Inspection on 16/07/09 for Pepenbury

This inspection was carried out on 16th July 2009.

CQC 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

Pepenbury 17/07/07

Pepenbury 24/01/07

Pepenbury 21/02/06

Pepenbury 05/10/05

Pepenbury 27/01/05

Pepenbury 29/06/04

Pepenbury 19/06/03

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Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Pepenbury Cornford Lane Pembury Tunbridge Wells Kent TN2 4QU     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: Helen Martin     Date: 1 6 0 7 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: Pepenbury Cornford Lane Pembury Tunbridge Wells Kent TN2 4QU 01892822168 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): stevemcdermott@pepenbury.info Larkfield Hall Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 70 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 70 The maximum number of service users to be accommodated is 70. 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 Pepenbury offers a range of services and support for adults with a learning disability. A large part of this is the care and accommodation for up to seventy adults on the main Pepenbury site near the outskirts of Tunbridge Wells. The centre of Tunbridge Wells is approximately two miles away and local facilities are available in the village of Pembury. Service users are accommodated in eleven detached houses, each with its own manager, staffing structure and records. There are extensive grounds which include Care Homes for Adults (18-65 years) Page 4 of 31 Brief description of the care home day service facilities, a swimming pool, a shop, cafe, gardens, animals, a woodland area and the organisations main administrative premises. Items produced and vegetables grown by service users who live on the site and those who attend day services are on sale to the public. Pepenbury provides a service for people with a range of different needs. For example, two houses are semi independent living accommodation whilst another two support people with challenging behaviour and more complex needs. Staffing levels vary across the houses depending on the needs of service users. Full details of the services provided and the fees charged are available from the Manager. 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: Pepenbury offers a range of support for adults with a learning disability. A large part of this is the care and accommodation for up to seventy adults on the main Pepenbury site. This inspection and report only looks at this service. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This Key Unannounced Inspection was undertaken by two inspectors and included a visit to Pepenbury near Pembury on 16th July 2009, where time was spent with twelve Service Users. In addition the Chief Executive, the Service Manager, the Manager, Quality Assurance staff, two Responsible Managers, one Senior Support Worker and Care Homes for Adults (18-65 years) Page 6 of 31 three Support Workers were spoken with. Some judgements about the quality of the service provided were taken from observation and conversation. Four out of the eleven houses, Finch, Briars, Pines and Robins, were visited and their individual facilities and records examined. The general facilities and the organisations main administrative premises were looked at together with some centrally held documents. In addition postal surveys were received from fourteen service users and four health and social care professionals. The last Key Inspection was undertaken on 27th July 2007 and an Annual Service Review was completed on 25th July 2008. An Annual Quality Assurance Assessment, AQAA, was received from the home on 10th June 2009. Any other information received since the previous Key Inspection has been reviewed. All of the above have been included within this inspection process and some of the gathered evidence is mentioned within this report where appropriate. What the care home does well: What has improved since the last inspection? What they could do better: People would be safer if the home made changes to the way they looked after medication and money. People might enjoy living in their house more if things that needed repair were fixed more quickly. Care Homes for Adults (18-65 years) Page 8 of 31 The support that people need could be written down better in some care plans. The home needs to make sure that all care plans are kept in a safe place. 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 thinking about moving into Pepenbury are given written information about the service, which helps them make an informed choice. Before they move in, people are assessed by the home to make sure that staff can meet their needs. Evidence: Written information about Pepenbury is available for people who are thinking about moving in. There is a statement of purpose about the service offered. Information has been reviewed since the last inspection and a service users guide is now available for each house. Some people have been living at Pepenbury for some time, whilst others have moved in more recently. Before they move in, people are assessed by the home to make sure that staff can meet their needs. Assessments are recorded and care plans for the support that people need are developed from these. Care Homes for Adults (18-65 years) Page 11 of 31 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 live in the home are supported to make choices and decisions about their lives. Their changing needs are reflected in care plans, although these would benefit from review to ensure that all are comprehensive and stored in a confidential manner. Evidence: Individual plans of care and support are developed for each service user. These aim to identify the action required from staff to meet peoples personal, social and health care needs. Nine care plans