Inspection on 09/04/09 for Emmanuel Care Services Ltd

This inspection was carried out on 9th April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Emmanuel Care Services Ltd 16/04/08

Emmanuel Care Services Ltd 25/05/07

Emmanuel Care Services Ltd 02/05/06

Emmanuel Care Services Ltd 06/12/05

Emmanuel Care Services Ltd 13/06/05

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: Emmanuel Care Services Ltd 33 Disraeli Close Thamesmead SE28 8AP 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: Maria Kinson Date: 2 0 0 4 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. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement 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. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 34 Care Homes for Adults (18-65 years) Audience Further copies from Copyright 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 34 Information about the care home Name of care home: Address: Emmanuel Care Services Ltd 33 Disraeli Close Thamesmead SE28 8AP 02083109340 02083109340 careemmanuel@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Remi Konan care home 3 Number of places (if applicable): Under 65 Over 65 3 0 learning disability Additional conditions: The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Learning disability Code LD The maximum number of service users who can be accommodated is: 3 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 34 A bit about the care home Emmanuel Care Services was registered in February 2005 to provide care for up to three adults with learning disabilities. The provider of the home is also the manager. The home is located in a three-storey semi-detached town house in central Thamesmead. A bus service connects with the town centre and local facilities. There is one single bedroom on the ground floor and two further single bedrooms on the second floor. None of the bedrooms are en-suite but all of the bedrooms have a hand washbasin. There is a lounge and kitchen/diner on the first floor, a bathroom with shower and toilet on the second floor and a toilet on the ground floor. There is a small, enclosed paved garden at the rear of the property. Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 34 How we did our inspection: This is what the inspector did when they were at the care home The last key inspection took place on 16th April 2008. This inspection took place in April 2009. We visited the home on 9th April 2009 but there was no one at home. We visited the home three times after this date, but had to leave on two occasions because one of the service users was agitated. The inspection took eight and a half hours to complete. Before we visited the home we looked at all of the information that we had obtained or received about the service. This includes information that the home sent us about significant events such as accidents and incidents, the previous inspection report and the annual quality assurance assessment form. We used this information to plan how we would carry out the inspection and what standards we would assess. We spoke to two members of staff and two service users during the inspection and received written feedback about the home from two members of staff, one service user and one health care professional. The feedback that we received from service users, staff and care professionals helped us to form a judgement about the Care Homes for Adults (18-65 years) Page 7 of 34 service. Some of the comments we received are included in this report. During the site visit we examined some of the records that were kept in the home, assessed the management of medicines and observed staff supporting service users. We visited all of the communal areas and two bedrooms. There were three people living in the home at the time of this inspection. The fees charged by the home range from £1000 to £1500 per week. The fees do not include clothing, toiletries or activities in the community. What the care home does well Staff carried out an assessment before people moved into the home. This provides basic information for staff about peoples support needs. Service users were supported to undertake activities that they enjoy in the home and community. Service users said there was always plenty to eat. Staff spent time talking to service users and maintained peoples privacy and dignity. Staff worked in partnership with other care professionals to promote service Care Homes for Adults (18-65 years) Page 8 of 34 users health and wellbeing. Service users were asked if they had any concerns during residents meetings and said they could speak to staff if they were unhappy. Staff said they would report concerns or allegations to the manager. The home was clean and welcoming. The staff team was stable. This provides good continuity of care for service users. Most of the staff had a care qualification. Equipment was serviced regularly to ensure that it was in working order and was safe to use. Staff said the manager was supportive and approachable. What has got better from the last inspection There was information in care plans about how staff should approach and manage people that were aggitated or aggressive. Service users were encouraged to assist staff at mealtimes and to complete chores around the home. The management of medicines had improved. Good records were kept about medicines that were received and used in the home. Care Homes for Adults (18-65 years) Page 9 of 34 The lounge was rearranged to make the route around the room safer. Thorough checks were carried out before people started to work in the home. Staff attended a challenging behaviour training course which they said was very helpful. What the care home could do better The Statement of Purpose and Service User Guide did not include some important information and was not provided in a format that some of the service users could understand. Before people move into the home staff should obtain and record detailed information about their needs and consider if the new service user is likely to get on with the other people that live in the home. It was not always clear in the records how people wanted to be supported or how much help they required with their personal care needs. Staff must record how service users use their money. This includes any payments that are made to the home. A system should be established for storing receipts. The home must ensure that repairs are carried out promptly because this could affect peoples safety. Care Homes for Adults (18-65 years) Page 10 of 34 Information that is recorded about the hours that staff work should be accurate. New members of staff were given some training before they started work but the training was completed quickly and did not cover the common induction standards. The home had introduced some quality assurance procedures but this did not include obtaining feedback from people that had an interest in the service or unannounced visits. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Maria Kinson 33 Greycoat Street London SW1P 2QF Care Homes for Adults (18-65 years) Page 11 of 34 02079792000 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 12 of 34 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 13 of 34 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 . Information was made available to service users, but it was not provided in a format that some of the people that use the service could understand. Staff carried out an assessment before people moved into the home. This provides information for staff about peoples support needs. Evidence: The registration and public liability insurance certificates were displayed in the lounge. The manager had developed a Statement of Purpose and Service User Guide. These documents provide information about the facilities and support the home can provide. The Statement of Purpose and Service User Guide were available in a written format. As some of the people that use the service cannot read or have limited understanding of written information the home should provide these documents in an alternative format. See recommendation 2. Information about the fees had been added to the Statement of Purpose but were not included in the Service User Guide as recommended in the previous report. See recommendation 1. Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: We were not able to assess the arrangements for admitting new people to the home as the home had not admitted any new service users in the period since the last inspection. We looked to see what information was provided in the homes Statement of Purpose about the admission procedure. The Statement of Purpose said people had to complete an application form and were interviewed to see what support they would require. There was no information about the procedure for emergency admissions. We know from the last inspection that peoples needs were assessed prior to admission but the assessments that we saw during that visit lacked detail and were not always signed. We have repeated the recommendation that we made at the last inspection about this issue. See recommendation 3. It was evident during discussions with some of the service users that their quality of life was affected by the behaviour of one of the other service users. Service users said some of their personal items were taken and damaged and they were sometimes disturbed by a service user who shouts. Although some of the service users didnt like this behaviour they said they wanted to continue to live at Emmanuel care home. It is essential that the compatibility of service users is assessed prior to admitting any new service users. Care Homes for Adults (18-65 years) Page 15 of 34 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Care plans and risk assessments provide information about the support that service users require to stay well and safe. Service users assist staff to prepare meals and keep the home clean but will require information in alternative formats to participate in other aspects of life in the home. Evidence: We examined the care records for two service users. Both of the files included a individualised care plan to address the persons health, social and personal care needs and information for staff about how potential risks should be managed. Care plans about the management of challenging behaviour had been updated to include information about signs that might indicate an individual is becoming agitated and what staff can do to help the person calm down. The key worker completes a monthly report. The report provides information about significant events, appointments and issues that had occurred since the last review. Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: The report provides useful information about service users health and wellbeing. The people that live in the home were able to say what they liked and disliked and make some decisions for themselves. Service users told us that they chose what they ate and what they wore and were asked if they wanted to attend events and activities in the community. People that use the service would require support from staff, relatives and advocates to make decisions about complex issues. There were regular residents meetings. We saw the minutes from the two most recent meetings that were held in February and March 2009. There was little evidence of input from service users. The manager should consider what she could do to help service users who have limited verbal communication skills express their views during meetings. We discussed the possibility of providing pictures of agenda topics such as activities, outings or meal options for discussion at meetings. See recommendation 4. Service users were encouraged to assist staff with some of the daily house chores such as drying the dishes, emptying the rubbish and clearing the table. Some of the service users were also responsible for keeping their bedroom tidy with support from staff. There was information in care plans about the tasks that service users undertook and staff recorded information about service users progress. Some of the service users were able to make hot drinks. One service user was known to have challenging behaviour. The manager had assessed the risk of people being harmed and recorded guidance for staff about the action they should take to protect themselves and other people. The