Inspection on 03/04/09 for Fengates (1)

This inspection was carried out on 3rd April 2009.

CQC 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.

Other inspections for this house

Fengates (1) 03/04/07

Fengates (1) 08/12/05

Fengates (1) 25/07/05

Fengates (1) 01/12/04

Fengates (1) 05/07/04

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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: Fengates (1) 1 Fengates Redhill Surrey RH1 6AH     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: Marion Weller     Date: 0 3 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. 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: Fengates (1) 1 Fengates Redhill Surrey RH1 6AH 01737778811 01737789608 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) : CMG Homes Ltd care home 6 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 6 The maximum number of service users who can be accommodated is: 6 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 1 Fengates is owned by CMG Homes Ltd. The home is a detached property providing accommodation for up to six adults who have learning disabilities. The home is located in Redhill, Surrey. The home is accessible to local shops and public transport. Redhill town centre is close by. The accommodation is provided over two floors. All bedrooms are for single occupation with en-suite showers. There is a comfortable lounge, separate dining room and a large kitchen. There is a patio area and a small garden that is laid with lawn to the rear of the house. Some limited parking is available at the front of the house. Please consult the manager for the most up to date information regarding the fees charged. Care Homes for Adults (18-65 years) Page 4 of 30 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: 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: The last key unannounced inspection of this service was completed on the 3rd April 2007. An annual service review was undertaken on the 15th April 2008. Marion Weller, Regulatory Inspector, conducted this Key Inspection of number 1 Fengates Road on the 3rd April 2009 and was in the home from 10:45 am until 3:45pm. During the site visit the inspector spoke with some members of staff, two service users and the Registered Manager. Parts of the home were toured and some records and documents were inspected and care practices observed. The homes medication administration practice and procedure was also inspected on this visit. The inspection report takes into account all the information obtained about the service since the previous site visit. This includes any formal notifications, phone calls and Care Homes for Adults (18-65 years) Page 6 of 30 letters received and any complaints or allegations notified to the Commission. The manager was asked to complete the homes Annual Quality Assurance Assessment prior to the inspection. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gives some numerical information about the service. The completed document provided relevant information that gave a clear picture of what was happening in the service and their plans for further development. Surveys were given to service users and professionals involved with the home to find out their level of satisfaction prior to the inspection taking place. Survey respondents were very satisfied with the care provided. Survey forms included the comments: ....The Staff are always there to listen to me when I need support. ....There are always fresh flowers to look at. And ....I am very happy living at Fengates and I am pleased with the support I receive. A medical professional asked to comment on what the service does well said, ...they maintain regular contact with professionals. Other statements made by survey respondents are included throughout the text of the report. No complaints have been made to the Commission about this home since our last inspection, neither have we been involved in any safeguarding alerts in connection with 1 Fengates Road. The manager and her staff gave their full cooperation throughout the site visit. What the care home does well: What has improved since the last inspection? What they could do better: In line with a statutory requirement issued in the last inspection report the manager has completed a risk assessment in respect of the need to supply covers to hot surfaces throughout the home. Service users however would benefit further from the home revisiting the risk posed from hot surfaces in the home, based on the assessment of identified need and potential vulnerability of the service users accommodated. Care Homes for Adults (18-65 years) Page 8 of 30 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. Admissions to the home take place only if the manager has undertaken a full needs assessment and the home is confident that they can meet identified need. Service users and their representatives can be confident that they will be provided with all the information they need to make an informed choice about moving in. Evidence: The home has developed a specific and comprehensive statement of purpose and information guide that is available for prospective and existing service users. Information about the service offered at Fengates can be provided to people in alternative formats suitable to meet their and their families needs. For example, the document can be provided in large print and a pictorial version. There are plans to make it available in different languages, relevant to existing service users. The content of the homes information documents are regularly reviewed to ensure they provide only current information. The homes AQAA records ....The Statement of Purpose now contains more information regarding staff training, equality and diversity and has a Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: photo gallery to allow service users to gain a good insight into the look of the home, the current layout and the facilities. One survey