were looked at. These are clear and easy to follow. Those seen in Finch and Briars were largely detailed, up to date and reflected service users changing needs and goals, however one exception is, although measures are in place for someone who wanders, these are not reflected in a written care plan or risk assessment. Daily notes are completed on a record sheet with good facility for recording detail; however the use of this in Robins and Pines is inconsistent, as is Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: evidence of regular reviews of care plans and risk assessments. The majority of care plans use a new format and include good personal information; however those not yet transferred do not reflect sexuality or religion. Care plans contain good information about service users health care needs. This is recorded in Health Action Plans. Any challenging behaviour is specifically monitored and recorded, although one such record in Pines did not reflect full detail. All service users are supported to be involved with their Scrapbooks. These are good visual records about how people express themselves, their likes, dislikes and the things they enjoy doing. Comments received in postal surveys from health and social care professionals indicated that, care planning and reviewing is something that the service does well; reviews are well documented. Service users are supported to take risks as part of maximising their independence. Staff spoken with demonstrated a good understanding of these and the individual needs of service users. People are protected from harm in their daily living activities through risk assessment, such as accessing the community, personal care and also in relation to particular individual activities or behaviours. Although risks are identified in care plans, not all are recorded or up to date. The provider is recommended to review all care plans and risk assessments to make sure there is consistency between houses; this is to ensure that all information is detailed, up to date and reflects all the needs of service users. People who live in the home are encouraged to participate in the running of their houses. They are supported to make individual choices and decisions and are encouraged to achieve as much independence as possible. Houses hold weekly service users meetings, where issues such as the choice of meals or activities are discussed. In addition some service users are involved with the recruitment of staff. The confidentiality of service users personal information is maintained through the secure storage of records in all houses seen, with the exception of Robins, where daily records were left unattended in a communal area. The provider is recommended to undertake a review to ensure that the confidentiality of service users personal information is maintained in all houses. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users enjoy individual lifestyles and are able to choose from a variety of leisure activities; they benefit from good opportunities for personal development. Contact between service users and their families and friends is encouraged and supported where possible. Residents enjoy a choice of nutritious food. Evidence: People who live at Pepenbury are treated as individuals who have different interests and aspirations. They enjoy a full lifestyle with a variety of activities, which are agreed with them and appropriate to their interests and abilities. These include day activities on site such as swimming, woodwork, pottery, music, art, computer skills, Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: independent living skills, gardening, working on the allotment, looking after animals; there is an area of woodland with accessible walks; horse riding is available locally. People are supported to take part in social outings and events. Comments received in postal surveys from service users indicated that they enjoyed organised holidays and trips out; I get good support regarding activities; I would like different activities. Service users benefit from being able to access local facilities such as the bank, shops, pubs, bowling or cinema either independently or with support. People are encouraged towards independent living skills and supported with domestic tasks. Comments received in postal surveys from service users indicated: staff help me to do personal shopping. The manager of Pepenbury said that since the last inspection, more people have moved out to live independently within the local community. Comments received in postal surveys from health and social care professionals indicate that promoting transition to the community; moving service users on to supported living, is something that the service does well; the residential side of Pepenbury retains high standards. Comments received in postal surveys from service users indicated: the home helps me to move on to more independent housing. The extensive grounds also include a shop and cafe, which are run by staff and service users. Comments received in postal surveys from service users indicated that they liked the coffee shop. Both are open to the general public and items produced and plants and vegetables grown by people who live on the site, and those who attend day services, are on sale. Pepenbury provides an outside catering service, where some service users are GNVQ trained and involved in the cooking and serving. Others work in charity shops or in a local supermarket. There are other projects run by the organisation within the local community. Contact between service users and their families and friends is encouraged and supported where possible. Service users benefit from being supported with cooking and menu planning. Weekly meetings include discussion about the choice of meals. Each house has a food folder which includes photographs of food and meals to