Inspection on 24/03/09 for Orchard End

This inspection was carried out on 24th March 2009.

CSCI found this care home to be providing an Good 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

Orchard End 03/04/07

Orchard End 16/03/06

Orchard End 17/11/05

Orchard End 21/02/05

Orchard End 26/07/04

Orchard End 18/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Orchard End Church Lane Minsterworth Gloucestershire GL2 8JJ Two star good service The quality rating for this care home is: 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: Lynne Bennett Date: 2 4 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. 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 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. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Orchard End Church Lane Minsterworth Gloucestershire GL2 8JJ 01452750587 01452750752 sally.lorimer@orchardendltd.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) : Orchard End Limited care home 12 Number of places (if applicable): Under 65 Over 65 12 0 learning disability Additional conditions: The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender 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 12. Date of last inspection 0 3 0 4 2 0 0 7 A bit about the care home Orchard End is a residential care home for 12 adults who have a learning disability and may demonstrate challenging behaviour. Accommodation is provided in two separate units, one of which is the main house and the other a bungalow. The home is surrounded by large level gardens which are maintained to a high standard. There is also a swimming pool, and a sensory garden built in a Japanese style. The home is one of five homes known as Orchard End Ltd owned by C.H.O.I.C.E. Ltd. The home has a Statement of Purpose and Service User Guide which displayed in the house and bungalow. Fees for the home range from 989 to 1911 pounds per week. These do not include payments for holidays, hairdressing or toiletries. 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 How we did our inspection: This is what the inspector did when they were at the care home This inspection started in March 2009 and included two visits to the home on 24th March and 2nd April. The registered manager was present throughout. The registered manager completed an AQAA (Annual Quality Assurance Assessment) as part of the inspection, providing considerable information about the service and plans for further improvement. It also provided numerical information about the service (DataSet). We (The Care Quality Commission) spent time observing people and the care they were receiving. We talked to 3 people using the service, and asked staff about those peoples needs. We looked at the care plans, medical records and daily notes for these 3 people. This is called case tracking. We had received surveys from 5 people living at the home. We talked to five members of staff, another 5 staff had returned surveys to us. We had also received surveys from health care professionals. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the care home does well People living at the home were observed going out to colleges, shopping and using local transport to visit neighbouring towns. They did lots of different activities. They said they helped around the home with their laundry and cleaning. People help to interview new staff. Staff had access to a robust training programme so that they could develop the skills to support people. Robust systems were in place to obtain the records needed when employing new staff. Quality assurance systems involved feedback from people living in the home. An action plan developed from this system was making improvements around the home. What has got better from the last inspection The house and bungalow provide homely accommodation reflecting the lifestyles of people living there. The Statement of Purpose and Service User Guide have been reviewed and provide up to date information. There has been an improvement in the administration of medication. Staff spoken with were confident about the Whistle blowing procedure and had received training in safeguarding of adults. Carpets had been replaced. What the care home could do better Health records should include a note of appointments with chiropodists. There should be a quick reference check for monitoring appointments with dentists. The bathroom in the bungalow should be refurbished. 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 Lynne Bennett Colston 33 Bristol BS1 4UA 0117 930 7110 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 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 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 have access to the information they need enabling them to make a decision about whether they wish to live at the home. A comprehensive assessment of the persons wishes and needs are taken into consideration before offering them a place. Evidence: The home has a Statement of Purpose and Service User Guide which were produced in a format appropriate to the needs of people living in the home, using a mixture of text, symbols and pictures. These documents had been reviewed in August 2008. Each person had a current copy of their terms and conditions on their file. One person had been admitted to the home since the last key inspection. Before they moved into the home from another home owned by Orchard End Limited, a full assessment of need had been completed by the Referrals Manager supported by an assessment of need and care plan from the placing authority. Transition meetings evidenced that the person had visited the home and had the opportunity to meet other people with whom they would be living. Staff said that they had been given sufficient information about the person before they moved into the home. The AQAA stated, Transition meetings are always held to ensure referrals, transitions and admissions are as smooth as possible. The person was observed being supported by staff in their new home and they appeared to have settled well into their new routines. An initial placement review had been held with their placing authority. 