respondent said .....upon my arrival I was given a statement of purpose information handbooK. There have been no new admissions to the home since the last inspection report was written. The registered manager confirmed that initial referrals for admission are received by the provider organisation. There is a dedicated assessment team that considers referrals. The manager of 1 Fengates confirmed that she would be provided with the opportunity to carry out her own preadmission assessment and to gather evidence to inform decision making as to whether the home could fully meet the prospective service users needs. There is now a local policy on admission procedures written by the manager. Existing service users files evidenced preadmission assessments and a summary of an assessment undertaken through care management arrangements, except for one service user who was placed there in an emergency. This is not ideal; the manager said that emergency placements are not encouraged. In normal circumstances the service would carefully consider a comprehensive assessment for the individual and the capacity of the home to meet their needs, prior to anyone moving in. In addition, prospective service users would be given the opportunity to spend time in the home and to meet and feel comfortable with the other people living there. The home currently has one vacancy. The registered manager said she is working in closely with the referral and assessment team and the people living at Fengates to ensure the vacancy is offered to someone whose individual assessment clearly illustrates that he or she are suitable. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have person centred care and support plans that ensure their needs are identified and met. They are supported to take assessed risks as part of an independent lifestyle and to make decisions in their lives wherever possible. Evidence: All service users have individualised person centred care plans which take into account their choices, aspirations and changing needs. These were found to be comprehensive and detailed documents that demonstrated the involvement of the servicee user in planning their care and support. It was evident that plans were regularly reviewed in consultation with service users and they were agreed and signed by them. The staff team have received specific training in person centred planning since the last inspection and have access to a dedicated trainer. It was clearly evidenced that service users are being supported to make their own decisions and are consulted regularly about the day to day running of the home. One service user survey rsponent said ....I Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: can make my own decisions on where I would like to go and what I would like to eat and how I dress. The manager records in the homes AQAA ....we consistently maintain the ethos that Fengates is the service users home, where staff come to ensure the best possible outcomes for the people living there. The staff spoken with said they encourage relatives and other people who matter to the person to be involved in care planning meetings and reviews. Staff were knowledgable about service users choices, needs and views and skilled in ensuring they were being met. Each service user has a named keyworker who works closely with them. Staff support service users to manage their own finances as well as providing clear guidelines for them. No survey respondents raised any concerns about the homes management of service users finances. Commendably, service users all have their own keys to access both the house and their bedrooms. This ensures their unrestricted freedom of movement, privacy and fosters ownership. Any restrictions to service users choices are managed through their personal support plans and risk assesments which are reviewed and are up dated regularly. They are made available in a pictorial format to service users so they or their representatives become fully involved and are kept informed. All plans have been signed by staff to confirm that they have read and are aware of individual risk plans. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are provided with a range of age appropriate individualised daily living and leisure activities. They are supported to take part in the local community and their rights and responsibilities are respected by the home. Service users continue to be provided with a well balanced and nutritious diet of their choice. Evidence: There is clear evidence that the service users at Fengates are encouraged and supported to take part in meaningful social and leisure activities of their choice and to integrate into the local community. One service user has secured paid part time employment at a local riding stable; another is planning on looking for part time work in a local Cafe A further three service users enjoy supported learning courses at the local community college. Each service user is supported to have a holiday of their choice every year and the manager records that the service regularly organises trips Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: out for individuals and like minded small groups living in the home. Events such as Bonfire Night and Halloween are celebrated communally with relatives and friends of service users being invited to the home. Service users are encouraged and supported to maintain links with their families and also visit them at home where this is possible. The manager spoke of service users who have their own mobile phone and a communal pay phone is available. Service users are free to access all areas of Fengates with no restrictions and have their own front door and bedroom keys, which fosters ownership and enables privacy. Menus are arranged on weekly basis, based on individual preference. Service users go food shopping supported by staff and are involved in the planning and preparation of food. The main meal is provided in the evening. The manager records that staff cook one meal a month that residents have not tried before to develop their knowledge and understanding of different types of food. This supports the aim of life long learning. There was clear evidence that menu planning offered service users a well-balanced and nutritious diet. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs and preferences and the principles of respect, dignity and privacy are put into practice. There have been improvements to medication administration in line with a statutory requirement and good a good practice recommendation that better safeguard service users health and welfare. Evidence: Individualised plans of care recorded service user personal and health care needs and detailed how theses would be met by the home. Care Plans included the strengths of the individual. It clearly showed where the individual could manage personal care independently and where they required some additional support from staff. Care Plans illustrated the likes and dislikes of each service user and their known preferences and contained all the information necessary for staff to offer appropriate and effective support and care. Individualised health action plans have also been completed in consultation with service users. Plans sampled were detailed and comprehensive covering health care Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: issues for individuals such as epilepsy, mental health, diabetes, diet and exercise. Records were being maintained of well person health screen checks and other visits to health care professionals, including psychiatry services, community nurses, chiropody, GP and dentist. The manager records in the homes AQAA, ....At Fengates we have a good working relationship with local GP practices and the community teams, which benefit service users. One senior health care professional when asked what the home did well recorded on a survey return, .....The home maintains regular contact with health professionals. The homes medication administration practices were examined on this visit. Photographs of service users were maintained with their medication administration records. A list of staff trained and authorised to administer medication was available to view. Medication administrators have provided specimen signatures and specimen initials for signing MAR sheets for audit purposes. The home has a clear medication procedure in place and all medication administered was signed for, with no obvious gaps. There is a GP agreed list of homely remedies available to service users which secures their welfare and discharges the homes duty of care. Staff members receive medication training from Boots the Chemist. They have supplied the home with new training and assessment packs recently, which staff are working through. The manager stated that internal assessments for the homes medication administrators are regularly carried out to ensure staffs ongoing competency and to protect the welfare and safety of service users. As a result of a statutory requirement awarded at the last inspection, together with a recommendation to improve some aspects of medication practice, it was evidenced on this visit that the manager has since reviewed the practice of secondary dispensing for one service users leave medication. Service users leave medication is now prescribed and dispensed separately from their normal daily medication. This secures the individuals safety and welfare and avoids any potential errors that can be made when staff secondary dispense into containers other than those supplied and checked by the dispensing Pharmacy. As mentioned previously, a recommendation was made to ensure that staff making hand transcriptions to service users MAR charts clearly signed the entry and that a second person signed after checking accuracy of transcription. Improved practice in this area was clearly evidenced on this visit. One further improvement was discussed with manager. Hand transcriptions should in addition clearly show the warnings and contra indications written on the original dispensing label, to better inform staff administering medication and to protect the health, welfare and safety of the service user. The manager stated her firm intention to make the necessary changes to Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: practice. Care Homes for Adults (18-65 years) Page 19 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place, which ensure that people who live in the home and those that visit can make their views and concerns known. They can be confident that issues raised will be investigated and where necessary action will be taken to put things right. Service users are further protected by staff that receives regular safeguarding training and a provider who ensures a robust recruitment system is in place. Evidence: Systems are in place which ensure that people who live in the home and those that visit can make their views and concerns known. There is a well developed complaints policy and procedure available for people to follow if they are dissatisfied with any aspect of the service. The manager maintains a complaints file and suggestions book where she records concerns, complaints and suggestions she receives. The suggestions book clearly showed where actions had been taken in response to peoples suggestions. If no actions could be taken, this had equally been explained to the person. The homes complaints procedure is also available in large print and a pictorial format to ensure it is accessible to all service users. The manager confirmed that no complaints have been received by the service since the homes last Annual Service Review in 2008. A service user survey respondent said when asked if they knew how to complain, ......I understand the procedure and I have my own copy. And ......I know I can talk to the staff at any time I like for support and help if I am unhappy. Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: The updated local authority multi agency safeguarding adults procedure was available to staff and the home has a whistle blowing policy. The manager and her deputy have attended the local authority safeguarding adults training. Staff training records indicates that staff have completed appropriate adult protection training and arrangements are in place to update regularly. The staff induction and NVQ training also have elements of adult protection. The home has recently had a computer system installed by the provider organisation, with the view to providing staff with increased opportunities for e learning. The manager records that the e learning safeguarding adults training programme will be available for staff in the home to access from February 2009. Staff spoken with were aware of safeguarding procedures and clear in their responses as to the action that they would take if they needed to safeguard service users. There have not been any safeguarding alerts raised in the last 12 months. Staff are all POVA and CRB checked. The home could evidence robust recruitment procedures designed to protect service users from harm. Care Homes for Adults (18-65 years) Page 21 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. Service users benefit from living in a homely, comfortable and clean environment. They would benefit further from the home revisiting the risk posed from hot surfaces in the home, based on the assessment of identified health needs and potential vulnerability of the service users accommodated. Evidence: Number 1 Fengates is a large family home with six bedrooms and is situated close to Redhill Town Centre. There are local shops and amenities close by. The home has a surrounding garden, which is well maintained and attractive. There are numerous bird feeders and a birdbath to encourage local wild life. Service users enjoy watching the activity this resource affords them. The manager said there are plans to purchase new garden furniture and a small greenhouse to provide service users with the opportunity to grow their own fruit and vegetables and to better utilise the garden. The service provides a homely feel and is being maintained to a good standard. There is a comfortable communal sitting room and a separate dining room. Two bedrooms were viewed. One was unoccupied. It is in need of some refurbishment. The manager said it would be decorated and carpeted to the taste and needs of the person being admitted to it. The other room viewed was personalised with the service users own Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: effects and reflected their individual tastes and interests. Service users are provided with the opportunity to choose the colour schemes in their bedrooms. This was confirmed by one service user spoken with who had firm plans for their bedroom to be repainted and spoke about the colours they had chosen. The manager records that some environmental issues are outstanding and await resolution. At the back of the home the external walls need repainting and a new front door is required. Some bathrooms and other areas, although homely, are looking a little tired decoratively. The manager records that one of the items they could do better is redecorate on a more regular basis. Two additional armchairs are outstanding from recent purchase requests. The intention is to place them by the glass doors in the dining room, which will enable service users to enjoy the garden when they are unable to go out or when they want to watch the birds without disturbing them. The home was cleaned to a good standard; it was odour free and hygienic. Suitable hand washing facilities were available and separate laundry facilities were provided to the rear of the house. Staff are provided with infection control training. The homes AQAA records that service users have also received information and guidance in infection control and food hygiene. In line with a statutory requirement issued in the last inspection report the manager has completed a risk assessment in respect of the need to supply covers to hot surfaces throughout the home. Whilst the risk assessment meets the demand of the requirement, it is limited in its scope and does not fully consider the safety of service users based on an assessment of their individual enduring health needs and therefore on their potential and increased vulnerability on occasions. This issue was further discussed with the registered manager and the providers Regional Director at the close of the site visit. Both managers made a firm commitment to revisit the original risk assessment and take action to ensure the health, safety and protection of the people accommodated. Care Homes for Adults (18-65 years) Page 23 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are adequate numbers of motivated, competent and trained staff to meet the needs of service users. The staff group provides continuity and service users are further protected by the homes robust recruitment practices. Evidence: The home is staffed by a registered manager, a deputy manager and support staff. Observation and records evidence there are sufficient staff rostered to meet service users needs and the home will offer service users 1:1 support when it is required. The staff team have worked together for a number of years and provide excellent continuity to service users. There are clear staff structures and roles and responsibility are well defined. The staff team are of mixed gender and reflect the ethnicity and culture of the service users accommodated, which is clearly to their benefit. It was observed that service users liked the staff that was supporting them. Throughout the site visit there was clear evidence of good relationships between the staff and the people living there. Staff spoken with said how much they liked working in the home and this was reflected in the way support and care was provided. Staff