help people choose what they would like to eat. The manager said that since the last inspection, a nutritionalist had been consulted and provided guidelines for each house. Some service users have special diets, for example diabetes. Planned menus are written down and the food that service users eat is recorded where necessary. Comments received in postal surveys from service users stated: the meals are nice; the home does nice meals; I can work in the kitchen and help the staff; get service users more involved when cooking. Care Homes for Adults (18-65 years) Page 16 of 31 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. People who live in the home benefit from having their personal and healthcare needs met in a way that they prefer. Service users may be better protected by improvements to the system for the administration of medication. Evidence: Pepenbury provides a service for people with a range of different needs. For example, two of the eleven houses are semi independent living accommodation, whilst others accommodate people with more specific needs. Four houses, Finch, Briars, Pines and Robins, were visited as part of this inspection. Finch supports people with challenging behaviour, whilst those who live in Briars have more complex needs, including some with multiple disabilities. People who live in the home are well supported. They are given the personal assistance they need to maximise their independence, whilst at the same time respecting their dignity and privacy. The manager of Pepenbury said that since the last Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: inspection Health Action Plans had been developed. These contain information and records to enable staff to understand and support service users with their personal and healthcare needs. Staff spoken with demonstrated a good understanding of individual service users needs, wishes and preferences. A good rapport was observed between service users and staff, who were attentive and respectful during the visit. Service users have access to health and social care professionals, such as GP, optician and dentist. They are supported to consult specialists where necessary and records seen show for example, a diabetic nurse and psychologist. One service user, through a programme of physiotherapy, hydrotherapy and swimming, is now able to walk. Service users weight and nutrition is assessed; food and fluid intake is recorded where necessary. Any challenging behaviour is specifically monitored and recorded, for example in Finch; each service user has an individual behaviour management programme with guidelines. Staff spoken with in Briars demonstrated a good understanding of the procedures in place to ensure the safety of one service user. Comments received in postal surveys from health and social care professionals indicated that working well with people whose behaviour challenges is something the service does well. Comments received in postal surveys from service users indicated: all my personal care and needs are looked after well; they look after me well. Systems are in place for the administration of medication, which aim to protect service users. Medication is stored securely. Administration records are kept with service users photographs, staff signatures and guidelines for when to administer medication prescribed on a when required basis. Records are mostly completed appropriately, although there are some inconsistencies across the four houses visited. Records seen in Finch were completed appropriately. In Briars one supply of medication prescribed to be administered on a when required basis was not recorded on administration records. The house manager assured us that this would be addressed together with the way in which audit signatures are recorded to avoid any confusion with administration; a missing GP consent for homely remedies would be replaced as soon as possible. Not all handwritten entries are signed by two members of staff as double checked, one of which in Pines did not include the specific dosage. There are three gaps in administration records in Robins and Pines. In Robins the temperature of the medicines cupboard is not recorded regularly and not all care plans reflect service users current medication. In Pines one service user holds a key to their individual medication cupboard, although their risk assessment has not been updated to reflect this. Since the last inspection the home has told us about errors made in the administration of medication. The Chief Executive stated that they recognised there had been a Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: number of medication errors; senior managers have the skills and knowledge to address this and are in the process of doing so, some improvements have been made and some further improvements will be made; the home is in the process of introducing individual medication cabinets in each service users room to reduce errors further. The provider is strongly recommended to complete their stated intention to review the system for the administration of medication in all houses in order to improve practice, reduce the risk of errors and fully protect service users. Care Homes for Adults (18-65 years) Page 20 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. The views of service users are listened to and receive appropriate consideration. Service users are safeguarded, although this may be improved by a review of appointeeship and some storage facilities. Evidence: Service users are at ease with staff who listen to their views and concerns. The home provides a written complaints procedure. A record of all complaints and the action taken is kept. Comments received in postal surveys from health and social care professionals indicated that, they had no concerns about the service. Comments received in postal surveys from