assessments that we saw included checking the service users mood prior to any outings, asking the service user to sit in the middle seat in the back of the car so that they could not make contact with the driver or open the doors and guidance about how to approach the service user. Risk assessments were updated when other professionals provided new information or advice. Care Homes for Adults (18-65 years) Page 17 of 34 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 . Service users were supported to undertake activities that they enjoy in the home and community. The menu was varied and people said they liked the food that was prepared in the home. Evidence: There was a separate weekly activity plan for each service user. The plans included information about the activities and events that service users attend regularly such as college or day centres and the activities and events that service users like to do in their free time such as playing computer games, watching television, attending church services, visiting local restaurants, shopping trips and playing basketball in the local park. One service user told us about the gardening project they were involved with at college and about the work they would like to do in the future. Records were kept about activities that service users undertook in the home and community. Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: Some of the service users had experienced difficulties accessing their personal money and opening a bank account as they did not have a relevant form of identification such as a passport. The manager said that once this issue was resolved service users would be given the opportunity to go on holiday. Service users used local community facilities such as the local health centre, shops and library and public transport or taxi services to get to and from outings and college. Service users had made several friends at college and church and said some of the staff that used to work in the home visit them. One person recently went out for a meal with a college friend to celebrate their birthday. Service users said they could telephone their relatives whenever they wanted to and this formed part of the care plan for one service user who sometimes became agitated. One service user was in regular contact with their relatives and sometimes stayed overnight at the family home. We saw one member of staff knock on a service users door and wait for a response before entering. Service users could lock their bedroom door from the inside if they wanted time alone. One health care professional told us that staff always respect service users privacy and dignity. Staff communicated effectively with service users and listened to their views. Two service users have an advocate who they see outside the home. Service users told us that there was always plenty to eat and said they particularly like cottage pie, the rice that the manager makes and pasta bolognase. There was a bowl of fresh fruit in the kitchen and some fresh salad in the refrigerator. Food was stored appropriately. Care Homes for Adults (18-65 years) Page 19 of 34 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 received assistance with their personal care needs but it was difficult to establish if their wishes and preferences were followed because plans did not provide adequate information about how people want to be supported. Service users were supported to manage health issues and access NHS services. The management of medicines had improved. Service users were protected by the records that were kept and the procedures that were followed by staff that handle medicines. Evidence: Service users told us that staff supported them to wash or have a bath. Although care plans indicated that people required assistance with personal hygiene it was not always clear how much help the person required or if they had any preferences about the way they were supported. One person was not receiving adequate support to keep their fingernails clean and tidy. See requirement 1. All of the people that live in the home were registered with a local GP and were supported to attend appointments and meetings. Records showed that in recent weeks one person had seen a variety of different health care professionals including a podiatrist, a specialist community nurse, psychiatrist and neurologist and was also Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: supported to attend hospital appointments for scans and tests. We examined two medication charts, one for a service user that took regular medicines and one for a service user that took medicine, if they needed it. All of the information recorded on the charts was hand written by a staff member and countersigned by a second member of staff. This practice reduces the risk of errors. Records were kept about medicines that were received in the home. Medicines were stored in a small room under the stairs. There was no surface in the room to place medicines pots or medication administration charts on but the manager said staff could use the top of the filing cabinet for this purpose. The home did not have any drugs that require special storage facilities and had stopped using homely remedy medicines. The homes medication procedure must be reviewed and amended to reflect this change. The manager is a registered nurse. The manager said she was the only member of staff that administers medicines in the home. We strongly recommend that some of the other staff are trained and assessed to undertake this task so that continuity of care can be maintained during holidays or sudden illness. See recommendation 5. Care Homes for Adults (18-65 years) Page 21 of 34 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 . Service users were encouraged to raise concerns during group meetings and knew who they should speak to if they were unhappy. Money records had improved but further work is required to ensure records are transparent and easy to follow. Staff received safeguarding training and knew what they should do if they were told about an allegation of abuse. Evidence: The home had not received any complaints in the period since the last inspection and we have