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 . A person centred approach to care planning provides the opportunity for people to take control of their lives. Peoples needs are being assessed and they are being supported to makes decisions about their lifestyles. Risks are being managed safeguarding them from possible harm. Evidence: The care of three people was casetracked which included the person who had recently moved into the home and one person from the house and another person living in the bungalow. Each person had a full assessment of need providing a holistic assessment of need from which person centred plans were developed for their physical, emotional, intellectual and social needs. There was evidence that plans were being regularly reviewed and any changes noted. All plans were being routinely reviewed every six months and annual reviews were being held by the home each year. Not all placing authorities had reviewed peoples needs. One person had not received a placement review since 2006. The registered manager stated that placing authorities would be invited to annual reviews being held by the home for 2009. There was evidence that scheduling of these was already in hand. Staff spoken with had a good understanding of the needs of the people they support and were knowledgeable about peoples care plans and risk assessments. Each person had several files providing staff with information about their identified needs. Support guidelines developed from assessments of need provided succinct and clear guidance about how people would like to be supported. Where risk management plans were in place the support plans made reference to these. Evidence: Risk management plans had been developed for a range of hazards and provided staff with clear guidance about how they could be minimised. These had been developed with input from the person, staff and other professionals involved in their care. Communication profiles were in place providing staff with information about how I communicate. Staff were observed using makaton sign language and talked about using objects of reference. It was evident that greater use was being made of photographs and symbols around the home to enable people to understand their environment. The AQAA indicated that future plans included, ensuring that care plans are fully reviewed with individual service users using preferred forms of communication to show that every effort has been made to fully involve them. There was evidence that people were being supported in major life decisions with a multi agency approach to decision making in line with the Mental Capacity Act. People also had access to advocacy and/or an Independent Mental Capacity Advocate (IMCA). Where any restrictions were in place regarding peoples freedom of movement or choice, such as access to the kitchen or use of listening devices, protocols and guidance were in place. There was evidence that assessments as required under the Deprivation of Liberty safeguards were being conducted. A missing persons file was in place providing a pen picture of each person with their current photograph. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who live at the home make choices about their lifestyle, and are supported to develop life skills. They have the opportunity to take part in social, educational and recreational activities and keep in touch with family and friends. People have a nutritional diet and their diverse needs are catered for. Evidence: Some areas of this outcome group were excellent with some creative work being done with people to enable them to lead a fully inclusive lifestyle. Each person had an activities schedule in place which had been produced in a format using text, pictures and symbols. These were displayed in the conservatory in the bungalow. Daily records indicated that people were having access to a range of activities including regular attendance at college, horse riding and swimming. People were also having trips out to places of interest, shopping trips, walks and drives out locally. People were observed being supported to use local transport as well as the homes vehicles. Where care plans indicated that people needed motivation to participate in activities there were strategies in place to support them to have either one to one staff support or to be extremely flexible when offering activities. This approach appeared to be working with one person being supported to go to London and Blackpool and to go out for drives, shopping or to the pub. People had taken holidays last year and were planning for the current year. One person wished to visit their homeland, and staff were planning to work with them Evidence: trying out short flights and building up to a long haul flight. Two other people had visited Cyprus last year. At home people had regular music sessions with an external provider. One session planned for April was advertised as a Spanish evening. Staff said people really enjoyed these events. People also have the opportunity to have Vital therapy providing alternative therapy such as massage. During the visits people were observed listening to music or watching the television. Some were doing puzzles and others helping around the home. Daily records indicated that people helped with the laundry, cleaning and cooking. A member of staff had taken responsibility for recyling at the home involving people living there. People maintain close contact with family and friends. Contact sheets evidenced frequency of visits and whether support was needed by staff. Some people go to a social club to meet up with friends. One person was supported by their family to follow their religion when visiting them. The registered manager explained that they were supported by the home to celebrate special religious occasions and to have their room blessed. Another person was being supported to explore their spirituality. The registered manager said that people had been involved in developing the menus for the home which were organised on a four week rota. Freshly produced meals were prepared by staff using the kitchen in the house. They then take meals over to the bungalow. These were being covered. Snacks and breakfasts were being prepared in the kitchenettes in each dwelling enabling people to become involved in this process and giving them more independence. There were further plans to develop the main kitchen into an area in which people could become more involved in the preparation of their meals. People on special diets were receiving support from a dietician and their care plans indicated their individual needs. Staff spoken with had a good understanding of how to support people on a soft diet or with diabetes. 