Inspection on 04/12/09 for Bellevue

This inspection was carried out on 4th December 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bellevue 02/01/09

Bellevue 27/10/08

Bellevue 21/07/08

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: Bellevue 78 Bushey Hall Road Bushey Watford 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: 0 4 1 2 2 0 0 9 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. 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 Care Homes for Adults (18-65 years) Page 2 of 35 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 © (2010) 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 35 Information about the care home Name of care home: Address: Bellevue 78 Bushey Hall Road Bushey Watford WD23 2EQ 01923490570 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: Conditions of registration: Category(ies) : Portland Care Homes Ltd care home 7 Number of places (if applicable): Under 65 Over 65 7 7 0 0 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is 7 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 fall within the following categories: Learning Disability - Code LD Mental Disorder, Excluding learning disability or dementia - Code MD Date of last inspection 0 2 0 1 2 0 0 9 Care Homes for Adults (18-65 years) Page 4 of 35 A bit about the care home Bellevue is a terraced house. It is in a busy road, and it looks like all the other houses in the road. Some shops are nearby, and the home is close to the town centre is nearby. Everybody who lives at the home has their own bedroom. Nobody has to share a room. Care Homes for Adults (18-65 years) Page 5 of 35 Everyone shares the lounge, dining room and kitchen. The accommodation charges for Bellevue 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 6 of 35 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 Care Homes for Adults (18-65 years) Page 7 of 35 How we did our inspection: This is what the inspector did when they were at the care home When we visited Bellevue the people who live in the home did not know we were coming. We talked to some of the people who live at the home. We looked some care plans and other papers. Care Homes for Adults (18-65 years) Page 8 of 35 We looked around the home. We talked with the deputy manager and some staff who work at the home. Before the inspection the manager sent us some information about the home. This is called the AQAA (Annual Quality Assurance Assessment). Before the inspection we sent out some surveys to the staff and to the people who live in the home. Care Homes for Adults (18-65 years) Page 9 of 35 What the care home does well Everyone told us that they are happy in the home. They said that the home has improved. Care Homes for Adults (18-65 years) Page 10 of 35 The people who sent us surveys before the inspection all said that the home is good. One member of staff said, The staff are highly committed to the care of the residents and are very responsive to their needs. The home is very clean and tidy. The care plans tell the staff how people like to be supported with the help that they need. Care Homes for Adults (18-65 years) Page 11 of 35 The staff support the people in the home well. They know what everyone needs and likes. What has got better from the last inspection There is new furniture and flooring in the lounge, dining room and office. The people who we spoke to said that it is very comfortable. The complaints procedure tells people how they can make a complaint if they are not happy. Care Homes for Adults (18-65 years) Page 12 of 35 The staff have had training so that they can look after people properly. What the care home could do better People need to have a Service User Guide, with information about the home. The manager must make sure that the electric heaters in the home are safe. Care Homes for Adults (18-65 years) Page 13 of 35 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 Claire Farrier East Region Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA 0300 061 6161 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. Care Homes for Adults (18-65 years) Page 14 of 35 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 15 of 35 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 16 of 35 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 adequate 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: The surveys that we received from people who live in the home all showed that the staff and managers treat them well. 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, The staff are highly committed to the care of the residents and are very responsive to their needs. We looked at the care plans and information for two of the five people who live in the home. One person has moved into the home since the last inspection. The assessment that was completed before they moved in provides good information on their needs and preferences, and is written in a person centred manner that shows that they were involved in the process of assessment. For example, X has agreed to have at least two baths a week, and one of them has to be on a Saturday before they [meet their family]. Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: However X has a diagnosis of mental health needs, anxiety and self neglect, and no learning disability. This is contrary to the homes Statement of Purpose, which states that the service is provided for people with learning disabilities, who may also have a mental illness. One other person who lives in the home also has no learning disability, but they have lived there for a number of years, and their needs are met appropriately. X was admitted while the manager was absent from the home, and he notified the Commission of his concerns when he returned. X moved from Bellevue to the sister home, Bel-Air on the day of this inspection. For this reason we have made no requirement on this occasion. But the manager and the proprietors must ensure that in future the service is conducted according to the aims and objectives and statement of services in the homes Statement of Purpose. The Annual Quality Assurance Assessment (AQAA) stated that the Statement of Purpose and Service Users Guide have been reviewed. We saw a Service Users Guide in one persons file that was reviewed in October 2009. However it was the Service Users Guide for Bel-Air, the sister home to Bellevue, and therefore did not contain the information that people living in Bellevue may need. Care Homes for Adults (18-65 years) Page 18 of 35 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 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 Bellevue. 