assessment for another person wishing to move into the home as soon as there is a vacancy. We looked at a random sample of two peoples files. We are satisfied that the service has ensured that it is able to fully meet each persons health and social care needs as outlined in the care needs assessment completed by the Assessment and Care Management Team (Social Services). We recommended as good practice that the home confirms in writing to each person whether it is able to meet their needs. We received five surveys from people who use the service and each confirmed that they were involved in the decision to move into Allan House and had been given enough information about the home to decide if it was right for them. Prospective people who wish to use the service are given the opportunity to spend time in the home prior to decisions being made about permanent admission. Following admission a formal review, including the person who uses the service and their representatives and other relevant professionals, takes place after one month. Everyone is able to express their views regarding the suitability of Allan House at this stage. This will assure people who use the service that their best interests are promoted. Care Homes for Adults (18-65 years) Page 12 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. The service involves people in planning the care that affects their lifestyle and quality of life. People are encouraged to make their own decisions and choices and support plans reflect their aspirations to provide staff with information how to achieve peoples individual needs and goals. Evidence: No requirements were made in this outcome area in the last inspection report. Three recommendations were made: 1. Support Plans should be more person centred 2. Support Plans should be more detailed so that staff know how to provide assessed care 3. Records of incidents should be held centrally to provide a useful at a glace overview. The service has introduced a new template for Person Centred Planning for its new admissions and is in the process of transferring everyones Support Plans using this format. The service is also awaiting confirmation of dates of training with Newcastle Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: College for all staff in Person Centred Planning. The AQAA tells us that the Registered Manager and Deputy Manager have both attended person centred care planning training. Those support plans seen were detailed and described the persons needs in respect of health and welfare so that staff can provide care in such a way as to meet peoples needs. The manager has introduced a central record of incidents that have enabled the service to monitor these in a more meaningful way which may identify triggers or indicate a change of approach by staff. We consider that the recommendations of the last report have, therefore, been met. The service works hard to involve people in the planning of care which affects their individual lifestyle and quality of life. People are encouraged to make their own decisions and choices. Staff at all levels are aware of the preferred communication style for each person and we observed positive interaction between care staff and people who use the service. We looked at the records of two people and found personal, social and healthcare needs were addressed for each person in an individual way that reflected individual characters, lifestyles and aspirations. Risk assessments had been carried out to cover a wide range of activities in both files we looked at and care staff were aware of these. These included health and safety issues, daily living tasks, access to the community and activities. Staff confirmed that they had received training in risk assessment. People we spoke with told us that their views are listened to. They are included in discussions of their care plans. They are also consulted about how the service can meet their needs on a daily basis. Everyone tells us that they are able to attend Residents Meetings where they can raise issues such as activities, holidays, outings, meals. Five people responded to surveys. The service had sent these to each individuals Day Service so that they could be completed in confidence. All expressed satisfaction with the service and confirmed that they make decisions about what to do each day and that they were supported to undertake activities and outings in the evenings and Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: weekends. When we asked what the home does well, the following comments were added: Care for us. Look after me and take me out. I am happy as I am. I like gardening and my own bedroom. The food is good. I am happy in the home. Two relatives completed surveys which expressed satisfaction with the services provided to their relatives who live at Allan House. The following comments were added: (name) is so happy there. I feel so happy knowing that they are safe. They have learned so much and achieved such a lot while they have been there. Everyone gets on with everyone else. At the same time the residents have as much independence as possible. We are 100 satisfied with the care our relative receives. One relative suggested that they would like to receive more contact from the service. It is recommended, therefore, that the service includes details about frequency of contact with relatives and information disclosure in support plans. We spoke with all people who are currently living in the home, including the person who had only just moved in and each confirmed that staff treat them well and that they feel comfortable in the home. Care Homes for Adults (18-65 years) Page 15 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. The service is commited to assisting people to develop or maintain their skills including social, emotional, communication and independent living skills. People are assisted to identify their goals and work towards achieving them. People receive a healthy diet and enjoy their meals and mealtimes. Evidence: No requirements were made in this outcome area in the last inspection report. A recommendation was made for the home to provide opportunities for people to develop independent living skills in the home. On the day of our visit we observed people assisting in the kitchen with staff supporting them to do as much as possible for themselves. We were asked by several people who use the service if we wanted drinks and one person made and presented the drink. Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: We consider, therefore, that this recommendation has been met. People are involved in the domestic routines of the home. They take responsibility for their own room, menu planning and cooking meals (where able). The AQAA tells us that two people have moved out of the home since the last inspection and moved into supported living accommodation They are now tenants paying bills and doing their own shopping and cooking. The AQAA tells us that another person has recently started to travel to college alone on public transport. People we spoke to on the day told us of a variety of ways in which the service is promoting their independence. Two people take part in swimming at the Special Olympics. People attend a wide range of meaningful daytime activities to meet their diverse needs and capabilities and access community facilities as appropriate. The service is delighted to have accessed a college course in horticulture for one person for whom the accessing of suitable activities has been difficult. Another person attends various activities as and when they wish. The home is working hard to assist them to prepare for a move to more independent supported living in the near future. Another person has moved on from their Further Education placement and will attend college at the start of the next academic year. This person told us about the leaving party they had attended the previous night. Several people visited the cinema with staff the previous evening and told us all about what they had done and seen. Everyone went on holiday together at the end of June. They told us that this was their choice as they all get on well. People confirmed that routines are flexible, particularly during holiday periods and weekends. One or two spend weekends at home with parents/relatives, others like a lie in. Discussions with staff and people who use the service confirmed that individual rights and responsibilities are recognised, and that appropriate personal, family and sexual relationships are encouraged. People tell us that they take part in planning meals and enjoy their meals. Mealtimes are very flexible to accommodate the various actitivies attended but tend to be more communal at weekends when everyone is around. People told us they enjoy sitting Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: down to Sunday Roast together. Care Homes for Adults (18-65 years) Page 18 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service ensures that people receive the personal and healthcare support they need to maintain a healthy lifestyle. Personal support is responsive to individual needs and preferences. There were concerns with the homes handling of specific medication that may place the person at risk of harm. Evidence: No requirements were made in this outcome area in the last inspection report. One recommendation was made for staff responsible for medication to have their competency regularly assessed. The service promotes a person centred approach to uphold the rights of dignity equality and respect. The plans of care for the two people we case tracked give a comprehensive overview of the health needs of each person, together with instructions for the staff group on how they must address any issues in order that delivery of care is flexible, consistent and reliable. The records show that people have access to community healthcare and remedial Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: services. People are encouraged to attend regular appointments and visits to health care services to maintain health and fitness. The AQAA tells us Allan House works well with outside services, recognising when further support is required. All residents have a healthcare support plan and routine checks are kept up to date. Personal care was seen to be responsive to individual needs and preferences. Staff were seen to respect privacy and dignity and listening to what people who use the service said to them. The AQAA tells us that the service has a Medication Policy covering the control, storage, disposal, recording and administration of medicines which was updated in September 2008. We discussed medication procedures with a member of staff and monitored the Medication Administration Record (MAR) charts. Medication is dispensed into a monitored dosage system. We found this system of administering medication and the MAR charts to be satisfactory. We were, however, disappointed to find that the procedures and records around storage of insulin were poor and may place the person at risk of harm. Insulin must be stored to manufacturers instructions which indicated that the Insulin must be stored between 2 and 8 degrees C. Staff were recording the temperatures of the medication fridge which held the insulin and for the past week, and several occasions before, the record showed that the fridge was -3 (minus 3). We checked the probe and found that this was showing -3. As a consequence, we asked the manager to check immediately with the general practitioner and the pharmacy. The pharmacy arranged for the Insulin to be disposed of immediately and a new supply provided. The service will need to discuss the situation with the persons doctor and Specialist Nurse to determine the possible effects. The MAR chart showed that this situation had been going on for some time but no one in the staff team had brought it to the managers attention. Clearly, monitoring procedures had not been carried out which would have identified the problem. Unfortunately, this means that the recommendation outlined above that was included in the last inspection report has only been partially met. We have identified that one staff member was picked up during a medication check for leaving gaps in the MAR. We have made a requirement as part of this report regarding this matter. We have taken into account that the manager has worked hard to address the requirements and recommendations in the last key inspection report and the fact that Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: the service has a history of compliance and working with us to