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 . Peoples health and personal care needs are being met helping them to stay well. Their health and wellbeing are promoted by satisfactory arrangements for the handling of medication and training of staff in specialised techniques. Evidence: The way in which people like to be supported with their personal care was clearly highlighted in their care plans and support guidelines. Staff spoken with were knowledgeable about the needs of the people they support and said communication between the staff team was good. Read and sign files enabled staff to keep up to date with any changes and daily handovers ensured information was passed on as shifts changed. People were observed choosing when to get up and daily records indicated that times for going to bed were flexible. Some care plans stated peoples preference for gender of staff supporting them with personal care. Where specialist equipment or adaptations were needed these were provided for people. Support guidelines for one person indicated that their feet needed to be monitored to ensure they were healthy and infection free. There was no evidence of appointments with a chiropodist or whether staff were doing this. The registered manager explained that they had 8 weekly appointments with a chiropodist and staff would indicate any concerns on body maps or in the daily notes. There was evidence that people have regular contact with health care professionals including the local Community Learning Disability Team. Comments from health care professionals indicated that the home was well organised. Appointments with Doctors, Dentists, Speech and Language Therapists and Dieticians were recorded with Evidence: a note of the outcome of each appointment. It was not clear how staff monitored when check ups were due, for instance with the Dentist. Records for all healthcare appointments were kept together and had to be searched through to find the last appointment. Each person had a health action plan in place. The registered manager said they had approached their Doctors surgery to help them complete these. People were being supported with hospital referrals and where needed best interests meetings were being held and IMCAs appointed to help people make decisions about future treatment. This was being done in line with the Mental Capacity Act and full documentation was in place. Systems for the administration of medication were examined and found to be satisfactory. Staff confirmed that they had attended training in the safe handling of medication and competency audits were in place. The home had a monitored dosage system and records were being maintained correctly. Temperatures of medication cabinets were being monitored and recorded. Medication information leaflets were in place and peoples allergies were identified on their pen pictures. Liquids and creams were labelled with the date of opening and stock records maintained. Staff had received training in the administration of insulin and rectal diazepam. Protocols were in place giving them guidance on the administration of these medicines. 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 . The home has an accessible complaints procedure which enables concerns to be raised by people using the service or on their behalf. Systems are in place which should safeguard people from possible abuse. Evidence: The home has a complaints policy and procedure with information being presented in a format using text, pictures and symbols. A copy of the complaints procedure was displayed in areas around the home. The registered manager said that the Quality Assurance Plan for 2008 identified that people living in the home needed to have their concerns recognised formally. There was evidence that key workers were recording concerns of the people they support. The complaints folder contained copies of concerns and complaints with evidence of the outcome and of any action taken. The DataSet stated that 4 complaints had been received. The AQAA confirmed that complaints as well as compliments were recorded. Since the last inspection the management team had provided additional training for staff in abuse and the whistle blowing procedure. Staff confirmed that they had also attended training in the protection of adults with the local adult protection team. Those spoken with had a good understanding of abuse and the whistle blowing procedure. They said they were confident in the practices within the home for monitoring peoples well being and that the management team would challenge poor practice. The AQAA said that the home had worked closely with the Adults at Risk team regarding issues within the home. We were also kept informed through the notification process. The home was aware of their responsibilities in reporting staff to the vetting and barring scheme. Staff confirmed that they had received training in MORE (Management of Response to Emotion) which was being replaced with SCIP (Strategies for Crisis Intervention and Prevention). The registered manager, had trained as a trainer of SCIP, and was enthusiastic that the approaches advocated would have beneficial effects on people Evidence: living in the home. Staff confirmed that physical intervention was being used after diffusion and diversion had failed. The AQAA indicated that staff had been involved in over 80 incidents during the past year. Reactive Management Strategies were in place for people which clearly stated triggers and courses of action open to staff. A psychology team worked closely with staff to monitor how incidents were managed and to identify any changes in peoples behaviour or anxieties. Support plans indicated the level of support needed by people to manage their personal finances. Records were being maintained of individual expenditure with evidence of regular checks by staff and management. The registered manager stated that CHOICE periodically conducted audits of peoples expenditures and that formal audits of personal finances were done annually. There were systems in place to check bank statements with financial records. Those examined had been signed and dated as correct. CHOICE had systems in place to manage peoples expenditure allowing a set amount to be withdrawn per week and larger amounts requiring authorisation from senior management. 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 . Long term plans for refurbishment and upgrade of the dwellings will provide an environment which is safe, well maintained and reflects the lifestyles of people living there. Standards of cleanliness in the laundry need to be maintained to promote good infection control measures. Evidence: Orchard End provides accommodation in two separate dwellings, the Bungalow and the House. At the time of the last inspection people appeared to spend most of their time with staff in the bungalow. Considerable work has been done with people living there and staff to develop each dwelling as a home base creating environments which reflect the interests and lifestyles of each group of people. There was a maintenance programme in place and long term plans for future developments in each residence. Communal areas were pleasantly decorated and fitted with good quality fixtures and fittings. Some carpets had been replaced and there were plans to replace others. Curtain poles which had been pulled down were replaced by the time of the second visit to the house. A new bathroom had been fitted in the house and there were plans for a bathroom to be refurbished in the bungalow. All people had rooms with en suite facilities. Some people showed us their rooms which they had decorated to reflect their personalities and lifestyles. People said they had been involved in this process and choice of colour scheme. The laundry floor was not clean at the time of the first visit to the home and staff commented that they were in the process of cleaning the bungalow. Some clothes were on the floor instead of being placed in the laundry baskets provided. This could be an infection control risk. Personal protective equipment was provided for staff. Paper towels and liquid soap was provided near communal hand wash basins. Staff said they had responsibility to keep the home clean and most areas were observed to be satisfactory during the visits. 