Inspection on 18/03/09 for Belvedere

This inspection was carried out on 18th March 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.

Other inspections for this house

Belvedere 14/03/07

Belvedere 06/07/05

Belvedere 05/01/05

Belvedere 04/01/05

Belvedere 26/05/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Belvedere Bridgetown Hill Totnes Devon TQ9 5BN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rachel Fleet     Date: 1 8 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. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Belvedere Bridgetown Hill Totnes Devon TQ9 5BN 01803867161 01803867161 enquiries@comae.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Lilah Ramsden,The Very Rev Mitred Archpriest Benedict Ramsden,Mr Simeon J A G Ramsden Name of registered manager (if applicable) Mr Stephen Escott Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home Belvedere is a domestic property in a residential area of the South Hams town of Totnes, close to local shops and facilities. It is part of the Community of St. Anthony and St. Elias, which has a number of homes in the South Hams and Plymouth areas. In this report, the organisation will be referred to as the Community. Care is provided for up to three people (currently all male) under the age of 65, who have mental health needs. The home does not provide nursing care other than through local NHS community services. It has three single bedrooms, a lounge, kitchen and a dining room, as well as a shower and bathroom. The homes office is also used for staff overnight sleeping accommodation. There are gardens at the front and rear of the property, with on site parking available. A well-organised activities programme is Care Homes for Adults (18-65 years) Page 4 of 32 care home 3 Over 65 0 3 Brief description of the care home offered by the Community. Current weekly fees for a place at the home range from 2100-2300 pounds per week. Not included in these fees are the costs of activities or holidays that individuals arrange independently for themselves, and personal expenses such as toiletries, hairdressing and clothes. Our previous inspection reports are available from the homes manager. Care Homes for Adults (18-65 years) Page 5 of 32 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: Date of the homes last Key Inspection: 15 March 2007. We carried out an Annual Service Review on 6 June 2008, concluding the home was continuing to provide a good service. This Key Inspection was part of our usual inspection programme. Our unannounced visit to the home took place over seven hours on a weekday. Before our visit Steve Escott, the Registered Manager, completed a questionnaire sent out by us (the Annual Quality Assurance Assessment, or AQAA). This included the homes assessment of what they do well and any plans for improvement, as well as Care Homes for Adults (18-65 years) Page 6 of 32 information about people living at the home, staffing, policies in place, and maintenance of facilities. We sent surveys to the home for them to give to the three people living there and to five staff. We received the staff surveys back but none from the people who lived at the home. Of four surveys we sent to health and social care professionals who support people at the home, one was returned. During our visit we met the people living at the home, two of whom gave us their views. We also spoke with three staff, and looked around the home. We checked peoples care plans, various other care-related records or policies, information relating to staff, and health and safety documents (such as accident /incident records and maintenance records). We discussed our findings with Mr Escott, who assisted us during the day. Information is included in this report from all these sources, and from communication with or about the service since our last inspection. What the care home does well: What has improved since the last inspection? What they could do better: The home has various measures in place to safeguard the people who live there. However, people at the home would be further protected from abuse or harm by increasing staff knowledge about local safeguarding procedures, and by evidencing that two people verify the accuracy of instructions hand written by staff on medication Care Homes for Adults (18-65 years) Page 8 of 32 administration sheets. Various health and safety measures are in place, though some additional attention to two aspects would further ensure the welfare of everyone at the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 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 32 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. The homes admission processes are such that prospective residents needs and aspirations are assessed and understood before they are offered a place at the home. Evidence: No-one had been admitted to the home since our last inspection. It was found at our last inspection that community professionals assessments had been obtained for each person living at the home prior to their admission, and the Communitys own assessments were also seen. These included the interests and aspirations of each person. Care plans, with clear goals, were in place for all three people. Risk management plans had been written on the basis of individual assessments of risk. These clearly identified actual and potential restrictions on peoples freedoms and choices. Current residents were men, aged 25-45 years old approximately. We discussed with Steve Escott whether there were any age or gender restrictions relating to residents. Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: He said each prospective residents needs and personality - rather than their age or gender - would be considered in relation to people already living at the home, to ensure they would get on together. Care Homes for Adults (18-65 years) Page 12 of 32 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. People living at the home are very well supported to make choices and pursue their individual goals, being encouraged to take risks responsibly, to improve the quality of their lives. Evidence: Staff surveys reflected that they felt they were always given up-to-date information about the needs of the people they supported at the home. We looked at the care plans for the three people living at the home. The plans were very well organised, and showed clearly how individuals goals or needs were being pursued and met. There was a clear, well-defined cycle of assessment, planning action and review. Care plans had been regularly reviewed under the Care Programme Approach, and were signed by the individual they were for. People we spoke with recalled having discussions about them, and support staff told us that they too had some input into care planning. Each plan set out detailed goals regarding the physical, emotional and social needs of Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: the individual. Documents were seen relating to specialist mental health support, with mental capacity assessments now part of peoples care plans. Discussion with people who lived at the home confirmed that the plans and related records accurately reflected the needs of each individual. Within the plans, there were comprehensive risk assessments and risk management plans. Restrictions on usual freedoms were recorded with the reasons for such restrictions, being tailored for each individual. For example, when someone should not go out to local shops. Our conversations with staff showed they were aware of and following such guidance in the care plans. We noted the kitchen was to be locked at night. Staff told us this was to help people keep to a healthy intake, and that only one person wanted snacks or drinks overnight, which staff helped them to get. The choices available to people at the home were evident from the care plans and discussion with staff. They had diverse support needs, and it was evident that different choices about employment, social activity and development of skills or interests were offered to each. One person confirmed that they were very satisfied with the support offered by staff. Our discussions and evidence from the plans showed a thoughtful and active approach to supporting each individual in meeting their diverse needs. Someone living at the home told us they were supported by others with their finances thus they were able to manage them realistically. The registered provider acted as appointee for one person, the manager confirming there was still a specific corporate bank account for peoples monies as stated at our last inspection, to keep it separate from any business monies. Relatives acted as appointees for others. Two people had their own bank accounts. People confirmed they had a lockable facility, but the home was holding some cash for people at their request, with records of each persons monies and any related receipts. Forms used indicated that two signatures were to be obtained of witnesses to each transaction, and the individual concerned had sometimes signed as one of these. Cash balances held matched those shown on the records we saw. Care Homes for Adults (18-65 years) Page 14 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples individual lifestyle choices, relationships and aspirations are respected and appropriately supported, promoting their independence and enabling them to have increasingly fulfilling lives. Evidence: There were excellent profiles about each of the people living at the home, in their care records, to help staff understand them and what was important to them. We found each was being very well supported to make choices about their lifestyles. They followed individual daily routines. One person was sitting, relaxing, outside when we arrived, telling us Its great here! when we spoke with them. They later went out with staff to collect compost for the garden; they also had some paid employment. Another person rose late, having a quiet day and choosing to spend time in their own Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: room. Someone went out with a staff member to get a haircut, get their glasses seen to, and do some shopping. People were going to be helping staff clean their bedrooms, and doing their laundry, also. A commendable activities programme was offered by the Community, which included arts, crafts, sporting and outdoor activities linked to peoples interests and needs such as for improving independent living skills. Some of the activities were led by support staff who had relevant qualifications, such as in art and outdoor activities. The Community had its own transport, although its use relied on availability of staff drivers for the cars. Care records showed people had enjoyed barbecues and singing groups at the home, which were attended by people from other of the Communitys services. One person went swimming, another went canoing. A garden shed had just been built for one person to enable them to pursue particular interests and have some space of their own outside the home. The AQAA told us that extra staff were made available to enable people to visit relatives at some distance from the home, including for overnight stays. On our visit, daily records, individual plans and conversations with staff showed how relationships with family, friends and the local community were well supported. This included family visits as stated in the AQAA, trips out, telephone contact and considering them in celebrations through the year such as Easter and Christmas. People living at the home told us their families and other visitors were made welcome, given drinks, etc. They told us there were good relationships with the neighbours either side of the home. One person confirmed they attended a local church group. Some had participated in a national Beach Art Day, and told us they were going to the beach again later in the week. Some had been on holiday, elsewhere in Devon - one remarking Its great and clearly happy with the place they had stayed at. One person spoke to us about a conservation course they had completed since our last visit, as well as other courses they had tried. The rights and responsibilities of person living at the home were clearly respected by staff. Each person had a key to their room. Individual plans demonstrated how the independence of each service user had been promoted within the framework of clear risk management plans. Fresh fruit was freely available in the homes lounge. Meals were organised on a shift by shift basis, in consultation with the people living at the home, who