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 plans describes the need to be met, the persons goal for meeting the need, and the route and actions for the staff to follow Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: to support them to achieve their goal. One persons care plan states, (The person) acknowledged their mental health problem and agrees with the staff team to help them maintain a positive mental health attitude during their stay with us. This is followed by very clearly written route to goal guidelines. The person concerned has signed all their care plans. The staff write a daily record on the progress towards each persons care plan goals, and these records are also clearly written in a person centred style. Most people have family members or social worker who can support them if they need advocacy. The deputy manager was aware of the principles of the Mental Capacity Act in ensuring that people can make decisions about their lives, and of the role of Independent Mental Capacity Advocates (IMCAs). The risk assessments that we saw include a management plan for supporting the person to achieve the activity and manage any risk involved. Examples of the risk assessments we saw were for epilepsy, road safety and smoking. 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. Care Homes for Adults (18-65 years) Page 20 of 35 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 supported to live full and active lifestyles. Evidence: Three of the five people who currently live in the home attend day care during the week. No one attends college or any other form of education. Two people have no programme of daytime activities in the home or in the community by their own choice, and staff support them with skills for independence in the home. The care plans include a section on independent living skills, and people are asked what they would like to do. The Annual Quality Assurance Assessment (AQAA) states that each person has a monthly Activity Chart that is completed with their keyworker and kept updated. Any new interest that they express an interest in is facilitated by the staff within a risk assessed framework. One person has a goal for returning home, and their care plan includes independence skills and visits home towards this goal. Everyone is encouraged to keep in touch with their families. The staff liaise with the Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: relatives of the people in the home, and encourage and support them to be involved in their relatives activities. We received four 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. The report of the homes residents survey in January 2009 states that everyone expressed satisfaction with both catering and food and with daily living. The manager commented in the report, But we personally believe there are 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. We spoke to three people who live in the home. On previous visits to the home, two of these have spent most of their time in their rooms and been reluctant to join in any social activities with other people. On this occasion both people agreed to speak to us, and one person came downstairs to the lounge specifically to do so. All confirmed that there have been positive changes in the home. They said that the staff support them to do the things they choose and that they are very involved in all decisions and choices about their lives in the home. The third person was also more sociable than they have been on previous occasions, and they were able able to take part in conversation about what was happening. The atmosphere in the home is relaxed and sociable and we saw evidence on the activities board and in care plans that staff support individuals in their choice of activities. There are joint parties for celebrations such as Halloween and a summer barbecue with residents from Bel-Air, which is next door to Bellevue, and both homes share a garden. One of the members of staff who completed a survey for the inspection said that what the home could do better is, More outings and holidays for the residents. The deputy manager said that due to the efforts put into restructuring the service this year they have not been able to arrange holidays and outings as they would wish to. But now that the home is fully staffed and the management structure is secure, this will improve during the next year. 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 of these told us that they can choose whether to join in the communal meal or to cook their own choice of food. Care Homes for Adults (18-65 years) Page 22 of 35 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 staff are employed and this is in progress. The healthcare records include references to hospital visits, and contact with GPs and other health professionals. These include the psychiatrist and community nurses. Staff Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: 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. Everyone has training in managing epilepsy and challenging behaviours and in mental health needs. One person recently died following a period of declining health. The staff supported them to receive appropriate healthcare, and ensured that they were admitted to hospital when their health declined. 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. The AQAA stated that in the last 12 months the staff have received more supervision in the administration of medication. 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. Care Homes for Adults (18-65 years) Page 24 of 35 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. We have produced a new user friendly complaints procedure. 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 two of the three people who live in the home who completed surveys said that they know how to make a complaint. All said that they know who to speak to if they are unhappy. No complaints have been recorded since the last inspection. One of the people who we spoke to told us of complaints that they have about the behaviour of another resident. The deputy manager told us that these complaints have been treated as disagreements, and the staff have worked with both people to resolve them. The incident reports contain full details of the incidents with the actions taken. However none of the persons concerns have been recorded as complaints, which may give the impression that their concerns are not listened to. Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: The home has appropriate procedures for safeguarding vulnerable people, and the whistle blowing procedure provides clear guidelines on reporting any concerns. The 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 deputy manager was aware of the principles of the Mental Capacity Act and 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 26 of 35 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 that protects people from the risks of the spread of infection. Evidence: Bellevue is a mid terrace family style house. It looks no different from other family houses in the street. It is within walking distance of local shops and it is not far from Watford town centre. The home employs a part time cleaner, and it appears to be clean and well maintained. The programme of refurbishment has continued since the last inspection, and the lounge, dining room and office have new flooring and furniture. This has improved the appearance of the home, and the atmosphere. It now gives the impression of a welcoming, comfortable and homely environment. The staff and residents who we spoke to all like the improvements. The dining room in particular is more user friendly, and has two smaller tables and chairs for people to use individually or in groups, rather than one large heavy table that previously dominated the room. The laundry is outside the home, in an outbuilding in the garden. It contains suitable equipment, including a washing machine with a sluice programme. All the staff have training in infection control, and the laundry procedures ensure good practice in this area. Care Homes for Adults (18-65 years) Page 27 of 35 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. 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. 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 three 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. She is included in the rota, but she told us that she has time to complete her management obligations. We looked at the rotas for the previous two weeks. One member of staff worked a night shift in addition to their day shifts, and in one week there was a break of only seven hours between a night shift and a day shift. However previous rotas showed that this was not a regular occurrence, and that two of the day staff may work occasional night shifts when needed. No-one works excessive hours that may affect the quality of their work. Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: 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. In addition the staff of Bellevue attend a two day training in mental health and learning disabilities. We spoke to two members of staff, in addition to the deputy manager. They 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. This person is looking forward to starting the NVQ qualification. 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. All the staff who completed surveys for the inspection said that they have good training and regular supervision. 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. We looked at the files of two members of staff who have been employed since the last inspection. 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 29 of 35 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 has worked at Bellevue for many years and has a level 4 NVQ in management and care. He is also the Registered Manager for Bel-Air, the sister home next door to Bellevue. Each home has its own deputy manager and staff team. The deputy manager of Bellevue has been in post since February 2009, and 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. All the homes policies and procedures have now been reviewed, and are available as Portland Care Homes documents. The deputy manager is aware of the Mental Capacity Act deprivation of liberty safeguards and authorisation conditions that apply to people living in residential care homes. 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 30 of 35 Evidence: 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. All the staff have training in moving and handling, fire safety, food hygiene and infection control. The records of fridge and freezer temperatures show that one fridge has regularly measured a temperature of up to 7.7 degrees centigrade. This should not cause a risk to food hygiene, for which the guidelines are up to 8 degrees Centigrade, but the homes own guidelines on the record chart state that fridge temperatures should be between 0 to 5 degrees. Staff should be aware of the reasons why they keep records, so that they can note any discrepancies and take any actions that may be required. Other records are well maintained. The monitoring of peoples weights as an aid to maintaining good nutrition and health notes any loss or gain of weight, so that actions can be taken if necessary. 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. We found one health and safety concern during our visit. There were several free standing electric heaters in use, including in the office and in the lounge. There was no risk assessment in place for their use, which should include management of any trailing wires and any risk from hot surfaces or access to the heat source. The deputy manager sent individual risk assessments to the Commission following the inspection, but these did not include a specific risk assessment to ensure the safety of residents, staff and visitors when the electric heaters are in use. Care Homes for Adults (18-65 years) Page 31 of 35 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 Care Homes for Adults (18-65 years) Page 32 of 35 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 1 5 04/03/2010 The correct Service Users Guide for the service must be made available for the people who live in the home and for prospective residents. People who plan to move into the home need accurate information so that they are able to make an informed choice about using the services. 2 42 13 04/02/2010 A risk assessment must be implemented to ensure that there is no risk to the people in the home from the use of freestanding electric heaters. People who live and work in the home, and visitors to the home, need to be confident that any equipment that is used will not cause a risk to Care Homes for Adults (18-65 years) Page 33 of 35 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 their health and safety. 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 34 of 35 Helpline: Telephone: 03000 616161 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 © (2010) 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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