not been made aware of any concerns about the service. Information about the complaints procedure was included in the service user guide. The procedure advised people how to make a complaint and stated how long it would take the home to investigate their concerns. The complaints procedure should be provided in a format that people that use the service can understand. See recommendation 2. One service user said they would talk to staff if they had any concerns or wanted to make a complaint and said they were always asked at residents meetings if they wanted to raise any issues. A visiting health care professional said the manager always followed their advice and responded appropriately if they raised any concerns about the service. The home has a safeguarding procedure. The manager said the procedure had not Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: changed in the period since the last inspection. It was identified in the last report that some minor changes were required to the procedure such as clarifying what action the home would take to protect people that use the service whilst an investigation was in progress and ensuring the procedure was signed and dated. We have repeated the recommendation that we made at the last inspection about this issue. See recommendation 6. Staff said they were required to hand over information about accidents and incidents at the end of their shift and report allegations or concerns to the manager. Some of the staff had recently completed a safeguarding training course. All of the service users had an appointee. The home was responsible for holding some personal money for two service users. Records were kept about money that was received in the home for service users and showed how each individual spent their money. The records were a little difficult to follow in parts as some entries were out of order. Receipts were kept but were not in any order. See recommendation 7. There were regular deductions for expenses. The manager told us that expenses cover the cost of toiletries, activities and transport and said this system was initially set up because two of the service users were not receiving any personal money. The manager said the actual amount spent often exceeded the amount that was claimed from service users. As service users now have access to their own money the home must state what each sum of money is used for. See requirement 2. Care Homes for Adults (18-65 years) Page 23 of 34 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 was clean and comfortable but there were some outstanding maintenance issues. Evidence: The home is located in a three storey town house, on a housing estate in Thamesmead. There is a local bus service and various shops within walking distance of the home. A member of staff and a service user showed us around the home. We saw the lounge, kitchen, medicine room, ground floor toilet and two bedrooms. All of the areas were clean, tidy and comfortable but there were several broken items, some of which could create a risk to service users or staff. The sofa covering was torn in parts and some of the foam was exposed, the radiator at the top of the stairs was uncovered because the cover was broken, the floor covering in the kitchen was worn in parts and one of the cooker doors was damaged. See requirement 3. We advised the local fire authority about the condition of the sofa. The manager said the radiator cover was replaced but was then removed by a service user. The home should try to locate a more robust cover for the radiator or consider resiting the radiator. All of the service users had their own bedroom which they could lock from the inside. Two people showed us their bedrooms and pointed out some of the items they had Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: recently purchased and some of the work that they completed at college. There was adequate space for service users belongings and clothing. Most of the service users had their own television. People said they liked their rooms. In the period since the last inspection the lounge was reorganised and some of the furniture and mats were removed to reduce the risk of slips and trips. This made the room look bigger. The lounge was pleasantly decorated and furnished. There was adequate seating for all of the service users at the table in the kitchen. Food was stored appropriately and was labelled once it was opened. Care Homes for Adults (18-65 years) Page 25 of 34 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 . Service users were supported by staff who were familiar with their needs and preferences. Staff training was improving but the induction programme for new staff did not cover some of the common induction standards. Service users were protected by the home recruitment practices. Evidence: The manager told us that 75 of the staff that work in the home had a vocational qualification in care at level two or above. This exceeds the standard set by the Department of Health. We examined the duty roster for the week of the inspection. There were periods where it was not clear if there were any staff on duty for short periods. For example on 16/04/09 there were no staff on duty for a one and a half hour period between 6pm and 7:30pm. The manager told us that there were always staff on duty and said the gap was a typing error. See recommendation 8. Staff said there were always adequate staff to meet service users needs and extra staff were provided if service users had to attend meetings or appointments. One service user said staff are good to me and listen to my views. The home had recruited one new member of staff in the period since our the last Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: inspection. We looked at the staff members recruitment file to see if the home carried out adequate pre employment checks and obtained copies of important documents. The file included an application form and employment history, two written references that were company stamped or on headed note paper, proof of identification, a recent photograph, a statement about the persons physical and mental health and an enhanced criminal record disclosure. The