are also involved in the getting the necessary shopping. One person helped to prepare a meal during Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: our visit. Records were kept about the food actually taken at each meal, and showed people had a varied diet. We had a lunch of soup and rolls with people living at the home and the staff, during our visit, in a relaxed atmosphere. We were told the evening meal had been discussed and people wanted liver and bacon casserole. The next evening, people were going out to play snooker, a regular event that also involved having a meal out. Care Homes for Adults (18-65 years) Page 17 of 32 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 living at the home are supported to look after their personal and healthcare needs, with agreed help given to ensure these needs are met safely, promoting their wellbeing. Evidence: Evidence was seen during this inspection of the diverse range of personal support given to people living at the home to meet their individual needs and preferences. Daily notes kept by support staff about each persons day reflected a holistic view of that person. One person living at the home told us there was no hierarchy at the home, and there were good relationships with staff. Another described staff as fair, and confirmed that staff respected their privacy, although they felt sometimes they were bossed about when it came to participating in housekeeping responsibilities. We noted staff generally had an friendly, respectful approach, using an encouraging tone and reflecting back peoples comments to check their understanding of what was being said. At times we heard some more direct or blunt communication with people who lived at the home, Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: which the manager said he would follow up. Peoples weights were recorded regularly, with one person particularly being supported to eat a healthy diet and take regular exercise. Staff we spoke with appropriately described that where someone required a diabetic diet this meant eating healthily, rather than just a low sugar diet. They also said the individual could still make other dietary choices but they tried to provide opportunities for them to eat healthily. One said they encouraged the person to re-read literature they had been given about their condition. Information on peoples medical conditions was also available for staff. Care records evidenced both routine and ongoing specialist healthcare appointments or checks blood tests relating to prescribed medication, specialist chiropody for someone with diabetes, flu vaccines, general health checks, etc. One person told us they had been to the dentist and optician in recent months. The Community employs a consultant Psychiatrist, who advises on peoples needs and on support that would help them. Staff also spoke about the involvement of the local NHS Learning Disability team, who worked with an individual and the staff on communication matters. A medical professional who had some limited contact with the home had no concerns about the service, saying All seems well. We noted that someone with a certain health condition was paying for private chiropody rather than having access to free NHS services as are usually available in such cases. The assistant manager said she was already looking into this. None of the people at the home was administering their own medication. Those we asked were happy with how staff dealt with their medication on their behalf, one saying staff were helpful about their medication. Medicines were securely stored, with a monitored dosage system used. On the day of our visit, there were no controlled drugs or medicines requiring cold storage prescribed for anyone, although a medicines fridge was available. Some homely remedies were available, with their use covered in a list approved by relevant professionals. Patient information leaflets were kept for the medicines in use, along with a record of staff signatures, and medicines received into the home. We noted hand written instructions on administration sheets had not been always been signed and dated by two people to verify their accuracy. We found instructions on an administration chart for one medication that differed from those on the container received from the pharmacy. Staff said they would follow this up. Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: Some medicine was to be administered as required. There were detailed guidelines for staff concerning when and how to use such medicines, including therapeutic or other strategies to be tried before considering medication. Staff had appropriately recorded the quantities they had given where a variable dose was prescribed. The medicines policy we saw included guidance about self-administration, medication errors, and home visits. Staff training in the use of medicines was provided by the Community as part of its ongoing training programme. Staff confirmed that new staff were observed by experienced colleagues to ensure they used good practise. Longer serving staff said they had not been observed recently. It is good practise to include this as part of regular supervision. Care Homes for Adults (18-65 years) Page 20 of 32 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. People using the service can feel assured that their views and concerns will be listened to and acted upon. Staff lack some knowledge about local safeguarding procedures, so people at the home may not be as fully protected from abuse or harm as possible. Evidence: Staff we spoke with were aware of the homes complaints procedure, as also indicated by staff surveys. A written version had been given to each person living at the home, which included how to complain directly to us. No complaints had been made to us, however, since our last inspection. We saw the home had recorded one complaint; though this was not about the registered service, staff had helped the complainant to resolve the issue. People who spoke with us said they would talk to Steve Escott if they had concerns or complaints, and they were confident he would try to help. One person told us they felt secure and safe at the home because the staff ensured external doors were locked at night and the person could lock their own bedroom door