Inspection on 18/12/08 for Burton Cottages

This inspection was carried out on 18th December 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Burton Cottages 22/10/08

Burton Cottages 20/06/07

Burton Cottages 26/04/06

Burton Cottages 18/10/05

Burton Cottages 27/04/05

Burton Cottages 24/09/04

Burton Cottages 26/04/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Burton Cottages Bishop`s Lane Robertsbridge East Sussex TN32 5BA     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: Caroline Johnson     Date: 1 8 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 30 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 30 Information about the care home Name of care home: Address: Burton Cottages Bishop`s Lane Robertsbridge East Sussex TN32 5BA 01580881715 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): maggie,griggs@sact.org.uk Sussex Autistic Community Trust (Care Services) Ltd Name of registered manager (if applicable) Mr Stephan Barton Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 12. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home Burton Cottages is registered to provide accommodation for twelve adults with autistic spectrum disorders. The property is owned by Downland Housing Association and is run by the Sussex Autistic Community Trust. It is one of four homes in East Sussex run by the Trust. Burton Cottages is purpose built and is situated in a quiet residential area of Robertsbridge. The town centre with its shops and access to bus and rail services is a short walk away. The building is split into two units, each capable of accommodating six residents. Each of the units has their own communal facilities and a kitchen. Care Homes for Adults (18-65 years) Page 4 of 30 care home 12 Over 65 0 12 2 2 1 0 2 0 0 8 Brief description of the care home Accommodation is on two floors and all bedroom accommodation is in single rooms. The home makes CSCI reports available to prospective residents and their relatives/representatives upon request. Fees for the service can be seen in the summary section of this report. Care Homes for Adults (18-65 years) Page 5 of 30 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: For the purpose of this report the people living at Burton Cottages will be referred to as residents. As part of the inspection process a site visit was carried out on 18 December 2008 and it lasted from 10:00am until 5.00pm. The appointed manager facilitated the inspection. Over the course of the inspection there was an opportunity to meet with four of the residents. In addition time was spent with two members of staff in private. A full tour of the home was undertaken. Two care plans were examined in detail and sections of a further four care plans were also seen. In addition records seen included; staff rotas, training, medication, menus, health and safety, quality assurance and leisure activities. Care Homes for Adults (18-65 years) Page 6 of 30 Since the last inspection the registered manager has left her position as manager of the home. A new manager has been appointed and he commenced working in the home in October 2008. He advised that he would shortly be submitting his application for registration. Fees range from 900 to 1300 pounds per week. Following the last key inspection of the home on 20/06/07, a random inspection was carried out in October 2008. The purpose of the random inspection was to review staffing levels, management arrangements and the risk management strategies in place for the people accommodated. What the care home does well: What has improved since the last inspection? What they could do better: As a result of this inspection there were two requirements and four good practice recommendations. Three requirements made at a random inspection in October 2008 are also included in this report, as the timescale had not lapsed at the time of this inspection. They relate to issues of risk assessment and although some progress had been made at the time of this inspection considerable work was still required to fully achieve them. The two requirements from this inspection relate to the need for a programme of refurbishment to ensure that areas such as the kitchens are redecorated. In addition the appointed manager must apply for registration with the Commission. Good practice recommendations relate to the need for clearer documentation in some areas such as recording goal development and recording choices and decisions made Care Homes for Adults (18-65 years) Page 8 of 30 by residents. 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 30 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 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are provided with clear information to assist them in making an informed choice about accommodation and this will be enhanced even further when the guide is available in a range of formats to suit individual needs. Evidence: There is a detailed statement of purpose in place, which has been updated recently to include the details of the new manager. The service user guide has also been updated and it was reported that each resident has a copy of the guide. The guide is produced using symbols. It was acknowledged that a number of the residents might not be able to comprehend sections of the guide. It was therefore agreed that further work is required to ensure that the guide is based on individual needs. The guide includes detailed information about the provider and manager, what support can be expected and how the home will keep residents safe. There is also a glossary explaining the definition of some of the words and terms used in the guide. There have been no new admissions to the home since the last inspection. However, Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: one resident was in the process of moving to alternative accommodation. Plans had been made for the staff from the home that the resident was transferring to, to come and work at Burton Cottages with the resident as a way of getting to know them and their abilities and needs. Care Homes for Adults (18-65 years) Page 12 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The quality of the support plans in place is good and with better risk management strategies and record keeping in some areas, this will be enhanced even further. Evidence: Two care plans were examined in detail and sections of a number of other care plans were also examined. Care plans seen had been reviewed and updated recently. Each file contained detailed information about the needs of the residents and how they were to be met. Development goals have been identified for each of the residents and in each case there is a training plan in place. There is a chart in place to record if a goal has been attempted, achieved