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Inspection on 27/02/09 for Arundel Close (1)

Also see our care home review for Arundel Close (1) for more information

This inspection was carried out on 27th February 2009.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Arundel Close (1) Arundel Close (1) Chippenham Wiltshire SN14 0PR two star good service The quality rating for this care home is: 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: Elaine Barber Date: 1 2 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: 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. 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. Internet address www.cqc.org.uk Information about the care home Name of care home: Address: Arundel Close (1) Arundel Close (1) Chippenham Wiltshire SN14 0PR 01249651112 01249765520 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): United Response Name of registered manager (if applicable) Jill Patricia Cooper Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 4 0 care home 4 learning disability Additional conditions: A bit about the care home 1 Arundel Close is one of a number of homes that are run by the national charity, United Response. The home is a detached property in a residential area of Chippenham. 1 Arundel Close fits in well with the neighbouring properties. The accommodation is domestic in style and includes a lounge, a dining room, a recreation room and four single bedrooms. People receive support from a manager and a permanent staff team. Relief staff members also regularly work in the home. The registered manager is Alison Wright. Information about the home is available in a statement of purpose and service user guide. Inspection reports are available in the home and on the Commissions website www.cqc.org. 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 & Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct and Management of the Home Poor Adequate Good Excellent How we did our inspection: This is what the inspector did when they were at the care home We asked the home to complete an Annual Quality Assurance Assessment, known as the AQAA. This was their own assessment of how they were performing. It also gave us information about what has happened during the last year, and about their plans for the future. We sent out surveys so that these could be completed by the people who lived in the home and people who had contact with them. We had surveys back from two healthcare professionals and two staff members. We looked at all the information that we have received about the home since the last inspection. This helped us to decide what we should focus on during a visit to the home which took place on 12th March 2009. We talked to four people who lived in the home and three members of staff. We looked at some of the homes records. We visited the organisations offices on 27th February 2009 to look at the staff training and recruitment records. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visits. The last inspection of the home was on 13th and 28th February 2007. What the care home does well The people who lived in the home had lived there many years. Their needs had been assessed when they moved in so that their needs could be met. Most of peoples abilities, needs and goals were reflected in their individual plans. Work was taking place to make the plans more person centred to make sure that all peoples needs were met. A new process was being introduced fro reviewing plans. Objectives were set at reviews and these were monitored to ensure that peoples needs and wishes were met. People were supported to make decisions about their lives and what they wanted to do. They made decisions about what they did each day and how they spent their time. They benefited from the approach that was taken to managing risk, which promoted their independence. People were provided with a range of activities and opportunities and used local community facilities. These included the cinema, theatre, shops, pub and swimming pool. People were able to maintain and develop appropriate relationships with family and friends. They saw their family regularly and met up with friends from other houses run by United Response. Peoples rights were respected and their responsibilities were recognised in their daily lives. They were involved in the routines of the home such as the cleaning and meal preparation. People were offered a choice of meals and enjoyed their food. People received personal support in the way that they preferred and required. Peoples physical and emotional health needs were met. They were all registered with a GP and saw a range of health care professionals including a psychiatrist, psychologist, community nurse, occupational therapist, physiotherapist, optician and dentist. Staff assisted people to take their medication. People were protected by the homes policy and procedures for safe medication handling. Peoples complaints were listened to, taken seriously and acted upon. There was a complaints procedure and people were given information about how to make a complaint. Any complaints and concerns were investigated. People were protected from abuse and harm. There was a procedure about abuse and staff received training about prevention of abuse. Any allegations of abuse were referred to the appropriate organisation to investigate. People lived in a comfortable, clean and safe environment, suitable to their needs. The accommodation was well decorated and furnished in a homely style. It was clean throughout and people were involved in cleaning the shared areas and their own rooms. Each person had their own bedroom and there were sufficient toilets and bathrooms. People were supported by sufficient numbers of staff, who were appropriately trained and competent to meet their needs. There were usually two staff on duty throughout the day and one sleeping in. Staff received a range of training including moving and handling, medication, challenging behaviour, the way we work, a course about the ethos of the organisation, first aid, prevention of harm, health and safety and equality and diversity. They also had training specific to peoples needs for example about diabetes, epilepsy and autism. People were protected by the homes recruitment practices. The manager was suitably qualified and experienced. She had recently applied to be the registered manager and had been approved as a fit person to run the home. There was a quality assurance process and peoples views underpinned all self-monitoring, review and