Inspection on 23/02/09 for High Cross House

This inspection was carried out on 23rd February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

High Cross House 29/01/07

High Cross House 23/01/06

High Cross House 14/09/05

High Cross House 01/03/05

High Cross House 09/12/04

High Cross House 20/11/03

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10 Whitfield Avenue

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: High Cross House 93 Blurton Road Heron Cross Stoke-on-Trent Staffordshire ST3 2BS     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: Wendy Jones     Date: 1 1 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 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 31 Information about the care home Name of care home: Address: High Cross House 93 Blurton Road Heron Cross Stoke-on-Trent Staffordshire ST3 2BS 01782594696 F/P highcross.house@craegmoor.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Strathmore Care Services Name of registered manager (if applicable) Ms Barbara Ann MacBryde Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The registered person may provide the following category/ies of service only: Care home only - Code 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 - Code LD (9) The maximum number of service users who can be accommodated is: 9 Date of last inspection Brief description of the care home High Cross is a detached property in a residential area of Blurton, Stoke-on-Trent. The home is owned by Strathmore Care Services a subsidiary of Craegmoor Healthcare. The property is a large house, which is in keeping with other properties in the immediate area. High Cross is within walking distance from shops and other local amenities, which include a mini market, hairdressers, and a dentist. A bus stop is located close to the home. The service provides for up to nine people who have a degree of learning disability who are supported to find full or part time local employment and in appropriate cases to attend the local college. Care Homes for Adults (18-65 years) Page 4 of 31 9 Over 65 0 care home 9 Brief description of the care home The accommodation consists of nine individual bedrooms, which are situated on the ground and first floor, two bathrooms, three WCs, a kitchen, laundry, office and communal dining room and lounge. The service also provides staffing support to three people in one of the organisations semi-independent facility situated 200 yards away. Prospective users of the service should approach the provider for the fee range and costs of the service. Care Homes for Adults (18-65 years) Page 5 of 31 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: The quality rating for this service is 2 star. This means the people who use this service experience good, quality outcomes. This was a key inspection site visit of this service that was started on 23 February 2009 and completed on 11 March 2009. In total we spent approximately 7 hours in the home. The purpose of this visit was to assess the services performance and to establish if it provides positive outcomes for the people who live there. The visit included checking that any requirements and recommendations of the previous inspection visit of 29 January 2007 have been acted upon; looking at information the service provides for prospective users of the service, their carers and Care Homes for Adults (18-65 years) Page 6 of 31 any professionals; looking at information that the service provides to people who use the service to ensure that they understand the terms and conditions under which they have agreed to live at the home and the fees they should pay. Other information checked included assessments and care records, health and medication records; activity and records relating to the menus, finances, staff training and recruitment, complaints and compliments, fire safety and health and safety checks. The manager, staff and people who use the service were spoken to during the site visit and a brief tour of the building was undertaken. Before the visit began, the service provided its own assessment of its performance, in the form of an Annual Quality Assurance Assessment (AQAA). Surveys were sent to the service for distribution to people who use the service, relatives, any professional that has involvement in the service and staff. We have received ten staff, one health professional and four relative surveys, we also received nine surveys from people who use the service. The main points are included in this report. Since the last key visit we have carried out an Annual Service Review (ASR). We do an annual service review when there has been no major inspection of the service (we call this a key inspection) in the last 12 months. It does not involve a visit to the service but is a summary of new information given to us, or collected by us, since the last key inspection or annual service review. At the time of the ASR we concluded that the service continues to deliver a good standard of care. Throughout this report we have referred to people using the service as residents, as we established from discussion that this is the term they have agreed they prefer. What the care home does well: What has improved since the last inspection? The service has introduced person centered planning and the staff are working to ensure that the documentation is completed in consultaion with relatives and people using the service. Care Homes for Adults (18-65 years) Page 8 of 31 We asked the service to ensure that people are protected from the high surface temperatures of radiators at the last inspection visit, and a programme of providing radiator covers is almost complete. We did not find any evidence that people are being place unnecessarily at risk during this visit. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. 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 31 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 31 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. People who use the service can be confident that they will receive information about the type of service they can expect and can be sure that their needed will be assessed prior to moving in. Evidence: The service told us in the AQAA that. The home has a Statement of Purpose which is reviewed and updated as required. There is a Service User Guide available in an easy to read pictorial format. We have seen copies of the Statement of Purpose and service user guide and not copies are on display in the home. We have been told that each person has their own copy, we noted that some people have chosen to retain their copy in their care records which are stored in the office, three people have chosen to have their own copy in their room. When we spoke to two people about the service user guide we couldnt be sure that they knew what the information was for. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: We spoke to 6 people who use the service and have received surveys from 9 residents, 4 relatives and staff surveys, in addition to one GP survey and verbal testimony from one relative. One relative said, I cant praise the manager and her team enough, they have gone above and beyond the call of duty to support my relative and us at a very difficult time for our family. We have every confidence that they will continue to offer excellent standards of support and care. We saw in the records of residents meetings, that they had been informed that a person who had been visiting the home (to establish if he wanted to move in), was hoping to do so. The records stated, There was a resounding YES when we said that the new person was moving in. Other records showed that people had an opportunity to raise any concerns about any new person moving in if they had wanted to. We looked at the records of the person who has recently been admitted to the home. They provide evidence of good and thorough assessment of need and that the service has made every effort to ensure that his needs can be met. We spoke to this person and were able to establish that he was satisfied and happy that he moved into the home. We spoke to the key worker about the transition and have been assured that the service has operated to a high standard. Care Homes for Adults (18-65 years) Page 12 of 31 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. People who may use the service can be confident that records maintained on their behalf are up to date and provide detailed information. Evidence: The service told us in the AQAA that,Completion and implementation of comprehensive, well documented person centred care plans and risk assessments that were devised with the full involvement of all residents and families and relevant others where possible. We saw a sample of the care records and noted that they contain alot of information, but need further work to ensure that staff know what they need to do to meet any assessed needs. We spoke to the key worker of one of the residents, who said, Getting the information was very time consuming and the PCP contains alot of information, but we are in the Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: process of looking at each area of need to ensure that we know how can meet it. For example where one person has communication difficulities we have asked and have been provided with the training we need. Another member of staff said in a survey, We have a communication book and diary staff must read as soon as they come on duty. This provides any information we may need to know or tells you to read a certain file for changes etc. Relatives said, They help our daughter with the skills to improve her life. Risk assessments are in place where an area of risk has been identified and as with care plans are subject to review. Care Homes for Adults (18-65 years) Page 14 of 31 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. People who use the service have a wide range of opportunities to access activities intended to broaden their experiences and which they value. But the service should further promote the person centered philosophy it says it does. Evidence: The service told us in the AQAA that, All residents access community facilities and travel independently. All residents are able to access college courses, work placements, social and recreational activities of their choice e.g. sports, drama group, craft, floristry, aerobics, cinema, theatre, pubs, meals out, holidays etc. We looked at the records of people using the service and spoke to them about their lifetsyle. One person said, I like trains, when I go home I catch the train. I have a job at a local steam train station. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: Another person said, Weve decided wed like to go abroad again this year. We spoke to individual and the manager about the holidays and noted that all residents go away together. While this may be an informed decision, we are concerned that the service is not promoting the person centered philosophy it says it is. We saw that people using the service meet regularly to discuss matters affecting them, the last meeting is dated 10/03/09, and shows that they discussed, holidays, fundraising for the special olympic movement, meals, red nose day, Your Voice meetings, advocacy and other matters of concern they may have. One person stated that they wanted their bedroom painting. We saw that minutes of residents meetings are displayed in the home, but are concerned that not everyone is literate and able to read them if they wanted to. The manager said, We do talk to people about the things we have discussed. One resident told us that she is the representative for the service at the organisations Your Voice meetings. These are meeting of people who use service to discuss any issues affecting them with the organisation on a local and broader level. The manager felt that these meetings provided with residents with an opportunity to discuss problems, concerns and share ideas intended to improve the service they receive. We observed people in the lounge waiting for transport to their sporting activity, and spoke to them. They were relaxed, were familiar with the inspection process and interacted positively with the manager throughout. We have been told by residents that they have passes to use public transport and the majority do so independently. We spoke to people about meal choices and have been told that they discuss their food choices at the monthly meetings they have. The opportunities people have to be involved in meal preparation and cooking is limited due to restraints on their time and because of the difficulty presented by having to cook for nine people. Again the service should look at this and consider how it can develop more person centeredness in this area and to also support residents to develop independence. We saw a person ironing her clothes, another person said, I make sure I keep my room clean and sometimes wash the dishes after tea. A relative said, The service takes responsibility for my son, encourages him to lead a useful and interesting life and to achieve goals and be independent as possible. There are no significant diversity issues affecting the people living at the home, all are white british and information in the surveys indicate that there are no strong religious Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: needs. One person attends church with her parents. Care Homes for Adults (18-65 years) Page 17 of 31 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. Peole who use the service can be confident that their health needs are met and they will be supported to self medicate if they choose to. Evidence: The service told us in the AQAA that, All residents have a designated Keyworker. All residents have a Health Action Plan. Residents likes, dislikes and preferences are well documented in the PCCPs. Residents are enabled/supported to access healthcare facilities. Residents are enabled/supported to attend medical appointments. We saw that the service has introduced Health Action Plans (HAP). A Health Action Plan is an individual plan, belonging to a particular person, that explains that persons health needs. It also describes what has