applicant was interviewed and notes were kept about their suitability for the role. Some of the staff that we spoke to had completed health and safety, safeguarding adults, physical intervention, challenging behaviour, medication, handling and fire safety training sessions in the period since the last inspection. Staff said the challenging behaviour session was particularly relevant and helpful. Copies of certificates were kept as proof of training. The manager should develop a training matrix so that she can see at a glance what training updates staff require. We saw the induction training programme for a new member of staff. Various topics were discussed with the employee but some of the common induction standards were not included. The induction programme was completed in one day. See recommendation 9. Care Homes for Adults (18-65 years) Page 27 of 34 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 was well managed overall and now meets most of the key standards. Some work was taking place to identify areas for improvement but this did not include regulation 26 visits to monitor the conduct of the service. Regular checks were carried out to ensure appliances were working properly and were safe to use. Evidence: The manager became the registered manager for the service in 2005. The manager holds a National Higher Certificate in Care, a Batchelor of Arts in Social Care and became a registered mental health nurse in 2008. The manager completed some distance learning training courses in the period since the last inspection. Staff had made good progress with the requirements that we made during the previous inspection. The management of medicines and staff recruitment practices had improved significantly. Staff told us that the manager was supportive and approachable. They said that if there was a crisis or emergency the manager always returned to the home and Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: maintained regular telephone contact with staff when she was off duty. We saw evidence of this during the inspection. A health care professional said staff from the home always attend meetings and make contact with other professionals. The manager had introduced a quarterly check to assess staff performance and to monitor the management of specific issues such as complaints. Service users views were obtained during residents meetings, but this was often limited as some of the service users have difficulty communicating. The home should consider sending out anonymous questionnaires to relatives, advocates and visiting health and social care professionals to obtain their views about the service. One of the directors or partners must carry out regular unannounced visits to assess the conduct of the service. See requirement 4. Fire safety equipment was serviced at regular intervals and in house checks were carried out to ensure the smoke detectors were working. Fire drills were carried out regularly to check that staff were familiar with the homes fire and evacuation procedure. Some of the staff had completed fire safety awareness training. Records showed that equipment such as portable electrical appliances, the mains electrical installation and gas appliances were serviced regularly. Refrigerator and freezer temperatures were monitored. Staff completed accident and incident reports about significant events. Care Homes for Adults (18-65 years) Page 29 of 34 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 34 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 18 12 Records must provide 07/08/2009 adequate information about the type and level of support that people require to maintain their personal care needs. This will help to ensure that service users receive consistent and suitable support. 2 23 17 Money records must provide a complete audit trail. Records must show the purpose for which money was used. 07/08/2009 This will help to protect service users. 3 24 23 The premises must be kept in a good state of repair. In particular the kitchen floor covering, the radiator cover outside the kitchen and the 25/09/2009 Care Homes for Adults (18-65 years) Page 31 of 34 broken oven door must be repaired or replaced. To protect service users and staff from potential hazards. 4 39 26 Regulation 26 visits must be carried out regularly and a written report about the conduct of the service must be completed. 14/08/2009 To assess the conduct of the service and to help identify areas for improvement. 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 1 The Service User Guide should specify what services are included in the fees and what services/items people are responsible for purchasing out of their own funds. The Statement of Purpose should include information about the homes procedure for admitting service users in an emergency. Information for service users such as the Statement of Purpose, Service User Guide and complaints procedure should be provided in a suitable format. Staff should obtain and record detailed information in the pre admission assessment about how people want to live their life and the support that they require. Staff should use alternative communication aids or methods to obtain service users views during meetings. In case of sudden ill health or absence some of the care staff should also be trained and assessed to administer medicines safely. The homes safeguarding procedure should be reviewed and 2 1 3 2 4 5 8 20 6 23 Care Homes for Adults (18-65 years) Page 32 of 34 updated. All references to the agency should be removed and the procedure should state what action, if any would be taken to protect people that use the service during an investigation. The procedure should be signed, dated and have a review date. 7 8 9 23 33 35 A system should be established for the safe storage and easy retrieval of receipts. The duty roster should provide accurate and up to date information about the hours that staff work in the home. The induction training programme for new staff should cover the common induction standards. Care Homes for Adults (18-65 years) Page 33 of 34 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. 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