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Inspection on 02/12/08 for Bradbury House

Also see our care home review for Bradbury House for more information

This inspection was carried out on 2nd December 2008.

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

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

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

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Bradbury House The County Durham Cheshire Home Worthington Close Crook Durham DL15 8NL     The quality rating for this care home is:   three star excellent 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: Steve Tuck     Date: 0 2 1 2 2 0 0 8 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 39 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.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 39 Information about the care home Name of care home: Address: Bradbury House Worthington Close The County Durham Cheshire Home Crook Durham DL15 8NL 01388768380 01388768519 clare.booth@lcdisability.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Leonard Cheshire Disability Name of registered manager (if applicable) Mrs Linda Blair Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: Physically disabled 18 years and over Date of last inspection Brief description of the care home Bradbury House is owned by The Leonard Cheshire Foundation and is registered as a Care Home which is also able to provide nursing care. The building was designed to meet the needs of people who have a physical disability and was purpose built in 1992. The home is situated close to the town centre of Crook in County Durham and provides easy access to shops, the library and other local leisure facilities. Bradbury House provides spacious communal and private living space with wide corridors and doorways which helps to ensure ease of access for wheelchair users. Communal space is made up of central, open plan areas used as sitting and dining rooms. People who live there have large bedrooms, all with individual adapted bathroom and some have adapted kitchen and lounge areas as well. Each room has its Care Homes for Adults (18-65 years) Page 4 of 39 care home 24 Over 65 0 24 Brief description of the care home own front door with access to the outside from patio doors to the gardens surrounding the home. The home also provides day time opportunities for up to 9 people each weekday. This takes place in a part of the homes communal space and people who live at Bradbury House can join in with day care activities if they want to. The home has their own vehicles that have been especially adapted for the needs of the people who live there. The previous inspection at this home was carried out on 5th December 2006 At the time of this inspection fees charged ranged from £697.07 to £1384.39 per week. The costs of newspapers, hairdressing, and toiletries are not included in the fees. Fees vary depending on people’s circumstances, further details can be found in the homes Service User Guide. Payments for nursing care is set nationally and is added to the fee rate. Fees for private chiropody and hairdressing are in addition the these charges. Care Homes for Adults (18-65 years) Page 5 of 39 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: three star excellent 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: Before the visit we looked at Information we have received since the last Key Inspection. How the service dealt with any complaints or concerns since then. Any changes to how the home is run. The providers view of how well they care for people. We asked them to examine their own service and write to us with the results. Care Homes for Adults (18-65 years) Page 6 of 39 We sent surveys to people who use the home, people who arrange for people to live there, those who visit the home to support people like doctors and therapists and the staff who work in the home to ask what they think about services there. The Visit An unannounced visit was made on 2nd December 2008. During the visit we Talked with the people who use the service the staff, the manager and visitors to the home. Observed life in the home. Looked at information about the people who use the service and how well their needs are met. Looked at other records which must be kept. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around parts of the building to make sure it was clean safe and comfortable. Checked on what improvements had been made since the last visit. We told the manager what we had found. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated it is likely that enforcement action will be taken. The quality rating for this service is 3 Stars. This means the people who use this service experience Excellent quality outcomes. What the care home does well: The home is a positive place to live; the atmosphere is up beat and lively but also secure and comfortable. The manager and staff are dedicated, talented and clearly enjoy working with the people who live there. People who live at the home like it. They have an individual service and are able to be in control of their lives whilst being respected and supported by staff in the best interests. This promotes their wellbeing and quality of life. A district nurse said, Clients are well looked after, care standards are high. People who move to the home have their needs assessed in detail by social or healthcare workers and the manager so that everyone is sure that this is the right place for them to live. This is very important where people have complicated nursing care and lifestyle needs that require well-managed and agreed ways of supporting them. Staff at the home are detailed organised and have well thought out ways that they meet the social, emotional and healthcare needs of each person