Inspection on 14/12/09 for Bel-Air Residential Care Home

This inspection was carried out on 14th December 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Bel-Air Residential Care Home 02/01/09

Bel-Air Residential Care Home 27/10/08

Bel-Air Residential Care Home 17/07/08

Similar services:

Chesham House

Argyll House

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Bel-Air Residential Care Home 76 Bushey Hall Road Bushey Watford Herts WD23 2EQ     The quality rating for this care home is:   two star good 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: Claire Farrier     Date: 1 4 1 2 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 29 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 29 Information about the care home Name of care home: Address: Bel-Air Residential Care Home 76 Bushey Hall Road Bushey Watford Herts WD23 2EQ 01923332540 01923332540 mo@portlandcarehomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Portland Care Homes (Bushey) Ltd care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is 6 The registered person may provide the following categories 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: Mental Disorder, excluding learning disability and dementia - Code MD Learning Disability - Code LD Date of last inspection Brief description of the care home Bel-Air is a care home providing personal care and accommodation for six people with mental health needs. It is owned by Portland Care Homes, a private company. The home was opened in 2007 and consists of a three storey terraced house in a residential road. It is indistinguishable from the other houses in the road. The home is located close to the centre of Watford, with its shopping malls, community health facilities and hospital. There is a small parade of shops within a short walking Care Homes for Adults (18-65 years) Page 4 of 29 2 7 1 0 2 0 0 8 6 6 Over 65 0 0 Brief description of the care home distance and easy access to major rail, bus and road transport. All the homes bedrooms are single. All the bedrooms have ensuite toilet and washbasin, and three have an ensuite shower. There is no lift and the home is not suitable for service users with mobility difficulties. The garden at the rear is mainly laid to grass with a large paved patio. The garden is shared with the companys sister home next door. The current fees range from £800 to £1400 per week. Information regarding the service is available in the Statement of Purpose & Service Users Guide. A copy of the CQC inspection report will be available from the manager. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We spent one afternoon at Bel-Air, and the people who live there and work there did not know that we were coming. The focus of the inspection was to assess all the key standards. Some additional standards were also assessed. Before the inspection we received Have Your Say surveys from two people who live in the home and from three members of staff. During our visit to the home we talked to two people who live in the home, and we met two more. We also talked to some of the staff and we looked around the home. We looked at some of the records kept in the home. We also looked at a sample of care plans so that we could see how people are involved in planning their own care and support. The manager was on leave at the time of this inspection. The manager sent some information (the Annual Quality Assurance Assessment, or AQAA) about the home to CQC before the inspection, and his assessment of what the Care Homes for Adults (18-65 years) Page 6 of 29 service does in each area. Evidence from the AQAA has been included in this report. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Adults (18-65 years) Page 8 of 29 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 29 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 29 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. Prospective residents are involved in the choice of the home and in the assessment process. Staff have the knowledge and experience to meet each persons care needs. Evidence: We looked at the care plans and information for two people who have moved to the home since the last inspection. Both the care plans contain a detailed assessment that was completed before the person moved to the home. One person moved to Bel-Air from the sister home Bellevue. Their assessment was completed before they were admitted to Bellevue, with a review that showed that they were not suitable for that service, and they should move to Bel-Air. The assessments provide good information on each persons needs and preferences, and they are written in a person centred manner that shows that people were involved in the process of their assessment. For example, X stated they are vulnerable in the community as when asked for money they would give if they like the person, so may be exploited. The surveys that we received from people who live in the home all showed that the staff and managers treat them well. One person commented,The home helps me Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: come to terms with my situation. And how to become independent. The people who we spoke to during our visit said that they are very happy in the home, and that the staff provide support in the way that they wish. The support staff who we spoke to and who completed surveys for the inspection said that they have sufficient information and training so that they can meet each persons needs. One survey included the comment, We provide excellent service and care for all our service users at all times. All of the service users at this home is always smiling. Care Homes for Adults (18-65 years) Page 12 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home are fully involved in all decisions about their lives in the home. The care plans are person centred and provide the staff with appropriate information to enable them to meet peoples individual needs. Evidence: Portland Homes has a Person Centred Planning Book that involves each person in writing their own care plan and making decisions and choices about their lives in the home and the support that they need. We looked at two care plans, and used them to track the care and support that is provided for the people who live in Bel-Air. The Annual Quality Assurance Assessment (AQAA) states, The Person Centred Care Plans we produce drive the issues of equality and diversity forward and put the Service Users at the front of plans for the future. The care plans are clearly written, with good details of each persons needs, and the procedures and guidelines for meeting those needs. Care plans include specific areas where dietary preferences of people using the service, personal care routines, choices and preferences, religion and culture, communication, behaviour and sexuality are respected. The format of the care Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: plans describes the need to be