development by the home. There was a range of health and safety checks and measures so that health, safety and welfare of the staff and the people who lived in the home were promoted. What has got better from the last inspection We made a requirement at the last inspection that the registered person must ensure that the safety of staff and people who live in the home is not compromised by the use of inappropriate blood testing devices. The manager had taken advice about safe blood testing devices and changed the devices used so that staff and people who lived in the home were kept safe. The manager had changed the storage of peoples individual risk assessments so that they were kept in the personal files. This made it easier for people to access all their records in one place if they wished. We recommended that objectives following a review are written into a plan, which identifies the objectives and the action needed to meet each objective. The organisation had introduced a new way of doing reviews to make them more person centred. An action plan with objectives was produced from each review and was monitored every two months to make sure the actions happened. Information was being included in the personal files about how staff would support people to make a complaint if they wished to. This included how to recognise whether a person had a complaint. This was to make sure that peoples complaints and concerns were followed up and acted upon. Improvements had been made to the accommodation. Some of the shared areas and the bedrooms had been redecorated. New carpet had been laid in the lounge dining area. A fireplace had been removed from the lounge to make the room more up to date and to make it safer for one person who was at risk of falling on it. What the care home could do better The care plans should be developed to make them more person centred to make sure that all peoples diverse needs will be met. The registered person must make sure that the controlled drugs cupboard meets with the new regulations for the storage of controlled drugs, (The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007). This is so that controlled drugs can be stored safely. A record must be kept of food provided for people in sufficient detail to show whether the diet is satisfactory, in relation to nutrition. This is so that it is possible to tell whether people are getting a balanced diet. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Elaine Barber 33 Colston Colston Avenue Bristol BS1 4UA 0117 930 7110 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 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 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 . Peoples individual needs were assessed so that their needs could be met. Evidence: We found at previous inspections that peoples needs were assessed before they moved into the home. The four people had lived together in the home for several years and their needs were assessed when they moved in. No new people have moved into the home. The staff had completed intimate and personal support assessments for each person and these were reviewed. 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 . Most of peoples abilities, needs and goals were reflected in their individual plans. Work was taking place to make the plans more person centred to make sure that all peoples needs were met. People were supported to make decisions about their lives and what they wanted to do. They benefited from the approach that was taken to managing risk, which promoted their independence. Evidence: We read the care records of three people. We saw that each record had a section called About me which provided information about personal history. There was detailed information about peoples daily routines and support plans for the morning and evening. These were reviewed and updated where necessary and the date was recorded. People had information about support needed with communication. The manager said in the AQAA that each person had a person centred plan. We found that the support plans were type written in small print and were kept in the files. People did not have their own copy in a format they could understand. A member of staff told us that people did not have person centred plans. The manager also said in the AQAA Training is given to all staff on Equality and Diversity. This is then upheld and taken into account in the Person Centred Planning of each individual. We found that the About me sections of the support plans did not contain information about peoples diverse needs such as their ethnicity, race, sexual orientation and faith. Some progress was being made towards making the plans more person centred. One person showed us their pictorial record of their daily routine. Photographs had been Evidence: taken of each aspect of their daily routine and put into an album for the person. The photographs showed clearly what activities the person participated in and the support that they needed from staff. Staff told us that each person also had a six monthly review with their relatives and any professionals involved. The manager told us that work had taken place to make these reviews more person centred. One person had photographs from their review in a folder. The photographs showed who was present at the review, what was discussed and what decisions were made. People at the review had written points that were discussed and the decisions on flip chart paper then taken photographs of these as a record. Objectives were set after each review and progress with these was monitored two monthly. These objectives were recorded in the photographs. We made a recommendation at the last inspection that objectives following a review should be written up into a plan, which identifies the objectives and the action needed to meet each objective. This had been done and a sheet was being used to record the actions and progress in achieving them, which was monitored every two months. We saw that there was information in the records about how people communicate. Any limitations on choice and freedom were recorded in the support plans. Information about how people made choices and decisions was also recorded. During the inspection the people who lived in the home and the staff gave examples of how people made choices and decisions such as choosing the decor of their bedrooms and their meals. People were supported to manage their own money. Staff took people to the bank and helped them to withdraw their money. During our visit we saw people choosing