improve services. We have also received feedback in person and through surveys that people are satisfied with the services provided. In view of these considerations this outcome area is rated as adequate and not poor. The AQAA tells us that all staff responsible for medication have received medication training and the records confirm this. Care Homes for Adults (18-65 years) Page 21 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. The home has an open culture that allows people to express their views and concerns. People feel safe and well supported by the service. Evidence: One requirement was made in this outcome area in the last inspection report for policies and procedures to safeguard people from abuse and reflect current legislation and best practice guidelines. The service has obtained copies of current Safeguarding Procedures and Protocols from the Local Authorities it works with. The manager had met with one of the Local Authority Safeguarding Co-ordinators to discuss safeguarding. The manager has reviewed and updated the homes policies and procedures to reflect current legislation and best practice guidelines. The homes is now aware of the need to work within local multi-agency guidelines and has made one safeguarding referral that was investigated by the local authority. Agreed strategies had been introduced to safeguard all parties concerned. We consider that this requirement has been met. The home has complied with the recommendation made in the last report for staff to receive training in safeguarding. The training record showed that staff have received in-house and external training for the protection of vulnerable adults from abuse. People spoken with on the day say they are happy to raise any issues with staff and Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: were clearly comfortable and confident in their approaches. People tell us they are confident staff will listen to them and act upon any issues. The home maintains a comprehensive record of complaints and safeguarding investigations. The record shows that issues have been satisfactorily addressed and appropriately acted upon. Staff are aware of whistle blowing procedures where they find poor practice and staff confirmed that they were given information about whistle blowing at the start of their employment when they are undergoing induction. The last report highlighted that the arrangements and records for managing finances of people who use the service were not sufficiently robust to protect all parties. The AQAA tells us that financial care plans have been developed. Robust procedures are now in place. We spoke with designated staff who were part of this process and they were clear about their responsibilities. We saw comprehensive records showing an audit trail for monies received and withdrawn. We also checked monies held and found these satisfactory. Care Homes for Adults (18-65 years) Page 23 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. The physical environment of the home provides for the individual requirements of the people who use the service. The home is well maintained, clean and comfortable. Evidence: No requirements were made in this outcome area in the last inspection report. One recommendation made was that the service should consider a programme of modernisation within the home. The AQAA tells us that over the last 12 months Allan House has purchased two leather sofas and a leather chair for the communal lounge, decorated and updated furniture and fittings in some of the bedrooms. One room which was previously used as an office has now been refurbished to provide another lounge with TV and radio facilities and has provided more space for people who use the service and family. Other unoccupied rooms have now been allocated as a staff office and sleep in room. We consider that the home has taken steps to address this recommendation and that it has been met. Six of the seven bedrooms are for single occupancy. There is one shared room which suited the people concerned. Staff were aware of maintaining privacy and dignity for each person. Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: A tour of the premises identified that the service provides a homely, comfortable and safe environment. It was clean, well maintained and smelled fresh. Four of the five people who responded to surveys tell us that the home is always clean and fresh, the fifth said it usually is. The service encourages people to be responsible for their own laundry which promotes independence and self-worth. Domestic and laundry duties are carried out by the care staff team with input from people who use the service as assessed within the goals, aims and objectives of each persons plan of care. Three of the four staff who returned surveys have commented that they think the home would be improved if the kitchen is updated and made more client friendly The service has a policy on communicable diseases and infection control which was updated in September 2008. Assistance is sought from external specialists when necessary. Staff are aware of the need to practice good hygiene in order to reduce risk of cross-infection. Care Homes for Adults (18-65 years) Page 25 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. People have confidence in the staff who care for them. The staff team is experienced and skilled in their role. Robust recruitment procedures protect the people who use the service. Evidence: No requirements were made in this outcome area in the last inspection report. Two recommendations were made: 1. The home should develop a training and development plan 2. Staff should have regular and recorded supervision. The statement of purpose/service user guide tells us that there are seven in the staff team. the AQAA tells us that all staff receive mandatory training We looked at two staff files and found that both had undergone Induction Training. It was noted that the latest recruit had undertaken more formalised Induction Training based on the common induction standards which the manager said had worked well. Both people had undertaken National Vocational Qualification level 2 in Care. The training record showed that both had received training in First Aid, Moving and Handling, Fire, Food Hygiene, Health and Safety, Infection