or refused but it does not provide detailed evidence or advice to staff on exactly what a resident can do and which parts of a task they are working on. It was noted that record keeping held in relation to this had been completed infrequently but that it had improved of late. The manager advised that as a result of Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: training on the role of the keyworker that had been provided the day prior to the inspection he anticipated that record keeping in relation to this would now improve. The manager also advised that some of the residents have reached a plateau in relation to goal development and it is hard to identify new goals. He is about to introduce a new assessment tool and was piloting its use at the time of inspection with one resident. The tool to be used gives ideas for goals and breaks down each step towards independence to be worked on one at a time. It was reported that one resident has capacity to sigh up to their goals, so this will be discussed with them and if they are in agreement, a signature will be obtained. Following the inspection the manager confirmed by email that during a review held since the inspection they had evaluated the goals from the previous six months and discussed the proposed goals for the following six months. The residents planner was then adjusted and a new training plan was drawn up. Guidelines have also been drawn up for staff to ensure that they are clear about how to complete the planner. This will be followed up at the next inspection. Following a random inspection of the home in October 2008 requirements were made in relation to risk assessments. The timescales for addressing these requirements was in January. However, it was noted that the home was in the process of reviewing and updating all risk assessments. A number of those completed have been sent to care managers for their comments and the home are awaiting their return. Some of the risk assessments do not currently state the level of the risk or all the measures that the home should take or have already taken to prevent accident/injury. An example of this is that there is a risk assessment in relation to one resident who may get into the bath, turn the tap on but forget to turn it off and this may result in flooding. There is no reference to the fact that the temperature of the water is controlled or that the resident could drown or be scalded of the controls were not checked regularly to make sure they continued to function correctly. In relation to one residents file it was noted that there was a summary list of risk assessments that had been carried out by the day centre. However, some of the risk assessments identified could also have been relevant for inclusion in the residents care plan at Burton Cottages. The manager agreed to look into this in more detail. All of the residents have an annual review and keyworkers write a detailed report in advance of this meeting. Residents meetings are held regularly and records showed that a range of topics including food and activities are discussed at these meetings. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are offered a good range of varied and stimulating activities to meet their individual needs. Evidence: All but two of the residents continue to attend one of the two-day centres run by the Trust. Each of the residents has a programme of activities that they participate in. Attendance at the day centre means that residents have access to a wide range of activities both at the centre and in the wider community. Activities include arts and crafts, bowling, computer use, movement to music, trampoline, gym, horse riding, roller blading, drama, swimming, African drumming, shopping and walks. The home continues to support two of the residents who have opted out of day centre activities, with individual programmes of activities and it was noted that significant Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: progress has been made in this area. One of the residents now has a worker from the day centre who comes into the home every day through the week to support them with their programme of activities. Activities include regular train trips, aromatherapy, puzzles, DVDs, reading (one to one), foot spa, watering plants, local walks and board games. One of the residents writes a weekly letter to their relative. One of the residents still regularly refuses the activity offered but will do alternatives. It is not clear from the records if they are choosing the alternative or if staff are presenting them with further choices. It was acknowledged that staff could provide clearer records in this area. However for another resident there was a daily log sheet detailing the activities planned, if they took place and if they were successful and the reason and what alternative was offered. Weekend activities are also planned and it was noted in records that the manager has delegated the task of compiling an activity choice list for weekends. Advice also included the need to ensure that there is always a driver on duty to ensure that activities can take place. In addition staff advised that they would be renewing teacch in relation to activities at weekends. On Saturday mornings staff will use a widget book to look at activities with residents and encourage them to make choices. Some residents like structure for example going to the shop for sweets, newspaper and having a cooked breakfast. It was clear from the care plans that residents are encouraged to participate in activities of daily living such as mopping the floor, loading the dish washer and setting and clearing the table. As stated previous residents meetings are held regularly. It was noted in minutes that the subject of food had been discussed. Records show the decisions made by residents but not what choice was given. There were laminated photos of seven different roast meats on file. The manager advised that it is current practice for the home to shop on line. However this will be changed so that residents can choose on weekly basis what they would like and the shopping will then be done. Guidelines are to be put in place. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that the health care needs of the residents are met. Evidence: An OK health check is carried out in relation to each of the residents. This ensures that the home keeps track of all healthcare appointments. Records showed that residents attended dental, chiropody, opticians and well man/woman clinics. A number of the residents have complex needs and when necessary the home seeks additional professional advice and support to assist them. It was noted that one resident has been referred for a SALT (Speech and language therapy) assessment and another resident is currently seeing a specialist at the local hospital to monitor ongoing health problems. The home has a detailed list of the homely remedies that can be used by the home. The list was agreed and signed by the gp. However, the signature is on a second sheet and there is no reference on the second sheet to the issues referred to on the front sheet. As the letter was dated 2007 it was agreed that the list would be updated and a Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: new signature sought. Since the last inspection the home has purchased a new trolley for storing medication. The trolley is locked and secured to a wall when not in use. The arrangements in place for the recording of medication administered are good and the home ensures that all changes are clearly documented. In addition to the detailed policy on administration of medication the home also has a local policy in place. One of the senior staff carries out regular audits of the medication. It was reported that training in medication is provided annually. In addition all new staff must complete an in-house assessment before they are deemed competent to administer medication in the home. Records showed that a bereavement questionnaire was sent to the families of the residents in 2006 to seek views of the families in relation to dying and death. There has been one death in the home since the last inspection. Care Homes for Adults (18-65 years) Page 18 of 30 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. There are procedures in place to ensure that anyone wishing to make a complaint can do so. Evidence: There is a detailed complaint procedure in place. In addition there is simplified version of the complaint procedure displayed within the home and a copy of the procedure is included within the service user guide. Records showed that there had been one complaint recorded since the last inspection. The complaint was thoroughly investigation but the result of the complaint was inconclusive. There were three compliments on file all praising the staff team for their work. It was reported that all staff are provided with training on the protection of vulnerable adults every other year. Staff spoken with during this inspection were clear about the action they would take if they suspected abuse. Care Homes for Adults (18-65 years) Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally well maintained but due to the needs of the residents it requires regular maintenance and renewing. Attention is required in some areas to ensure that a good standard is maintained. Evidence: The home is divided into two cottages known as cottage one and two. At the time of inspection the connecting door between both cottages was locked. In each cottage there is a lounge, kitchen and dining room. In addition, in house two the sleep in room doubles as a mini gym and in house one there is an additional room that is currently used to house the medication but is also used as an activity room. The home is generally well maintained and decorated to a good standard. However there were some exceptions to this. Both kitchens are tired looking and in need of attention. Kitchen doors need replacing and the flooring needs to be replaced. In one of the kitchens the ceiling is also in need of redecoration. During the inspection it was noted that there was a wire loose in one bedroom and that one of the hand driers in one of the bathrooms was not working. The day after the inspection the manager confirmed by email that an electrician had been called and would be attending that day to attend to the wire in the residents bedroom. Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: There was a strong odour of urine in one bedroom. It was reported that the flooring is due to be replaced in this room. The wall outside of another bedroom is in need of redecoration. Bedrooms seen had been personalised and were very homely. Attention has also been given to ensuring that cultural needs have been taken into consideration. It was noted that the wardrobe doors for the fitted wardrobes in two bedrooms had been removed as the doors were too heavy and residents and staff had problems opening the doors. Curtains have been fitted over the wardrobes. All areas seen during the inspection were clean. All staff have opportunities to complete training in infection control. Care Homes for Adults (18-65 years) Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are provided with regular opportunities to update their knowledge and skills to meet the needs of the residents. Evidence: The staff rota seen showed that there were sufficient numbers of staff on duty at any one time. As at the last inspection there are a number of vacant hours that are covered weekly by part-time staff increasing their hours and working flexibly. In addition there is a number of bank staff that can be called upon. It was reported that this generally works well. However it was also noted that one trainee is about to leave, one support worker is on long-term sickness and one support worker is due to commence working on night shift. The manager advised that they would advertise for staff positions. The home does not have an overall staff training matrix in place but individual staff training records are kept and in those seen there was evidence that staff receive regular training. However, without a matrix in place, it was not possible to make an accurate judgement about staff training. It was noted that all staff had training on the role of the keyworker the day prior to the inspection. The manager advised that training on the use of Teacch and how to apply it would be provided the week of the Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: inspection. In addition to the mandatory training that all staff are expected to attend at regular intervals, examples of other training courses made available to staff include Studio 111, aspergers syndrome, sexuality, communication and social integration. There is also a range of addtional training that is made available to senior staff. Information provided by the home following the inspection confirmed that out of fifteen staff, eight have completed National Vocational Qualifications (NVQ) at level two and two are working towards this qualification. Two staff files were seen in relation to staff recruitment. Both files contained a range of checks that had been carried out in advance of appointment. In relation to one staff member it was noted that the staff that had interviewed the applicant recommended that they be employed as a relief worker to assess progress. However the applicant was employed as a support worker and there was no reference to the reason for this decision. In addition neither of the references