met, the persons goal for meeting the need, and the route and actions for the staff to follow to support them to achieve their goal. One persons care plan states, (The person) stated that they are independent in personal hygiene. However they agreed staff to encourage them to attempt shower or wash. Another care plan states, (The person) can cook their meals however at times they lack motivation. When in a low mood they may require prompting or encouragement from staff. The people concerned have signed all their care plans. The staff write daily records on the progress towards each persons care plan goals, which record any issues that need to be communicated to other staff, or to be monitored. Examples of this are when one person refused their medication, and when a person lost their keys. The staff who we spoke to said that the care plans provide them with good information. One new member of staff said that the care plans in Bel-Air are 100 better than in the service where they previously worked. The risk assessments that we saw include clear guidelines for supporting the person to achieve the activity and manage any risk involved. One example is a risk assessment for verbal aggression. The monthly progress notes record that: (The person) said that they will not be aggressive or verbally abusive in this Home. They would like to remove this from their care plan. This risk assessment is now marked as completed, and provides a good example of how people are actively involved in planning and monitoring their own goals. There is also a missing person procedure for each person, with individual protocols for the actions to follow if they do not return to the home when they are expected. Other risk assessments include individual management plans for the risks from smoking. There is a shed on the patio where people can go to smoke, and the homes policy is that people should not smoke in the house, or in their bedrooms. The risk assessments state that if a person smokes in their room, they will hand over their cigarettes and lighter to the staff. One persons risk assessment states, If any decision is made on behalf of (the person) staff to inform them well in advance about those as they may get irritated and anxious about it if not given enough time to adapt to the decision. There is no indication that a formal assessment has been made about their capacity to make decisions in line with the Mental Capacity Act. Training on the Mental Capacity Act is in progress in the home, and the manager needs to ensure that all staff are aware of and comply with the Mental Capacity Act deprivation of liberty safeguards and authorisation conditions that apply to people living in residential care homes. We talked to two people who live in the home about their involvement in decisions about their lives. One person said that they are working on their independence skills, with the goal of moving to a smaller, more independent environment. There are regular residents meetings in the home, and we saw the minutes of the last meeting Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: in November 2009. The issues discussed were games, DVDs, trips out, the menu, complaints procedure, the smoking policy, Christmas meals and decorations. Two people agreed to complete surveys for CQC. In the AQAA the manager said that as a result of people giving their views they are planning to have a cards evening each week, because some people have said that they would like to play cribbage and whist rather than board games. Care Homes for Adults (18-65 years) Page 15 of 29 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 people who live in the home are encouraged to make choices for their activities, and the staff support them to develop their skills for independence. Evidence: We received two surveys from people who live in the home, and all stated that they make their own decisions about what they do each day, and that they can do what they want to do during the week and at weekends. One person said that what the home could do better is more outdoor activities. One of the staff who completed a survey said that the home could: Try to arrange more activities for clients. The report of the homes residents survey in January 2009 states that everyone expressed satisfaction with both catering and food and with daily living. However the manager commented in the report, But we personally believe there is more room for improvement and we are having our activities structured in such a way that all parties benefit from them. During our visit to the home we saw improvement in this area. Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: We spoke to two people who live in the home. They both go out every day, one to the town centre and to a local cafe, and the other to walk or to the shops. They both said that they spend more time in the home than they used to, and that they take part in some of the social activities with other people in the home. During past inspections these people have spent most of their time outside of the home, and have not chosen to socialise with others. Each person has an individual activity planner, and the staff support them to achieve the things that they want to do. The manager said in the Annual Quality Assurance Assessment (AQAA): One of the Service Users has shown an interest in museums and exhibitions and enjoys history. We have agreed a list of places in London where they particularly would like to visit and have made a member of Staff available to accompany them each month. The activities on the planners that we saw include housekeeping tasks such as laundry, shopping and preparing lunch, independence skills for planning, shopping and handling money, and social activities such as gardening, visiting their family, going to church and having fun. More structured activities in the home and community include going out for lunch, pizza party and tea party in the home. One person wants to go to a pantomime, and staff are supporting them to find out about the tickets for themself. There are joint parties for celebrations such as Halloween and a summer barbecue with residents from Bellevue, which is next door to Bel-Air, and both homes share a garden. One person has a goal to get voluntary employment. Their care plan has details of the progress towards this aim, and staff have supported the person to complete an application to Work Solutions for voluntary work. The menus on display in the kitchen show that there is a cooked meal in the evenings, and at lunchtime on Sunday, and people choose individually what they would like for lunch and breakfast. Two people buy their own food, and they are given a budget by the home for this. One person was cooking their own meal in the kitchen while we were in the home, with support form the member of staff who was cooking the main meal for the other residents. Care Homes for Adults (18-65 years) Page 17 of 29 