who lives at the home. And these are written down in ways that are clear so that people who live at the home and the staff who work there can see exactly how the support is to take place. One person who lives at the home said the home has, Excellent care and support to avoid problems for example with pressure care and infections. Staff help people to have interesting lives, they help make sure that people can take part in activities they like and they help them to find and try new ones. The staff and manager help people to make choices about their lives and support them to be as safe as possible when they want to do something risky. One person who lives at th home said,If they put their trust in the risk assessors nothing can go wrong. Care Homes for Adults (18-65 years) Page 8 of 39 The staff work well as a team. They are well trained so that they have the necessary skills to support the care and lifestyle needs of people living at the home and there are sufficient staff available so that these needs can always be met. One person who lives at the home said, There is an excellent commitment to staff training and development. People who visit their relatives or friends at the home are made to feel welcome and relationships are supported. And people are asked about the way they wish to live and listened to when they have concerns. Many of the staff have worked at the home for over ten years and have a good understanding of their roles and work well as a team. They have very strong principles about how they support peoples rights and empower them as valued citizens within society and follows the governments White Paper Valuing People. They remain enthusiastic about their work and give good quality, person centred care and support. Care is provided to people with a wide range of needs, with varied ages, expectations and backgrounds. This diversity, including age and gender, is reflected in the staff team, giving the opportunity for staff to be matched to people where appropriate. Both care practice and staff recruitment practices are governed by equal opportunity principles. There are always fully trained nurses and care staff available to meet peoples nursing care needs. Staff who specialise in finding or providing opportunities during the daytime are an asset to this home and the way that staff are recruited makes sure that they are suitable for working with vulnerable people. The building is purpose built and very well designed, well maintained and adaptable. It is a very comfortable place to live. There are wide attractive communal areas and Care Homes for Adults (18-65 years) Page 9 of 39 different styles of rooms some of which also have their own have kitchens and lounge areas. This home is run by a very experienced, knowledgeable and hardworking manager. She is an exemplary management practitioner who is thoroughly grounded in the practicalities and philosophy of providing excellent quality of care to the people at this home. The manager collects the views of service users, families and friends so that she can check to see if the service is meeting the needs of all parties the owners show that they are have the commitment to invest time skill and finances in the home to produce excellent outcomes for the people who live there. One senior social services manager said, Linda and her staff give a unique ,high standard of care for the more dependent service user....they provide a very valued service. and Linda and her staff are responsive to need and have a very positive rapport with myself and other professionals. 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 set out on page 4. Care Homes for Adults (18-65 years) Page 10 of 39 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 11 of 39 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 12 of 39 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Trained staff from the home find out and understand the needs of people who wish to live there before they move in. This information helps to make sure that peoples needs can be met at the home and agree the ways in which staff are to support them Evidence: Each persons needs are assessed before they move to the home by a team of workers such a social worker, a community nurse, a psychologist, as well as the manager. This is to make sure that the home is suitable for meeting the needs of people who are going to live there. The manager has shown that she has a leading role to make sure that the home is able to successfully support people before they move there. Care Homes for Adults (18-65 years) Page 13 of 39 Evidence: The person themselves and their representative if they have one is involved in the assessment process. This is to make sure that plans are put in place which are acceptable and their views about how their physical emotional and lifestyle needs are known and understood by staff at the home. From talking to the people who were living at the home we could see that this person centered approach to care and lifestyle planning had meant that people were largely satisfied and happy with the way that they are supported there. Everyone said that they felt in control of their service. One person who lives at the home said, Its good here because your not just one of a load of people living together, this is my service and I know I am able to change the way I live my life if I want to. Records show that the manager and staff have found out about the cultural and lifestyle needs of people who wish to move to the home to make sure that these can also be met. All peoples assessment information is detailed which helps staff to plan and write down the ways that they are going to support them. This is important where people have complicated needs and social networks which require a lot of insight and well-organised support. The