service users indicated: I am very happy at Pepenbury; the home makes me happy; all is well. Written policies regarding safeguarding vulnerable adults are available for staff. These include the procedures for the local authority. Records show staff have received appropriate training. The Chief Executive stated that all safeguarding vulnerable adults investigations since the last inspection have been closed with all issues addressed. Pepenbury is in the process of training staff about the Mental Capacity Act and Deprivation of Liberty. Regarding the latter, the home has undertaken some assessments but no applications have been made to the local authority. All care plans Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: are in the process of being updated to include any relevant issues. The home has a system in place, which aims to protect the financial interests of people who live there and small amounts of cash are held on their behalf. This is generally kept securely, although the provider is recommended to review storage arrangements in Finch. All money is stored individually and transaction records are maintained. Cash checked tallied with accounts seen. Receipts are kept for purchases made. Good information regarding service users understanding of money was seen in Pines. Discussion took place regarding appointeeship for service users. The Chief Executive stated that appointees for all recent and future service users would either be their family or local authority; there are long standing arrangements for twenty eight service users who have Pepenbury as their appointee; the home continues to try to obtain more appropriate provision. The Provider is recommended to complete their stated intention to make more appropriate arrangements for service users appointeeships held by Pepenbury. Care Homes for Adults (18-65 years) Page 22 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. Residents benefit from living in a homely and comfortable environment, although their safety and welfare could be enhanced by undertaking necessary refurbishment and repair in a timely manner. Evidence: Pepenbury has extensive grounds which include day service facilities, a swimming pool, a shop, cafe, gardens, animals, a woodland area and the organisations main administrative premises. Service users are accommodated in eleven detached houses. Each building has its own unique style and atmosphere that meets the differing needs of the people who live there. Each house provides lounge and dining areas, a kitchen, personal accommodation, sufficient bathrooms and toilets and access to a small garden and patio. Service users are supported to personalise their bedrooms to reflect their individual taste and interests and benefit from living in comfortable accommodation. Comments received in postal surveys from service users indicated: I like my room; the house is tidy. Most houses are purpose built and single storey. People who have physical disabilities Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: benefit from the adaptations and specialist equipment provided. In Briars, which accommodates people with more complex needs, an adapted shower, assisted bath and various mobility aids are provided. The house manager explained a system in place, including alarmed external doors and secure bedrooms, which ensure the safety of one service user whilst not restricting the freedom of others; possible future plans were discussed. The manager of Pepenbury stated that there is an ongoing programme of redecoration and refurbishment and, since the last inspection improved pathways have led to greater access for service users throughout the site. The house manager for Finch described plans to make the lounge area more personal for service users by installing a specifically designed cabinet to display items made by service users. The four houses visited were generally maintained adequately, although discussion took place regarding the system for refurbishment and repair, which is undertaken by the organisation centrally. In Finch items needing attention included an odour and an area of damp on the ceiling in one service users room; a crack in the hall ceiling, an odour in the recently installed walk in shower room and the front of a low surface temperature radiator is missing, exposing the inside of the appliance. The house manager assured us that the radiator is currently not used and not a risk to service users; they had requested repairs and a new carpet for the service users room. In Robins the kitchen floor covering and a work surface are damaged and the whole kitchen in Pines is in need of refurbishment. The house manager explained maintenance had been requested and quotes obtained for the latter. The manager of Pepenbury assured us that the foliage, currently overgrowing the path between Finch and Briars, will be cut back to avoid any potential trip hazard. In order to enhance the safety and welfare of service users, the provider is strongly recommended to review the system for maintenance to ensure that requests for necessary refurbishment and repair are undertaken in a timely manner. Care Homes for Adults (18-65 years) Page 24 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 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 in the home benefit from the support of a committed, well trained and enthusiastic staff team who have a good understanding of their needs. Evidence: There are four house managers for eleven houses, each with its own staff team and records. Each house accommodates service users with different needs, routines are flexible and the staffing structure varies accordingly. The manager of Pepenbury said that, since the last inspection the appropriate allocation of service users and staff to the different houses has improved. People who live at Pepenbury benefit from the