as well. Policies and procedures were in place concerning the protection of vulnerable adults from abuse and whistleblowing by staff. Staff we spoke with generally had a good knowledge of safeguarding, including their responsibilities to report various forms of abuse should they witness or suspect them, and external agencies to whom concerns Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: could be reported. However, there was little guidance specifically on the local authoritys safeguarding procedures, and staff were not aware of these. One told us they had not had a safeguarding update for over a year. The manager said he would address these points. Staff told us their training programme included elements of understanding and managing aggression, including communication, trying to de-escalate anger as well as physical intervention. They said they were not specifically asked in their supervision sessions if they had any concerns about the home, but felt they could raise concerns at any time. Care Homes for Adults (18-65 years) Page 22 of 32 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 live in a sufficiently clean, comfortable, homely and safe environment, which is improved in line with their needs and lifestyles. Evidence: Belvedere is within easy reach of local facilities, shops, public houses and a leisure centre. There are good local bus and train services. The kitchen, office, lounge, dining room and a toilet were on the ground floor, with bedrooms, a bathroom, a shower room, toilet and another office on the upper floor. Peoples possessions were much in evidence around the home. One of the people living at the home showed us the large enclosed rear garden, where the home had provided them with a shed as they requested. Another person kept their pool table in what was the garage but which was now a games room. Since our last visit, the garden and drive had been improved. Internal areas had been redecorated, with one person who lived at the home telling us that they appreciated this. We noted that although the shower room had been repainted, there were signs of damp, and these areas (bathroom, shower and toilet) looked less homely than the rest of the home. Steve Escott told us that the lounge was to be re-carpeted in the near Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: future; the lounge suite and peoples beds had been replaced. Daily records included equipment needed by individuals (such as a lamp), as well as cleaning tasks to be done. The premises were generally well decorated, attractive, homely, clean and comfortable. Details in the repairs log showed maintenance requests were addressed in a timely way, as staff also confirmed. They felt the home was generally maintained well, and said it was up to the staff team to request any equipment they thought they needed. People living at the home told us they heard the fire alarms tested regularly, but were less sure whether fire drills were carried out. Records showed routine maintenance and safety checks for the home were kept and up-to-date. These included, for example, checks of fire safety equipment and fittings and the testing of electrical equipment. Some radiators in the home were not covered. A risk assessment should be produced concerning these unprotected hot surfaces. Staff confirmed some safety checks were carried out daily and others were carried out at the change of shifts ie every 48 hours (such as hot water checks) A satisfactory standard of hygiene was evident. Individual needs were taken into account, such that the cleanliness of toilets was checked regularly for example. Staff described different disposable cloths used for different cleaning jobs, and said gloves and aprons were available. They told us the Health Protection Agency had been contacted in the past for advice on infection control matters. Laundry facilities were sited separately from food preparations areas, domestic in nature and appropriate for peoples needs. Care Homes for Adults (18-65 years) Page 24 of 32 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 living at the home have their needs met and are supported well by staff, who as individuals are suitable to work in such a care setting, and who are trained, supervised and supported well by their manager. Evidence: When we first arrived, the assistant manager was on duty with two male support workers. The registered manager came to assist with our visit, and other staff were on duty later in the day. Although one staff member was on his first shift at the home, the other staff had worked for several years within the Community. Staff surveys indicated they thought there were always enough staff to meet peoples needs, one adding that the structure of the organisation always enabled this. Someone living at the home confirmed they felt the staffing levels were sufficient. Support staff usually worked 48 hour shifts, acting as sleep-in staff overnight. A staff member we spoke with felt the skill mix of the team was managed well, in that it was related to and revised according to the variable needs of the people at the home. Another said it was up to the staff to request training or a change to the skill mix if they felt it necessary to meet peoples needs properly. Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: Staff we met had a positive attitude to their work. They showed a very clear understanding of individuals needs and how to meet them or support the person. This was reflected in the interactions observed during our visit and in discussion with people living at the home. Staff confirmed that new employees observed colleagues in the workplace before being observed as they worked with people at the home. Induction training included health and safety issues as well as topics specific to individuals needs, and was linked to recognised care qualifications that several staff went on to achieve. A staff member commented positively on the quality of their induction programme. Five of the current six staff held a National Vocational Qualification (NVQ) in care, at level 2 or above. The assistant manager was undertaking NVQ Level 4 in care. Staff files showed evidence of a supervision and appraisal system which identified their training needs. Training had been undertaken which was specific