obviously know the client group well and how best to meet their needs. There is an Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: active key worker system in place. A service user survey respondent said, ....the staff are always there to listen to me when I need support and they support me at all times. People applying to work at the home have to complete an application form, provide two references and have a POVA and Criminal Records Bureau check and attend for interview. As part of the recruitment process, the homes AQAA records that service users are invited to show potential employees around their home and ask questions as part of the interview panel. This ensures they have a say in the people who support them. New staff receives induction based on the Skills for Care Standards. The home has recently had a computer system installed by the provider organisation, with the view to providing staff with increased opportunities for e learning. The on line training courses will cover all mandatory training subjects such as Safeguarding Vulnerable Adults, Fire Safety, Health and Safety, Food Hygiene, First Aid and Infection Control. The manager records, ...this is an extremely positive move and will enable staff to achieve their individual training requirements in an efficient manner. More traditional workshop training will also be available. The homes AQQA provided evidence that over fifty percent of staff have obtained National Vocational Qualifications at Level 2 or above. It is planned to enrol more staff to gain their qualification as opportunity arises over the next 12 months. Three staff personal files were sampled. They were maintained to a very good standard and contained the required information. POVA first and CRB checks are carried out with appropriate records maintained to secure service users safety. Copies of the General Social Care of Conduct are made available to staff and were present on individuals files. Care Homes for Adults (18-65 years) Page 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from a well run home and an experienced, competent manager. There is a firm commitment to ensuring the minor environmental improvements required are completed to further benefit service users and protect their safety and welfare. Evidence: The registered manager has 16 years experience of working in residential care provision and has managed the home at 1 Fengates Road for the last 8 years. She consistently updates her practice and skill base and provides an excellent role model for other employees. She communicates a clear sense of direction to staff and is able to evidence a sound understanding of best practice. The manager has successfully completed the Registered Managers Award and is well supported by an efficient and effective deputy manager, who also holds the RMA qualification. Service users benefit from the approach of the management team who are open, Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: warm and transparent in their dealings with individuals. It was clear both from documentation and observation that the manager consistently seeks to improve the service to ensure it provides the best possible outcomes for the people who live in the home. It is also clear from talking to her that she values the work that staff do and she therefore works hard to support this through supervisions, appraisals, staff meetings, post training evaluations and talking and listening to staff on a day to day basis. The home conducts regular quality assurance exercises. Questionnaires are also sent to relatives and other stakeholders annually by the provider organisation. The responsible individual conducts monthly quality assurance visits to the home which are recorded. The Provider holds an annual service users forum where there is an opportunity for service users to discuss their views and opinions in relation to subjects chosen by them and covers issues raised from feedback questionnaires. This provides service users with a clear sense of ownership in relation to the services they receive. The homes quality assurance system is also nationally recognised by an authoritative independent accrediting body, known as Investors in People. Equality and Diversity, human rights and person centred thinking are given priority by the manager who was able to demonstrate a high level of understanding and to demonstrate best practice in these areas. The way the home is run shows an understanding of peoples needs in respect of the six strands of diversity, which includes gender, age, sexual orientation, race, religion and disability. The AQAA records that health and safety records are up to date. Water temperature records are being maintained and monthly health and safety checks are conducted and results recorded. Accident and incident records are being appropriately maintained. In line with a statutory requirement issued in the last inspection report the manager has now completed a risk assessment in respect of the need to supply covers to hot surfaces throughout the home. Whilst the risk assessment meets the demand of the requirement, it is limited in its scope and does not fully consider the safety of service users based on an assessment of their individual enduring health needs and therefore on their potential and increased vulnerability on occasions. This issue was further discussed with the registered manager and the providers Regional Director at the close of the site visit. Both managers made a firm commitment to revisit the original risk assessment and take action to ensure the health, safety and protection of the people accommodated. Care Homes for Adults (18-65 years) Page 27 of 30 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 28 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 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 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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