manager also finds out what cultural and lifestyle needs people have to make sure that these can be met. The manager and senior nursing staff have also had training which has given them the skills to find out what peoples needs are. Care Homes for Adults (18-65 years) Page 14 of 39 Evidence: The home has written information called the Service Users Guide which gives all of the important details that people need to know about what it is like to live there. This includes information about how to make a complaint and the most recent Inspection report. The Service User Guide for this home has been drawn up in ways which help people to understand what the information means and staff also help to explain it. The Guide also includes information about how peoples rights will be respected regardless of age, gender, sexual orientation, race and religion. There is clear information about the terms and conditions and fee rates. As a result of these measures, all of the people living at the home at present have been properly placed and the home is able to meet their needs. Care Homes for Adults (18-65 years) Page 15 of 39 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. Each person has an individual plan of care, which sets out their preferences and how their assessed needs will be met. These plans describe the measures which staff use so that they can consistently meet peoples needs. Evidence: Some people at this home have needs which require the staff to respond to them in particular ways for example to give them support to feel confident and help them to manage their anxieties. All people living at the home have a detailed plan of care, which gives a thorough description of how their physical, emotional and lifestyle needs Care Homes for Adults (18-65 years) Page 16 of 39 Evidence: are to be met. People get support from staff which is individual and tailored to their specific needs so that they can live as valued citizens within their community. Nursing and personal care is carried out in ways that arranged so that each person is at the centre of a network of support and tailored so that they have highly individual lifestyles. Staff have an excellent understanding of peoples histories, needs and preferences which they need to support people. As well as the health and personal care they get at the home, staff also work closely with other community-based health and social support staff to make sure that peoples wider needs are supported by fully co-ordinated care. The way that care plans are written down shows that how they are to be supported and there are reviews to see if their needs have changed. There are examples of where a great deal of thought consideration and care has gone into this planning. For example how peoples relationships are supported, how the service makes sure that they are not vulnerable to abuse are clearly and carefully recorded. People living at the home are treated with respect by staff who know them well. Relationships between people and with staff are relaxed, friendly and informal which helps them to feel comfortable. People appeared to be relaxed and happy with the support they get from staff. Staff meet regularly where they talk to each other about Care Homes for Adults (18-65 years) Page 17 of 39 Evidence: peoples needs so that they remain up to date, work well as a team and remain consistent. One person who lives at the home said, The staff and nurses are simply excellent they know me well, give me my own space and treat me with respect. All people living at the home have access to someone outside of the home who can speak on their behalf and help to make decisions in their best interests if they wish. One person who lives at the home said, They asked me if I would like to invite my family to my planning meeting which I thought was a good idea. One of the homes strengths is how the manager and staff help people to be as independent as they can, stay in control of their lives and to take measured risks if they wish. The manager and staff take actions to support people and reduce the likelihood of harm so that that there is a balance between promoting peoples independence and rights and making sure that they are safe. Care Homes for Adults (18-65 years) Page 18 of 39 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. People are encouraged and supported by the staff to make choices about their lifestyle so that they can lead fulfilling and interesting lives and staff help people stay in touch with their circle of family and friends so that they can keep links with people outside of the home. Evidence: People living at this home have the opportunity to have active lifestyles. Everyone has his or her own routines and activities many of which occur outside of the home. The Care Homes for Adults (18-65 years) Page 19 of 39 Evidence: staff are very knowledgeable and skilled at helping people to choose activities that they would like to take part in or to try out and to find opportunities and arrange them. there is a specific service which has been set up to support people with their daytime activities. Here staff also encourage people to make decisions, and help them to organise the different opportunities they have each week. Examples of opportunities include Shopping, social clubs, visits to places of interest and football matches. People also have opportunities to continue with their further education at local colleges where they can also gain work experience or voluntary or paid employment. One person who lives at the home said,Its good that staff are there to help you to get out and about and do something with your life. Staff at the home were busy planning how individual support for service users was is to take place so that all of their choices and event commitments could be met. One of