supplied were from an employer but both were from work colleagues. Files need to be updated to include both start and finish dates for induction. Some gaps were noted in the provision of supervision but the manager advised that he was confident that he and his senior staff would be able to get back to providing supervision regularly. Staff spoken with confirmed that they felt well supervised and that the manager was very approachable. Following the inspection further evidence was provided to demonstrate that staff had received regular formal supervision. Care Homes for Adults (18-65 years) Page 23 of 30 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 recent emphasis on improving systems and procedures should enhance the quality of the lives of the residents accommodated. Continued support should be provided to the appointed manager to maintain consistency in this area. Evidence: Since the last inspection of the home the registered manager has left her position. In October 2008 a new manager was appointed. He has completed NVQ level 4 and the RMA (Registered Managers Award). He has worked previously as a senior at Burton Cottages for six years and he was a registered manager at one of the sister homes for three years. He brings a wealth of experience to his current role as manager. He has yet to apply for registration with the Commission. The manager advised that shortly after his appointment there was a senior managers meeting and that following this, an action plan was drawn up detailing how the home was to move forward. The manager advised that although he has not had formal supervisions his line manager is always at the end of the phone, there is regular Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: senior management presence in the home and he feels well supported. There is a managers meeting every other month. Minutes of staff meetings show that a wide range of issues are discussed and agreement is reached on the way forward. The organisation has begun the task of reviewing and updating the policies and procedures. Records showed that eleven policies have recently been updated. A staff member spoken with stated that the recent increase in staff numbers is working much better. In addition the home also now has capacity to use agency staff if needed. Staff meetings are held every 2-3 weeks and are helpful. The manager is really good, very professional but a human being. The home has IIP (Investors in People) accreditation and this was renewed in August of this year. The home will be reassessed for accreditation with the National Autistic Society in February 2009. A manager from another of the homes within the organisation carries out a Regulation 26 visit to report on the conduct of the home. Records show the starting time of the visit but not the duration. The format for the report is a tick system with a rating given for each area examined. Shortfalls are identified by the allocation of a low rating and where this is the case a corrective action plan is put in place highlighting all work to be carried out. There are guidelines in place detailing how the visits are to be carried out and the areas that need to be looked at. As part of the homes quality assurance system satisfaction questionnaires were distributed to service users, their families and visiting professionals in February 2008. There was a wide range of comments from the relatives surveys from very positive points to areas of concern. As it is some time since the last survey, along with changes to the running of the home, the manager advised that he would shortly be undertaking this exercise again. Discussion was had about how to make the service user questionnaires more appropriate for the residents accommodated. Records were seen in relation to the management of two residents finances and all records seen were in order. As part of the random inspection in October 2008, three requirements were made in relation to risk management. The timescales for achievement of these timescales had not lapsed and it was noted that some progress had been made but considerable work was still required to safeguard the risk of accidents/incidents occurring in the home. The organisation undertook an extensive review of all their policies and procedures two Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: years ago. They have recently commenced a further review and records showed that eleven of the policies and procedures had been reviewed recently and that staff were expected to read and sign them. The manager advised that as they are updated they are discussed at team meetings. Information provided in advance in the inspection showed that all equipment is tested and serviced at regular intervals. A fire risk assessment was carried out in February 2007 and this was reviewed by the home in January 2008. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13 That the registered person ensures that the risk management strategies are agreed with the service user if possible and relevant specialists and are recorded and reviewed. To protect the service user from possible harm. 02/01/2009 2 9 13 That the registered person records the circumstances, including the nature of restraint used in the care of the service users. To protect the service user from possible harm. 02/01/2009 3 9 13 That the registered person 02/01/2009 ensures that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated and provide clear guidance for staff in promoting residents safety. To protect the service user from possible harm. Care Homes for Adults (18-65 years) Page 27 of 30 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 1 24 23 The registered provider must ensure that all areas that require refurbishment or renewing are attended to and that details of the timescales for these works are sent to the Commission. Service users should live in a homely, comfortable and safe environment. 30/05/2009 2 37 9 That the appointed manager 30/05/2009 must apply for registration. Service users benefit from a well run home. 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 2 1 6 The service user guide should be available in a range of formats to suit the individual needs of the residents. The home should continue to define more clearly the action to be taken to achieve goals and to improve record keeping in relation to progress with goal development. Page 28 of 30 Care Homes for Adults (18-65 years) 3 4 20 34 The homely remedies list should be reviewed and a new gp signature obtained. In relation to staff recruitment the registered person should ensure that one of the references obtained is from the applicants most recent employer. Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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