how to spend their time and what to have for lunch. The food records showed that there was a choice of meals. We saw that there were records of risk assessments that covered a range of activities and facilities. These showed that attention was being given to supporting people with activities and pastimes that may involve a degree of risk. Although some were of a general nature, for example, bathing and window openings, others were specific to an individual and covered things that they liked to do, such as going to the shops and having a Center Parcs holiday. We saw that the risk assessments had been updated annually and the date was recorded. At the last inspection we found that these risk assessments were kept together in a separate risk assessment file. We made a recommendation that it would be good practice to keep personal information about individual people in their personal files to enable easy access to their records. This had been addressed and each persons risk assessments were kept in their personal file. 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 were provided with a range of activities and opportunities and used local community facilities. People were able to maintain and develop appropriate relationships with family and friends. Peoples rights were respected and their responsibilities were recognised in their daily lives. People were offered a choice of meals and enjoyed their food. Evidence: We read the personal records of three people. Each had a Weekly Activity Plan. The weekly programmes involved some activities outside the home. Three people attended a local resource centre. Changes in day centre provision meant that people had fewer planned activities. The staff team were providing support with more home based pastimes and community activities, such as swimming. We saw that each person also had a Monthly Activities monitoring sheet. These were used by staff as a way of helping to ensure that people regularly participated in a range of community activities throughout the month. These monitoring sheets and the daily records showed that people had a range of activities and used community facilities. Activities included shopping, going to the cinema and theatre, going to the bank, having a haircut, swimming and massage. People also went to the local leisure centre, went swimming and bowling, went for walks and had meals out. Everyone had been to Center Parcs for a holiday. Each person had a pictorial record of the activities they followed. The staff took Evidence: photographs of each person doing various activities and put them in a folder for them to look at. One person showed us their folder. This showed various activities including a visit to a hawk conservation centre, bowling, meals out, going to the pub, a Center Parcs holiday and trips to the theatre. Two people told us that they had been to the cinema. People also had activities at home. These included colouring, stencilling, watching TV and videos, games and crafts. At the beginning of the inspection one person was colouring. We observed people choosing where to spend their time during our visit. One person was out at their day service and sat in the recreation room on their return. One person chose to watch TV in the lounge. Another watched a DVD in their room and later went bowling. One person went swimming with a member of staff. When we looked at the photographs of peoples activities we saw that people were involved in the routines of the home. They cleaned their own rooms with support, changed their beds, did the washing up, dusted, vacuumed, cooked food and cleared the table after meals. The people and the staff spoke about the visits that were made to family members. One person stayed with parents every other weekend. The others also visited their parents and had visits from parents and other relatives. The personal records included an About Me section, which recorded peoples important personal contacts and relationships. These were also discussed at review meetings and recorded under a Family and Friends section. When we looked at the photographs we saw pictures of three people during their visits home. One person said that they had friends at a local rugby club where they were made to feel welcome. They were well supported with this by one of the support workers. Opportunities for other people and their capacity to develop friendships outside the home appeared to be more limited. One person talked about friendships with people in other houses managed by United Response. They had been on holiday with one person from another house and had an ongoing friendship with them. The menu showed that a variety of meals was served. The food records showed that people had a choice of meals and each person often had different meals. A staff member told us that they offered people different meals and suggested new things so that people choose a variety of foods. Staff told us that one person had a diabetic diet. Drinks and snacks were also recorded briefly. However, the record of food served was not in sufficient detail to tell whether a balanced diet was being served, for example whether five portions of fruit and vegetables were being consumed daily. During the inspection a choice of lunch was offered of sandwiches or cheese on toast. No fruit or vegetables were offered with this. We observed people enjoying their lunch. People were involved in shopping for food and meal preparation. A dietician had provided advice about one persons diet. 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 received personal support in the way that they preferred and required. Peoples physical and emotional health needs were met. People were protected by the homes policy and procedures for safe medication handling. Evidence: When we read the records we saw that information was recorded in each persons file about how they liked to be supported at particular times of day. Each person also had an Intimate and Personal Support assessment form and a Medical Profile. This information provided staff with individual guidelines for how to support people. Any assistance with personal care was identified in the support plans and personal support took place in the privacy of peoples own rooms or the bathroom. Peoples preferred times for getting up and going to bed were identified in the daily routines while meal times were fitted in with activities and were flexible. People chose their own clothes and hairstyles. The records showed that the people who lived in the home were registered with GPs at a local