the staff said, We work hard to think of new things to do and ideas that people can take part in which are based on their interests. Staff are good at finding out about opportunities or activities which are taking place in the local and wider community and making sure that support and transport is available for those people who want to take part. Photographs of people taking part in activities and during visits are displayed in peoples rooms. Staff help people to keep in touch with friends and relatives where this is possible. Some people have taken college courses where they have an interest or skill and Care Homes for Adults (18-65 years) Page 20 of 39 Evidence: several certificates are displayed which show their success and commitment. Several choices of meals are offered at all times and people help to plan their meals. Attempts to offer a balanced diet whilst still responding to peoples choices were noted. Mealtimes are pleasant sociable events at the home where people meet and share each others company. People said that they liked the food, one person living at the home said, You could not ask for better food, its always fresh, theres plenty of it and there is enough choice for everyone to find something they like. Care Homes for Adults (18-65 years) Page 21 of 39 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal and health care needs are identified and arrangements are in place to help make sure that they can have a healthy lifestyle. Evidence: Most people at this home have complicated personal care and nursing needs. Nursing and care staff keep detailed records of peoples healthcare needs in their care plans. These show that staff look out for changes in their physical or emotional state which may need a change in treatment the involvement of specialist healthcare workers from outside the home. This has promoted joint working with consultants, GPs and healthcare staff and helped home staff make sure that people get the best healthcare Care Homes for Adults (18-65 years) Page 22 of 39 Evidence: support that they are entitled to. People are registered with healthcare facilities for example their general practitioner or dentist and are supported to attend appointments if they wish. Any personal care is carried out in private with staff encouraging people to be discrete where this is required. Some, but not all people living at the home need support to administer their own medicines, and designated staff therefore help in this area. For those who manage their own medication, for example if it fits in better with their lifestyle and promotes their independence, staff have weighed up the risks and taken steps to minimise the likelihood of mistakes or harm. Medication is securely stored and there are effective systems in place which help to minimise risks. When checked there were no errors found. The manager confirmed that nursing staff at the home have undertaken further refresher training to maintain their effectiveness and to maintain recognised good practice guidelines. Care Homes for Adults (18-65 years) Page 23 of 39 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at this home and their families can make a complaint if they are unhappy, have a grievance or dispute which helps them to have control over their lives and there are measures in place which protect people from being harmed which helps to promote their safety and security. Evidence: There is a clear complaints procedure in place at the home, which tells people how to complain, and the length of time a response will take. Observations of the staffs day-to-day practices show that they ask for the views of service users all the time and help people to make real choices and decisions. People who live at this home assert their views and preferences and were clearly empowered to say what they thought. There is a record kept at the home of all complaints, which includes details of any Care Homes for Adults (18-65 years) Page 24 of 39 Evidence: investigation and the outcome. No one has approached the Commission for Social Care Inspection (CSCI) because they have been unhappy with the way that the home has managed their complaint. One person living at the home said, People who live here can say when they are or are not happy, that is important and the staff and manager do listen. Another person said, You may not always get your own way, for example you cannot smoke in your room, but at least you will get a good hearing and they (the managers) will explain the reasons for their decision. Whilst there have been no instances where abuse has taken place, the home has an adult protection procedure which can be used where abuse has been suspected. This helps to make sure that the people who are vulnerable and living at the home are properly protected. There is a staff guide that gives clear instructions about the actions which they must take if abuse is disclosed or witnessed. All staff spoken to are knowledgeable of these practices knowledgeable and vigilant, and have had training as part of their introduction to the home, the organisations training programme and National Vocational Qualifications. Care Homes for Adults (18-65 years) Page 25 of 39 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 excellent 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 well designed, homely, clean and comfortable environment, which promotes their privacy, independence and comfort during their stay at the home. The home is very well equipped, clean, pleasant and hygienic which supports the health and lifestyles of people living there. Evidence: All communal areas and some of peoples bedrooms were viewed during the inspection (by invitation). The home has been designed so that all the people who live there can have safe access to the areas where they live. Everyone is