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. The staff support people to maintain their health needs and to consult other medical professionals to ensure their continued well being. Evidence: The Annual Quality Assurance Assessment (AQAA) stated, We have a mixed gender Staff team and can offer choice of gender for personal care. We work closely with the Community Services, Social Services and the Community Psychiatric Nursing Services to ensure there is a continuity of support for the Service Users. The care plans that we saw during this inspection contain good details of each persons care needs. People are treated with respect regardless of the background, race, gender, disability, sexual orientation age religion and belief. Care plans include specific areas where peoples choices and preferences for personal care routines, communication and behaviour are respected. The report of the homes residents survey in January 2009 states that everyone expressed satisfaction with their personal care and support, and the manager commented in the report, We believe we can do better when more staffs are employed and this is in progress. The healthcare records seen included references to hospital visits, and contact with Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: GPs and other health professionals. These include the psychiatrist and community nurses. Everyone has contact with the psychiatric services and regular CPA (Care Planning Assessment) meetings. Staff have had training in the management of malnutrition, and monitoring of peoples healthcare includes regular weight checks. The staff who we spoke to said that training and information is available for them so that they have the knowledge and skills to support people with specific needs. People are encouraged and supported to take responsibility for their own healthcare and to visit GPs and other health professionals independently. One person had a care plan for support with a planned operation. The home has systems in place to manage peoples medication safely. All the staff have training in administering medication, followed by supervision until they are judged to be competent to administer medication without supervision. One person looks after their own medication, and there is a risk assessment in place for this. We checked the medication records for the people who we were case tracking. The records were free of errors, with no signature gaps found on the MAR (medication administration record) charts. One person had refused their medication on one recent occasion, and this was recorded on both the MAR chart and in their daily record. Care Homes for Adults (18-65 years) Page 19 of 29 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 people who live in the home are encouraged and supported to make their views and concerns known, and appropriate procedures are in place to ensure that they are protected from abuse and neglect. Evidence: The Annual Quality Assurance Assessment (AQAA) stated, We support the Service Users to make a complaint or raise a concern without fear of reprisal of any type. We always raise this at the residents meetings. The complaints procedure has been reviewed to ensure it is more user friendly and this has been circulated to the Service Users. The complaints recording system has been re-developed. The new Portland Care Homes complaints policy is clearly written in an easy to read format and uses pictures as an aid to understanding. All the staff who completed surveys for the inspection said that they know what to do if someone has concerns about the home, and the people who live in the home who completed surveys said that they know how to make a complaint. There were no complaints recorded in the home for two years, but two complaints have been recorded in the last two months, one concerning a lamp not working and one concerning the selection process for the home. Both were addressed appropriately, and provide evidence that any concerns of the people who live in the home are listened to and taken seriously. The home has appropriate procedures for safeguarding vulnerable people, and the whistle blowing procedure provides clear guidelines on reporting any concerns. The Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: staff who we spoke to were aware of the safeguarding procedures, and of their responsibilities for whistle blowing. All the staff have a full days training on safeguarding vulnerable people as part of Portland Care Homes three day mandatory induction training. Training is also available from Hertfordshire to ensure that the staff are aware of the local interagency safeguarding procedures. The staff who we spoke to were aware of the principles of the Mental Capacity Act, but they were not so clear about the Deprivation of Liberty Standards (DOLS), which protect people from restraints that may be in place without proper authorisation. No-one living in the home is currently subject to a deprivation of liberty authorisation, and no-one currently has their liberty deprived without an authorisation. Care Homes for Adults (18-65 years) Page 21 of 29 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 home provides a comfortable and well maintained environment for the people who live there, and the staff maintain a good standard of cleanliness and hygiene. Evidence: Bel-Air is a mid terrace family style house. It looks no different from the other family houses in the street. It is within walking distance of local shops and services and is not far from Watford town centre. The home employs a part time cleaner and the home appears to be clean and well maintained. A shed on the patio outside the lounge has been furnished with a table and chairs so that people who wish to smoke can use it. Two people enjoy spending time there chatting, drinking tea and listening to the radio. The laundry room is on the first floor, and contains domestic style machines that do not have a sluice programme. However one of the staff described the laundry procedures, which include the use of red alginate bags for soiled laundry, and this is washed at 90 degrees Centigrade. These procedures are satisfactory for effective infection control for the people who currently live in the home. There is a laundry outside of the home, in an outbuilding in the garden, which contains suitable equipment for prevention of infection, including a washing machine with a sluice programme. Use of this equipment should be considered if laundry should require sluicing in the future. Care Homes for Adults (18-65 years) Page 22 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in the home are supported by a stable staff team who have the experience and training to understand and meet their needs. However some people continue to work excessive hours, and this may affect the quality of their work. Evidence: Several new staff have been employed in the home since the last inspection, and there is now a