Control, Medication. Both have also undertaken Challenging Behaviour, Epilepsy, Diabetes. One has received Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: training in Dementia and Deprivation of Liberty Training in a previous job. Further medication training is booked for the staff team in September 2009. The AQAA tells us all staff apart from one are trained to at least NVQ 2. The record also showed that regular supervision has taken place at approximately three-monthly intervals. We consider, therefore, that the two recommendations of the last report have been met. The staff files show robust recruitment procedures that include the taking up of references and police checks. Staff spoken with on the day said they were supported well by the manager and that they received regular supervision. They also confirmed that staff meetings are held on a regular basis and are used for consultation and training purposes. From observations on the day we consider that staff have the skills to communicate effectively with people who use the service. We received surveys from four staff members. All confirmed that they received training which is relevent to their role. All expressed satisfaction with the way they are supported to do their job. The following comments were added: The home provides a high standard of care, promotes independence to live as normal a life as possible. We have a good staff team who work well together to promote the clients well being and lifestyle. We provide a good standard of care and support and work well together as a team. I have worked at other homes and I think this one works well. Managers and staff are the best I have worked with We support people to be independent and make their own choices. We provide a warm environment. The home does well on supporting the clients and their needs to live as normal a life as possible. The home gives 100 to all the clients at all times. Staff rotas show that no agency staff have been used in the last three months which Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: provides consistency for people who use the service. The proprietors have another home locally and staff from both homes will support each other if necessary at times of holiday and sickness. There is one male worker on the staff team. This provides an element of choice for male users of the service. Care Homes for Adults (18-65 years) Page 28 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. The service promotes human rights, equality and diversity issues to ensure that all people who use the service have a good quality of life. The health and welfare of people who use the service are promoted and protected. Evidence: No requirements or recommendations were made in this outcome area in the last inspection report. The manager has the required qualifications and experience to run the home. She has a clear understanding of the key principles and focus of the service. There is a strong ethos of being open and transparent in all areas of running the home. Since the last inspection the service has strengthened its management team with the appointment of a Deputy Manager. The manager is now spending more time managing the service rather than being hands on. As a consequence, there is an improvement in the procedures, processes and paperwork since the last key inspection report. Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: The AQAA contains clear, relevant information, although it could be improved by giving more detail about improvements made since the last inspection. The service has policies and procedures in place that the manager is gradually working through and updating in line with current practice. People are supported to manage their own money where possible. As there was a concern in the last report regarding the systems in place to cover finances, the manager has introduced more robust procedures. We looked at these on the day and found them to be clear and accurate. The AQAA tells us that the service sends out annual questionnaires to residents, families and friends. Staff also complete a management behavioural feedback form. Following return of questionnaires the AQAA tells us that issues identified are addressed and dealt with accordingly. The outcomes of the latest quality audit were monitored at the last inspection. We did not monitor the quality audit on this visit but will look at this on our next inspection. We looked at the Accident Record which was completed as required giving details of accidents and any strategies to reduce any identified risks. There is current and appropriate insurance in place. The Certificate of Registration is prominently displayed in the home as required by regulation. Care Homes for Adults (18-65 years) Page 30 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 31 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 1 20 12 Regulation 12(1)(a) and 21/08/2009 13(2). The service shall ensure that all treatments/medicine held in the care home are stored in accordance with the manufacturers instructions. This will ensure that medicines are safe to administer and promote the health and welfare of people who use the service 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 3 Following the homes assessment of whether they are able to meet an individuals needs, it is recommended that the manager write to the person to confirm whether they are able to meet their needs. This will assure people that the service has made a measured decision to determine that they are able to meet their needs.and will also comply with Regulation 14(d) of the Care Homes Regulations 2001. Care Homes for Adults (18-65 years) Page 32 of 34 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 2 10 It is recommended that the service includes information about agreed frequency of contact and disclosure of information details with relatives and advocates in Support Plans. This will promote openness and discussions regarding confidentiality at an early stage. All staff responsible for the recording, handling, safe keeping, safe administration and disposal of treatments/medicines received into the care home should have their competency assessed on a regular basis. 3 20 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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