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 . Peoples needs are met by a competent staff team, who have access to a comprehensive training programme that provides staff with the opportunity to gain knowledge about the diverse needs of people living at the home. Recruitment and selection procedures involve people living in the home and should safeguard them from possible harm. Evidence: New staff confirmed that they had completed an induction programme and shadowed staff when starting at the home. Copies of induction booklets were examined on their files which indicated that the induction programme was equivalent to the Skills for Care Foundation Standards. Staff said they would be completing the Learning Disability Qualification and then have access to a National Vocational Qualification Programme (NVQ). The DataSet indicated that 50 per cent of staff had a NVQ qualification. Staff spoken with were knowledgeable about the needs of people they support and most were observed positively supporting people during the visits. Concerns about the professional conduct of a member of staff were fedback to the registered manager who immediately followed this up and took the appropriate action. The files for three new members of staff were examined and found to contain all information as required by us under Regulation 19 and Schedule 2. A checklist was being used for each new member of staff providing evidence of when documents had been requested and received. Where there were gaps in employment history these were investigated and a full employment history recorded. Where needed further references were sought to clarify the reason why people had left former employment. Staff working before their Criminal Records Bureau check had been received confirmed they shadowed staff and had a named mentor. A risk assessment was put in place for them and we had been informed of their employment. Copies of the General Social Care Council Code of Conduct were in place and had been made available in alternative Evidence: formats. The registered manager confirmed that people living in the home had been involved in interviews for new staff. The outcomes for this standard were excellent. A training matrix was in place for the home monitoring when refresher training was due. Copies of training certificates were on staff files. Staff confirmed that in addition to mandatory training they had access to courses in Autism, Epilepsy, Mental health awareness, Sexuality and Learning Disability and Loss and Bereavement. A staff survey commented, training is good, always provided if you ask for something. 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 home is well run. The management and administration of the home is based on openness and respect. Effective quality assurance systems are in place involving people who live at the home. Health and safety systems should protect people from possible harm. Evidence: The registered manager has considerable experience supporting people with a learning disability and has the Registered Managers Award and a NVQ Level 4 in Health and Social Care. She had also completed training as a trainer of SCIP. She returned a comprehensively completed AQAA to us before the deadline. Since the last inspection she had maintained contact with us and kept us informed of any incidents or issues being dealt with by management. Staff spoke positively about her management skills and were confident that she would challenge poor practice. One survey indicated that a member of staff rarely saw the manager but this view was not reflected in other surveys or from discussions with staff during the visits. One survey commented, if you have concerns, the manager is always available even when not at the home, problems are dealt with fast and in confidence. CHOICE have a quality assurance system in place which includes monthly unannounced visits to the home with a production of a report and action plan. The registered manager had a copy of this on her wall indicating when each issue had been completed. In addition to this the Operations Manager had completed an annual audit of the service which included feedback from people living in the home, families and external agencies. The registered manager had a copy of the Improvement Plan for 2008 and was able to evidence that these improvements had taken place. CHOICE were in the process of introducing a new Internal Inspection Procedure which would be Evidence: completed by an Operations Manager from another area inspecting to the National Minimum Standards. The outcome for this standard was excellent. Staff and management had received training in the Mental Capacity Act and Deprivation of Liberty Safeguards. As mentioned there was evidence that IMCAs were being involved with people where appropriate and the necessary assessments and records were being completed by the home. No one in the home was subject to a Deprivation of Liberty Safeguard at the time of the inspection. Systems for the management of health and safety in the home were observed to be in place and records were being maintained by staff. These confirmed information provided in the AQAA that servicing of equipment and systems were in place. A current fire risk assessment was in place and each person had individual fire risk assessments. 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 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 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 3 4 19 19 27 30 A system should be put in place so that dentist appointments can be easily monitored. Appointments with chiropodists should be recorded. The bathroom in the bungalow should be refurbished. The laundry should be kept clean, including the floor and dirty washing placed into laundry baskets. Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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