able to lock their room doors so that they can Care Homes for Adults (18-65 years) Page 26 of 39 Evidence: have privacy and there are areas where people can meet and talk in private. There are garden areas which are accessible to everyone and popular when the weather is good. This home has been exceptionally well designed to meet the needs of the people who have disabilities and nursing care needs who live there. The building is light any airy and has lots of adaptable communal areas and wide spaces which link peoples rooms and public areas. Opened in 1992 the building remains in good condition and has been furnished with good quality fixtures and fittings. For example much of the interior woodwork has been completed in oak and along with attractive flooring and overhead windows has resulted in a home which is visually attractive and hardwearing. There is evidence of ongoing maintenance, replacement and repairs of the building and furnishings taking place so that the environment is kept in it current good state of repair. Personal accommodation is very adaptable. Private rooms all have their own bathroom which can be adapted to each persons needs and there is also direct level access via patio doors, to the outside and grounds. There are some rooms which are suites, where people can live more independently if they wish. These rooms are also equipped with accessible kitchens, separate bedroom and living room areas all of which are adapted to peoples own requirements. Everyone has their own lockable front door which protects their privacy and supports their rights and ownership. Care Homes for Adults (18-65 years) Page 27 of 39 Evidence: One person who lives at the home said, Its up to me who I have in my room, the staff are very good about that, they always ask. Everyone who lives at the home had personalised their rooms to their own tastes and rooms reflect peoples individual styles and interests. Because of the design of the building the home is able to support people to live in a way which gives them opportunities to take part in the community life of the home. For example people take part in daytime activities, meals and social events and have personal space where their nursing and care needs can be met. One of the strengths of this home is how it balances these two requirements so that people can be supported to have stimulating and independent lifestyles. There are enough toilet and bathrooms available around the building, all of which have been designed to help people who have mobility needs to use them. The home is kept clean by staff who take effective steps make sure that there are no unpleasant smells. There are laundry facilities are in place to make sure that that peoples clothing and linen is hygienically cleaned and the risks of passing on any infections is reduced. Arrangements are in place to make sure that clean clothing is always returned to their owner and mistakes are avoided. There is a large well equipped kitchen which is designed to meet the catering needs of Care Homes for Adults (18-65 years) Page 28 of 39 Evidence: the people who live work or visit the home. The home is inspected by the Fire Prevention Authority and the Health and Safety Executive (HSE) to make sure that the building and safety systems are suitable for the protection of those who live and work there. Care Homes for Adults (18-65 years) Page 29 of 39 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient staff working at the home to meet the needs of the number of people who presently live there and most staff have been trained to make sure that their care practice is good. Evidence: The manager has organised the home so that overall there are sufficient staff available to meet the needs of the people who currently live there. Nursing and care staff support each other and their manager both in their practice and also in their willingness to remain flexible about their working hours so that people who live at the home will benefit. Staff show that they know a great deal about the needs of the people who live at the Care Homes for Adults (18-65 years) Page 30 of 39 Evidence: home and can describe these in detail; they get on well together and with people who live at the home and promote an inclusive and supportive structure at the home. Staff work in teams and they have structured ways of working so that people get consistent support. One person living at the home said, I know I can trust the staff here. another person said, It is important that they know everything about what you like and what you need so that you dont have to keep telling them all the time. It shows they have respect for you. Staff spend time with people who live at the home, listening to their opinions and experiences and taking part in discussions and laughing together which creates a happy atmosphere at the home. Staff turnover at the home is low which gives people who live there and staff the opportunity to get to know each other. For example some of the staff have worked at the home for over 10 years. There is also a daytime support service which has different staff who are well trained in this area of work and specialise in finding out about, and supporting people in, a wide range of opportunities within the home and local and wider community. There are qualified nurses at the home who have taken on further training to refresh and further develop their skills. As well as this all of the care staff team have now achieved National Vocational Qualification awards in care at level 2 or above. There is a Care Homes for Adults (18-65 years) Page 31 of 39 Evidence: detailed plan in place which describes the training which staff are to undertake based on the needs of the home and their personal training requirements. This shows that staff undertake a wide variety of