to the needs of individuals living at the home, with staff files reflecting that this had included autism and on diabetes, for example. The AQAA stated that there was training material available on Aspergers syndrome and acquired brain injury. One person commented that the training provided was flexible and related to many aspects of their particular work with individuals at the home. Staff we spoke with told us they were booked on their annual update training in the next month. Discussion with the staff indicated sound recruitment practises were used, such as obtaining two references, police checks and an interview before they started working at the home. Recruitment is managed at a corporate level, and some staff recruitment information had to be obtained from the Communitys main office by the manager because it was not stored at the home. How such information is to be made available for inspection in a timely way will need to be considered on future inspections. Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is run for the benefit of people living at the home, using their views and other monitoring systems to ensure ongoing improvement of the service for each individual. Various health and safety measures are in place, though some additional attention would further ensure the welfare of everyone at the home. Evidence: Feedback from people at the home and staff confirmed that the home is generally well-run. Steve Escott, the registered manager, has many years of experience in managing care services, is qualified to NVQ level 4 in Care, and has completed the Registered Managers Award. Since our last visit, he has attended training about the Mental Capacity Act 2005 and Cognitive Behaviour Therapy. He also told us he also learns through working regularly with the Communitys Consultant Psychiatrist. As he is the manager for another of the Communitys homes, Mr Escott is assisted at Belvedere by an experienced Assistant Manager. Staff told us there was always at least one senior staff member on call for advice or Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: support, and they readily came to the home if necessary. A staff survey included There is always lots of support from the management team. One said they did not have specific staff meetings but had regular one-to-one supervision and handover sessions when matters could be discussed. We saw reports left at the home after unannounced visits by the providers representatives, which included checks on various aspects of daily life at the home (medication, personal monies accounts, health and safety matters, etc.). Staff we spoke with were aware of these monitoring visits. People told us there were no residents meetings as such, but confirmed they could raise issues or suggestions at the reviews of their care plans. Staff told us people also regularly raised matters with them, on a day-to-day basis. Steve Escott said family members were at some of the care plan reviews, as well as being consulted when they came to the home, etc. The formal quality assurance system included questionnaires for people about their experience of the home. These had been given out in February 2009, for return to and analysis at the Communitys main office. Other monitoring systems were in place, such as regular checks on the effectiveness of personal care and support people received or needed, and on the cleanliness of the home. We found actions had been taken subsequently to address any issues identified that affected the quality of peoples lives or might affect their welfare. A staff survey included If I do find anything [that could be improved] I know I can rely on my manager to provide assistance to make changes. Records showed that staff had received training in health and safety topics such as fire safety, first aid and infection control in recent months. A staff member we spoke with said they had had first aid training that gave them skills relevant to the outdoor activities they went on with people from the home, as the manager confirmed. Those we spoke with said they were due to attend fire safety and other refresher training soon, regular training days having been commenced in recent weeks. Staff we asked felt they had a safe working environment. Risk assessments for environmental hazards were seen and routine checks were being carried out regarding, for example, water temperature. We recommended at our last inspection that risk assessments should be conducted in respect of uncovered hot surfaces. Steve Escott told us that there were no written risk assessments yet but no-one at the home was at risk of burns from radiators, etc. The AQAA indicated that servicing and checks of equipment and mains services was up-to-date. During our visit, we saw evidence of this regarding safety checks for Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: personal electrical equipment, the hard wiring, and fire safety equipment. We noted in one bedroom and the lounge that several multiplugs were being used, with one suspended rather than on a surface. The manager said proper provision of wall sockets, etc. would be addressed in current plans to redevelop parts of the home. Window restrictors were in place where we checked at random upstairs. The kitchen was domestic in nature, clean and orderly. Fridge and freezer temperatures were within recommended ranges, with other groceries stored appropriately. Care Homes for Adults (18-65 years) Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 32 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 1 20 It is recommended that hand written instructions on medication administration sheets are signed and dated by two suitably qualified people, to verify their accuracy. It is recommended that, by training or other means, staff are made aware of local multi-agency safeguarding procedures, to ensure the home has robust procedures for responding to suspicion or evidence of abuse. It is recommended that action be evidenced to ensure the safe use of electric multiplugs plugs around the home. Written risk assessments should be produced concerning uncovered radiators. 2 23 3 4 42 42 Care Homes for Adults (18-65 years) Page 31 of 32 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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