to happen for those needs to be met. We looked at a sample of one persons records and noted that there is regular input from health professional and the service have sought advice regarding the individuals particular health needs. We saw that one person has a significant hearing loss and recommended that the service seeks advice re the provision of a loop system as we Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: have been told that he chooses not to spend time in the main lounge with others because his hearing aid picks up background noise when he is trying to watch the tv. We understand that a loop system may help with this. We discussed medication and have been told that people using the service are assessed if they wish to self medicate to ensure that they have the ability to do so safely. We have also been told that the service respects the rights of people who do not wish to self medicate. The manager gave an example of one person who had recent reviews and changes of her medication has decided that she does not want to self medicate at the moment. We understand that two people currently self medicate. There is a lockable medication trolley provided for medication storage we saw that the service does not have anyone who is prescribed controlled medication. Changes to guidance indicates that services should have a controlled medication cupboard we have recommended this. We saw that records of medication are properly maintained with good evidence of stock controls. There was one example with a prescription of Diazepam that is prescribed as required where the service hasnt made a note of the stock and we couldnt undertake a proper audit. The deputy manager who has responsibility for medication stated she would address this. We also saw that the prescription has been received in 2007 but there is no expiry date on the bottle. There is a protocol in place for the administration of the Diazepam but it does not correlate with the prescribed dose on the medication bottle, we have asked the service to review the protocol to ensure that the information provided is accurate, this will ensure that all staff know under what circumstances it is to be administered and the the dosage. A relative said, Staff always inform us of any appointment regarding health and personal affairs. In a verbal testimony a relative said, The staff have been brilliant and I cant thank them enough for the support they have shown to my relative. They have made sure that he can attend appointmtents and have asked if they can attend with him, to be sure that they can provide what the health professionals advise. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be confident that their concerns will be listened to and acted upon and the staff team have the skills and experience to protect them from abuse. Evidence: The service told us in the AQAA that, Staff are aware of, understand and adhere to the policies and procedures relating to complaints, concerns and protection. People using the service told us, I know what to do if I have any problems, and would go to Barbara or the staff. Surveys confirmed that all nine residents know what to do if they have any concerns. The service has a complaints procedure that has been produced in a format that people using the service find easy to understand. We saw the record of the complaints the home has received and noted that there are two entries since the last key visit to the service. We saw that the record shows the action the service took to look into the matters raised and how they had been resolved. A relative said, If any problems arise or concerns from our daughter we can say with Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: confidence that it is dealt with promptly. Staff said, If you cant approach the manager there is a whistleblowing policy to follow, or you could approach the area manager. We have good procedures in place to deal with any concerns I would also speak to my manager and colleagues to infom them. We saw in the staff training records that all staff have received training in recognising and reporting suspected abuse. We have not been alerted to any safeguarding issues relating to people living at the home. We looked at sample of staff recruitment records and saw that the procedures are robust. We are kept informed of incidents and accidents and according to our records there has been one incident reported since the last key visit. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be confident that the home they live in is clean and properly heated. Evidence: The service told us in the AQAA that, Residents choose to personalise their rooms to their individual taste, including choice of decor, furniture and fittings if appropriate. Residents are involved in the choice of redecoration, refurbishment, equipment etc. The house is homely, warm, clean and welcoming. Residents and staff take pride in the home and work together to ensure good standards of cleanliness and repair are maintained The service is a detached property in a residential area and not distinguishable as a care home. The grounds and the property are well maintained and we noted that the home is warm and clean. Each person living there has their own bedroom and we have been told that they have a bedroom door key if they want one. Front door keys are not issued, we think that this could be something the service reconsiders, based upon the individuals ability and risk assessment. We are concerned that people have to knock to be let into their own home. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: None of the bedrooms have en-suite facilities. We were invited to see one persons bedroom and noted that they did not have a chair to sit on, we spoke to the person about this, and at their request have asked the manager if a chair can be provided. The bedroom we saw was pleasantly furnished and decorated, the resident told us she did her own cleaning. There was evidence that she had been supported to personalise her room, with personal and family photographs on display. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be sure that staff are properly recruited and well trained, this should give them confidence that they are provided with a good quality service. Evidence: The service told us in the AQAA that, Supervisions are completed every two months, along with an annual appraisal. The home manager and deputy are available at any other time to discuss any concerns or problems. The home manager ensures that she sees every member of staff on a weekly basis where possible so that issues can be dealt with promptly. The service has a well established staff team with very little turnover of staff. The manager provided an over view of the staff training and reported that the organisation has a good record for providing training opportunities. We spoke to one member of staff about supervision and the support she received she confirmed that she meets with the management regularly and commented that the training opportunities provided by the organisation have improved and any training needs identified have been provided. Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: In the staff surveys, comments included, There are staff of all ages and experiences that work at High Cross and I feel that there is always someone that has the right experience, knowledge or understanding to support the service users. Staff also said,I was given all the most important info that I would need when I first started. All other info was gained during my induction period. I was not allowed to start work until CRB checks was passed and my references where checked out. We looked at a sample of two staff recuitment and training records and can confirm there is evidence that the service has robust recruitment procedures in place. We saw that 5/8 staff have been trained to National Vocational Qualification (NVQ) at level two or above, this exceeds the minimum standards recommended. We saw that the staff training information shows that there are good standards relating to mandatory training. We saw that 80 of the staff team have received training in Person Centered Thinking and spoke to one member of staff who demonstrated her understanding of what this means. But our evidence during this visit, indicates that there is further work needed in this area. Relatives said, we always attend the house meetings when there is an inspection. I can only speak for our daughter, we are more than happy and confident in the staff. The manager said in her survey that, Craegmoor constantly strives to improve its staff training I recently enquired about Makaton training to help staff communicate with a new admission and received training within 3 days. We spoke to one member of staff who confirmed that she meets regularly with a manager for one to one supervision sessions. Care Homes for Adults (18-65 years) Page 25 of 31 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. People who use the service can be confident that the service is properly managed and audited and strives to continually improve the service it delivers. Evidence: The service told us in the AQAA that, The home manager is dedicated, professional and well qualified, holding NVQ4 and RMA and has twenty-nine years of experience in the care industry. There is a stable, experienced, consistent and committed staff team who support each other well and go the extra mile to ensure the health, safety and welfare of the residents and provide them with a satisfying and challenging quality of life. One relative said, We have always been happy with the way the care home is managed by all staff. In a verbal testimony a relative said, I cannot praise the manager and her team highly enough. Staff said, I have a very good working relationship with my manager and I am not Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: afraid to voice my opinion I have a good standard of support from her and the rest of the team. We also have regular staff and key worker meetings. The area manager is extremely supportive and visit the unit regularly including monthly reg 26 visits. We looked at the most recent copies of the monthly reports on the conduct of the service we ask the provider to carry out and saw that no significant issues had been reported. We are aware that the organisation undertakes regular audits of the service and produced action plans for the service to address any areas of deficit identified. We understand that the service seeks the views of people using the service about the quality of the service they receive, but could not tell if residents are informed of the outcome of the quality audits. We saw that the last financial audit had awarded the service 82 and that was an improvement on the previous audit. We looked at a sample of financial records, we saw that the balance checked against the money saved on behalf of people. We saw that records are properly maintained, and that regular audits of records are carried out by the manager and the organisation. We made a recommendation that all inventories of personal property are maintained as we saw one example where this hadnt happened. We saw that one person had purchased his own laundry basket, towels and bed linen. While accepting that people have the choice to do so, we reminded the manager that the organisation has responsibilty to provide basics such as bedlinen and towels. There is also a necessity to ensure that fire retardancy standards are maintained. The service should seek advice from fire safety officer about this. We did not check the records of fire safety during this visit but spoke to people using the service and have been assured that they know what action to take if the fire alarm goes off. We saw the staff training records that 90 of the staff team have attended fire training this year. At the last inspection visit we asked the service to ensure that people using the service are safeguarded from the risk of scalding by protecting them from unsafe radiators. The manager reported that action had been taken to address any radiators assessed as high risk. Three more radiator covers have been ordered. The service returned the AQAA when we asked for it, we saw that it provides relevant information and identifies areas the service needs to improve. Care Homes for Adults (18-65 years) Page 27 of 31 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 31 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 20 13 A protocol for the 11/04/2009 administration of as required medication must be reviewed. To ensure it provides accurate guidance for staff to follow. 2 20 13 The quantity of all medicines 11/04/2009 received and any balances carried over from previous cycles must be recorded. To enable audits to take place to demonstrate the medicines are administered as prescribed 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 6 6 People using the service should have their own copy of their PCP if they want one. Further action shold be taken to promote person centered Care Homes for Adults (18-65 years) Page 29 of 31 thinking. 3 4 5 6 11 12 17 20 Information available to people using the service should be user friendly The service should produce documents in a user friendly format. People using the service should be actively included in food choices and cooking The service should provide a Controlled Drug Cupboard. To ensure that any future controlled medication is stored safely. People using the service should be issued with a door key to their home. The service should ensure that people using the service have sufficient furniture and fittings in their bedrooms. Basics such as bedlinen and towels should be provided by the provider unless an individual chooses to purchase their own. The outcomes of the quality audits of the service should be included in the Service users Guide. The service should maintain an inventory of peoples personal belongings. To continue with the planned schedule of covering radiators. 7 8 9 22 22 23 10 11 12 39 41 42 Care Homes for Adults (18-65 years) Page 30 of 31 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). 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