additional training which can be used to support people at the home for example counselling skills and training about social values and disability issues which helps to promote peoples lifestyles . Records showed that all staff have received fire, food hygiene, infection control, moving and assisting and COSSH training. The manager makes deliberate attempts to recruit staff from similar cultural backgrounds as the people living at the home. In some cases they share the same community and social links, which helps to ensure that people are confident with the way in which they are supported. Examination of files for staff newly appointed in the home confirm that rigorous checks are carried out before they are employed to work in there. This includes receiving appropriate references and completing the necessary criminal record check to make sure that staff are suitable to work with people who are vulnerable. Staff files contain detailed employment histories, records of training and any training certificates. Staff work well as a team, they are well organised and thorough. They have good support and direction from the manager, who knows them well and from senior staff who help to co-ordinate their work and who works alongside them. Staff take part in regular supervision with the manager or senior staff to help to stimulate their ideas Care Homes for Adults (18-65 years) Page 32 of 39 Evidence: and enhance their work and there are regular staff meetings where the manager can give direction and receive feedback about how the home is run and where issues which need the support of the team can be discussed and resolved. Care Homes for Adults (18-65 years) Page 33 of 39 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is very well managed, organised and efficient; and people are asked for their views about their care. All of which gives people who live at this home the confidence that they will continue to have their needs met by staff who support their best interests. Evidence: This home is run by a very experienced, knowledgeable and hardworking manager. She is an exemplary management practitioner who is thoroughly grounded in the practicalities and philosophy of providing excellent quality of care to the people at this Care Homes for Adults (18-65 years) Page 34 of 39 Evidence: home. The manager is a valuable resource for this home and the staff team and she has excelled in all of the areas that were examined at this Inspection. The registered manager is a first level registered nurse who has worked at the home for the part 16 years and has been the manager since 2001. She has completed the National Vocational Qualification (NVQ) Registered Managers Award, completed an NVQ in Care at Level 4 and carries out regular training as a professional nurse so that she can show that her Nursing and Midwifery Council practice skills are up to date. The home is well organised by the manager who makes sure that staff get the support and guidance from senior staff and herself to make sure people get good quality nursing and personal care. The owners Leonard Cheshire oversee the managers work and the running of the home. Senior managers visit the home at least once a month to check that the staff and the manager are working well and that the quality of care remains high. The manager collects the views of service users, families and friends so that she can check to see if the service is meeting the needs of all parties. There are a number of meetings held at the home and other informal occasions where the manager is able to check that people are satisfied with the service. This helps the manager to monitor progress and develop the service. The owners also regularly check that the home is Care Homes for Adults (18-65 years) Page 35 of 39 Evidence: running properly by carrying out visits where specific areas are looked at and checked to make sure that they meet the expectations that everyone has. There is a detailed Business Plan for the home which shows how it is to be most effectively run and there is a development plan designed every year which identifies priorities, timescales for achievements, and action plans which show how these will be put in place. These are all examples of good management practice which are in place at the home. There were no significant hazards at the home throughout the inspection and arrangements are in place to minimise risks for people living at the home and staff. For example, Staff have had training in safe working practices. Fire training is completed every three months for night staff and six months for day staff. Accidents are clearly recorded and the manager completes monthly accident analysis to examine and track any trends. A fire risk assessment is available and up to date. In house health and safety checks are carried out weekly. Water temperatures are recorded to ensure temperatures of 44 Degree Centigrade is not exceeded. External contract certificates are up to date. The home is also subject to inspections by the Fire Authority and Health and Safety Executive (HSE) to make sure that the home is safe. People living at the home said, The manager is very good. You can go to her if you have a problem and she will sort it out. She makes sure that there is a good atmosphere here. The manager makes sure she is available if people living at the home or their families need to talk to her. Through out the inspection numerous people came for advice, direction, comfort and support. Care Homes for Adults (18-65 years) Page 36 of 39 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 37 of 39 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 38 of 39 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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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