surgery. Specialist support was being provided through the Community Team for People with Learning Disabilities including community nursing, occupational therapy, physiotherapy, psychology and psychiatry. Peoples individual needs in respect of medical conditions and disabilities were assessed and recorded. One person had an epilepsy profile and they saw a specialist epilepsy nurse and a consultant neuropsychiatrist. Visits to opticians, dentists, podiatrists and other health care professionals were also recorded. A staff member told us that people had recently had flu vaccinations and one person had had a pneumonia vaccination. We looked at arrangements for the handling of medicines. Medication was stored in a locked cupboard. A monitored dosage system was used with printed medication Evidence: administration record (MAR) sheets. These were used to record medication received into the home and administered, and were recorded appropriately. There was a controlled drugs cupboard and a controlled drugs register. However, there was no evidence that the controlled drugs cupboard complied with the new regulations for the storage of controlled drugs. No people were able to manage their own medicines. Each person had an agreement for giving homely remedies signed by the GP. Training records showed that staff had all been trained in safe medicine management and most had had training in additional tasks to enable them to support people. Information about medicines and a procedure were available to staff. Care staff were using blood testing equipment. In response to a requirement at the last inspection the equipment used had been changed. All medicines were stock checked regularly. All staff except the newest member had received training about specialised techniques of giving epilepsy medication. A staff member told us about the arrangements when people went home. Staff put the tablets into a dosette box and make a record of the medication with the dose and the directions of when and how to give it. Two staff signed this record and the relative signed the record to show that they had received the medication. 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 . Peoples complaints were listened to, taken seriously and acted upon. People were protected from abuse and harm. Evidence: United Response had produced an organisational complaints procedure. When we looked at the personal files we saw that each person had a pictorial version of the complaints procedure in their file. People would need support to use the complaints procedure. Peoples views and the views of relatives and other professionals were sought at review meetings. The manager told us that there had been no complaints since the last inspection. We saw that there was a book to record concerns and complaints and how these were dealt with. Some concerns were recorded and had been followed up but there had been no complaints. We recommended at the last inspection that the written information and guidance about complaints includes a reference to the different ways and opportunities that people may have to raise concerns and how these will be followed up. We saw additional information in the files about how the home would support people to make a complaint and how they would recognise when someone had a complaint, for example by a change of behaviour. There were opportunities to raise issues through the keyworker, relatives, reviews and quality assurance questionnaires. The homes policy and procedures file contained information on the prevention and reporting of abuse. This had been produced as a new policy in 2004. There was an easy to read protection of vulnerable adults policy and information about No Secrets and the local multi-agency adult protection procedures. A member of staff said that all staff have this information. Staff training records showed that staff had received training about prevention from harm as part of induction and this training was updated. The manager told us that there had been one safeguarding issue. She said that she referred it to the vulnerable adults team as soon as she found out about it. Meetings had been held and the police were investigating. Evidence: Staff supported people to manage their money. Records were kept of peoples finances and two staff signed the record when money was withdrawn. Each person also had a bank account and staff helped them to withdraw money. Some of the support workers were signatories to the accounts. This had been agreed with each person and the bank. We saw information about the arrangements for personal banking in the files. 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 lived in a comfortable, clean and safe environment, suitable to their needs. Evidence: When we visited the home we saw that the property was a detached house in keeping with other houses in the street. The home was very spacious. There was a large lounge and dining area with a linked snooker room and office area. There was also a separate activities room and a large kitchen. People could receive visitors in private in the activities room or their own rooms. Each person had a single bedroom, which was individually decorated and furnished. Staff had supported people to choose the colours of their rooms. People had made their rooms very individual with their own possessions. Downstairs there was a toilet and shower room. Upstairs there was a bathroom with a walk-in bath to meet the needs of two of the people who lived in the home. One person had an ensuite bathroom. Some of the shared areas and the bedrooms had been redecorated since the last inspection. New carpet had been laid in the lounge and dining area. The manager told us in the AQAA that the fireplace in the lounge had been removed as it was out dated and also possibly a danger for one person who has epilepsy and could have fallen on its hard edges and surface. A member of staff showed us where the fireplace had been taken out and the decor had been made good. We saw that there was a laundry area with an industrial type washing machine and a tumble drier to meet the needs of the people who lived in the home. The home was clean and tidy throughout. Two people told us that they vacuumed and dusted. We saw photographs that showed that people were involved in the cleaning of their own rooms and the shared areas. 