support of staff who are enthusiastic and committed to promoting their welfare. Staff spoken with were clear about their roles and demonstrated a good knowledge and understanding of individual service users needs and wishes. A good rapport was observed between service users and staff, who were attentive and respectful during this visit. Comments received in postal surveys from service users indicated: I like the staff. The manager of Pepenbury stated that although there is some staff turnover, many have been employed for some time and this together with a stable management team Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: provides continuity of care for service users. Service users are encouraged towards independent living skills and supported by staff with domestic tasks, such as cooking and cleaning. The house manager for Finch and Briars explained that, as people who live there have more challenging and complex needs, some with multiple disabilities, they are currently recruiting for a housekeeper. Service users are protected through rigorous recruitment procedures, which aim to appoint suitable staff to meet their needs. Records examined showed appropriate pre employment checks such as written references and a criminal record disclosure. One house manager described how service users are trained and involved in the recruitment and selection of staff. Comments received in postal surveys from service users indicated that they liked the new staff. Two new staff spoken with in Briars confirmed the recruitment process and described their induction training. The house manager said this had recently been reviewed in line with Skills for Care and explained the system for supervision and assessment of new staff. People who live at Pepenbury benefit from the support of well trained staff. House managers request training from the organisation centrally, based on needs identified during staff supervision and appraisal meetings. The system was described as including basic training, personal development and more specialist courses, such as Tourettes syndrome, Makaton and diabetes, designed to enable staff to meet individual service users needs. One house manager stated that they had requested specialist training for acquired brain injury and cerebral palsy. Staff spoken with confirmed that training was good and records were seen. Pepenbury continues to promote National Vocational Qualifications. Staff spoken with confirmed this and the house manager for Finch stated that all house staff had either obtained or were in the process of undertaking a National Vocational Qualification. Staff are supported by regular individual supervision and annual appraisals. Those spoken with and records seen confirmed this. The manager of Pepenbury stated that there have been no recent staffing problems and that any previous issues since the last inspection have been addressed. Care Homes for Adults (18-65 years) Page 26 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 live in the home benefit from the support of a strong management team. They enjoy living in a well run home with a relaxed atmosphere. Service users benefit from their views being sought about the service they receive. The health and safety of people who live in the home is safeguarded. Evidence: People who live in the home benefit from the combined knowledge and experience of a well qualified management team. Responsibility for the day to day running of Pepenbury is shared between the manager and senior management team, overseen by the Executive Director. The manager stated they are in process of application to be registered with us, described possible plans for future and said that since the last inspection the management and administration systems had improved. There are four house managers for eleven houses, each with a combination of care coordinator, senior support workers and support workers dependent on the needs of the people Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: who live there. There was an open and friendly atmosphere in the houses visited, and the people who live there were relaxed, spending time with the staff and managers. The views of service users are sought about the support they receive; they are involved in the running of their houses and in staff recruitment. Since the last inspection Pepenbury has appointed designated staff for quality assurance. This was described as including monthly house audits and regular visits from senior managers; the Chief Executive assured us that they would review this system to ensure that all issues are being addressed. Annual questionnaires are provided for service users, their families and friends and regular reviews take place. The organisation sets general and individual house targets and objectives to further improve the quality of life and increase opportunities for the people who live there. Pepenbury has undertaken an Annual Quality Assurance Assessment, AQAA, and returned this to us. This indicates a wide range of written policies and procedures are available as guidance for staff. Quality assurance staff assured us that they would ensure and confirm that this includes information regarding the promotion of continence. The AQAA also indicates the testing and maintenance of systems and equipment within the home, including procedures in place for the control of infection and hazardous substances. A number of records have been looked at as part of this inspection and these have been mentioned previously within this report where appropriate. Care Homes for Adults (18-65 years) Page 28 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 29 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 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 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. 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