stable, enthusiastic staff team. The Annual Quality Assurance Assessment (AQAA) stated that only ten shifts have been covered by agency staff in the last three months, and, We now use an accredited Staff Agency to support the permanent Staff Team for annual and sickness leave. We have found the Agency Staff are well trained and fit in with the permanent Staff team. The staff rota shows that there are two support staff in the home throughout the day, and one at night. The Registered Manager was on leave at the time of this inspection, and the deputy manager was covering for him. Her hours are additional to the staff complement on the rota. We looked at the rotas for the current month. One person is scheduled to work excessive hours of up to 64.5 hours in the next two weeks, and has worked 60 hours in previous weeks. This person is scheduled to work three nights a week in addition to a full week of day duties. During the previous two weeks the hours that they worked were within the Working Time Directive maximum of 48 hours. The Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: same person was working excessively long hours at the time of the last inspection. At that time the manager said that this was a temporary measure until they could recruit more staff. The Annual Quality Assurance Assessment (AQAA) reported that the home now has a full complement of 10 support workers, and it is a concern that this practice is continuing. In order to comply with the Working Time Directive a persons hours can be taken as an average over 16 weeks. We did not see evidence that this has been breached. However there is a risk that any person working over 60 hours, with a mixture of day and night shifts in the same week, may not be able to provide the best quality of care and support for the people who live in the home. One member of staff who completed a survey for the inspection said that there is a need for more staff, especially during the night shift. Portland Care Homes provides a good training and development programme. Induction training includes three days that covers all the mandatory health and safety training, and all staff have completed this. Additional training is available that includes mental health, challenging behaviour and person centred approach. We spoke to three members of staff, and they all said that they have very good training and support. A new member of staff said that the induction training was very good, and the staff team are supportive. Portland Care Homes expect all their staff to register for NVQ when they complete their induction, and 4 of the 10 support workers currently have a NVQ at level 2 or above. We saw the supervision schedule, which shows that all staff have a formal supervision every two months. We also saw supervision records in staff files. All the staff who completed surveys for the inspection said that they have good training and regular supervision. One person said that that what the home does well is: Enough support from management. Providing training for staff to increase their knowledge and meet peoples needs. However two people commented that communication could be improved. One said that what the home could do better is, Making sure everyone is informed about the changes in care plans, activities, getting messages passed on to all staff members and clients. The staff who we spoke to during the inspection said that communication is good. They have a handover between every shift, and the daily contact records are used to communicate any changes for individuals (See Individual Needs and Choices). Staff files are kept in the sister home, Bellevue, and we saw a sample of these during a recent inspection of Bellevue. They contained all the required information to show that the home practices a robust recruitment procedure that ensures the person is fit to work with and protect the vulnerable people in the home. All the staff files now include their photograph. Care Homes for Adults (18-65 years) Page 24 of 29 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 is well managed for the benefit of the people who live there, and their views are actively sought and acted on. Evidence: The manager worked at Bellevue, the sister home next door to Bel-Air, for many years and he has a level 4 NVQ in management and in care. When Bel-Air opened he was registered as manager for both services. Each home has its own deputy manager and staff team. The deputy manager of Bel-Air has the RMA (Registered Managers Award), and NVQ level 4. The manager was on leave during this inspection, and the deputy manager was covering for him. The deputy manager was not present during the inspection. But all the staff who we spoke to said that she manages the home well, and provides good support for the staff team. One survey from a member of staff said that what the home does well is: Enough support from management. All the homes policies and procedures have now been reviewed, and are available as Portland Care Homes documents. No-one living in the home is currently subject to a deprivation of liberty authorisation, and no-one currently has their liberty deprived Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: without an authorisation. The procedure for monitoring the quality of the services that the home provides includes annual questionnaires to residents, relatives and other stakeholders. The report of the last survey in January 2009 analysed the results, and provided an action plan from the outcomes. The proprietor makes regular monitoring visits to the home. The home maintains appropriate records for the health and safety of the residents and staff in the home, including monitoring hot water temperatures, checks of fire equipment and regular fire drills. Water temperature records show the actions taken if if any temperature is seen to be high. The records of fire drills provide a comprehensive account of the process. A fire safety report from Herts Community Fire Service in February 2009 assessed that the premises has suitable and sufficient measures to satisfy the requirement of The Regulatory Reform (Fire Safety) Order 2005. All the staff have training in moving and handling, fire safety, food hygiene, first aid and infection control. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes R 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 1 33 18 The registered person must 02/04/2009 ensure that sufficient staff are employed in the home in order to comply with the Working Time Regulations. The staffing rotas show that some staff work very long hours. People who work excessively long hours may be too tired to provide a good quality of care for the people who live there, and there is a risk of errors due to poor concentration. Care Homes for Adults (18-65 years) Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 28 of 29 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. 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