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 were supported by sufficient numbers of staff, who were appropriately trained and competent to meet their needs. People were protected by the homes recruitment practices. Evidence: Some of the staff had worked with the people who lived in the home for several years. The rota showed that there were usually two people working in the home when the four people were at home. There were more when people needed support with activities or appointments. One member of staff slept in at night. Two staff told us that there were usually two members of staff on duty throughout the day and one sleeping in at night. Comment cards were received from two staff. They said that there were usually enough staff to meet the needs of people who lived in the home. Both staff said that recruitment checks such as references and Criminal Records Bureau (CRB) checks were obtained before they started work. We went to the office to look at the recruitment records. Two new staff had been recruited since our last inspection. Both staff had completed an application form with a declaration that they had no offences and they had made a declaration that they were physically and mentally fit. Two written references and CRB and Protection of Vulnerable Adults (POVA) checks were obtained before they started to work with people. One of the staff had a third written reference. One person had a copy of their birth certificate and the other had copies of their passport and driving license as proof of identity. The two staff who completed surveys said that they had an induction which covered what they needed to know to do the job when they started. They both said that they were given training that was relevant to their role, helped them to meet peoples diverse needs and kept them up to date with new ways of working. We looked at three individual training records when we visited the office. They showed that staff had an induction using the common induction standards. They then had a range of basic Evidence: training including training about moving and handling, medication, challenging behaviour, the way we work, a course about the ethos of the organisation, first aid, prevention of harm, health and safety and equality and diversity. Some training had also been undertaken in areas relating to the needs of service users, such as diabetes. There was also training about managing epilepsy, makaton, and autism. The training was regularly updated. All the staff had received training about epilepsy and specialist methods of administering particular medication. A member of staff told us that there were six members of staff. They said that one member of staff had a Diploma in Social Work, one had a National Vocational Qualification (NVQ) level 2 in care, one had a General Vocational Qualification (GNVQ) in Health and Social Care. They said that they and another member of staff were starting their NVQ. When we looked at the recruitment records we saw that one of the new staff had an NVQ in care. 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 home was managed by a person who was suitably qualified and experienced and had been judged to be a fit person to run the home. Peoples views underpinned all self-monitoring, review and development by the home. The health, safety and welfare of the staff and the people who lived in the home were promoted. Evidence: The manager had a CG 325/3 Advanced Management in Care qualification and was undertaking National Vocational Qualification (NVQ) Level 4 in management. She had applied to become the registered manager and had recently been approved as a fit person to manage the service. She was supported by senior managers in the organisation. There was a quality assurance folder and a process for assessing the quality of the service. Questionnaires had been sent to the people who lived in the house, their relatives and relevant professionals. A report of the findings from the survey had been produced. The format of the report included What we do well, What we could do better and an action plan to improve the service. The manager provided information about the quality of the service in the AQAA. It was clear and provided the information that we needed. It told us what the service does well, what has improved since the last inspection and what improvements they planned in the next twelve months. A number of individual risk assessments and more general risk assessments about safe working procedures had been recorded. These included a fire risk assessment and individual risk assessments about the safety of radiators and unrestricted windows. A risk management manual had been produced by United Response. Arrangements were in place for the training of staff in moving and handling, fire safety, first aid, food Evidence: hygiene and infection control. A monthly safety inspection of the home was carried out by staff. Fridge and freezer temperatures were taken and recorded. Hot water temperature regulators had been fitted to all hot water taps except the kitchen. These were regularly serviced. There was a health and safety policy and a health and safety handbook was available to the staff team. This detailed the action to be taken in order to comply with the relevant regulations. There were Control of Substances Hazardous to Health (COSHH) assessments and a range of safety checks. These included portable appliance testing, servicing of the boiler, taking of hot water temperatures, vehicle checks, cleaning of the shower head and fire safety checks. There was also fire instruction for staff and the people who lived in the home to ensure that they were kept safe in the event of a fire. Are there any outstanding requirements from the last inspection? Yes  No  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 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 Description 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 Description Timescale for action 1 17 17 A record must be kept of food provided for people in sufficient detail to show whether the diet is satisfactory, in relation to nutrition. 10/04/2009 So it is possible to tell whether people are getting a balanced diet. 2 20 13 The registered person must 30/06/2009 make sure that the controlled drugs cupboard meets with the new regulations for the storage of controlled drugs, (The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007). So that controlled drugs can be stored safely. 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 Each person should have a person centred plan which reflects their diverse needs, their wishes and hopes so that all their needs will be met. Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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