Inspection on 08/04/09 for Quince House

This inspection was carried out on 8th April 2009.

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

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

Other inspections for this house

Quince House 13/05/10

Quince House 03/02/10

Quince House 01/12/09

Quince House 01/05/07

Quince House 01/06/06

Quince House 12/10/05

Quince House 06/07/05

Similar services:

Coopers Mill Ltd

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Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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: Quince House 77 Adeyfield Road Hemel Hempstead Herts HP2 5DZ 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: Claire Farrier Date: 0 8 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 36 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: Quince House 77 Adeyfield Road Hemel Hempstead Herts HP2 5DZ 01442248316 01582840023 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) : Complete Care Services Limited care home 6 Number of places (if applicable): Under 65 Over 65 6 0 learning disability Additional conditions: Date of last inspection 0 1 0 5 2 0 0 7 A bit about the care home Care Homes for Adults (18-65 years) Page 4 of 36 Quince House is a detached, family style house. It looks like all the other houses in the road. Six people live at the home. There is a train station near the home. There are also lots of different bus routes. This means that the people who live at the home can get around easily. Everybody who lives at the home has their own bedroom. Nobody has to share a room. Everyone shares the lounge, dining room and kitchen. Care Homes for Adults (18-65 years) Page 5 of 36 The accommodation charges for Quince House are from £1650 to £1950 per week. The Statement of Purpose and the Service Users Guide tell people about the home. The manager will give a copy the CSCI inspection report to people who want to see it. Care Homes for Adults (18-65 years) Page 6 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 7 of 36 How we did our inspection: This is what the inspector did when they were at the care home Last year we completed an Annual Service Review, which showed that the home continued to provide good outcomes for the people who lived there. When we visited Quince House this time, the people who live in the home and who work in the home did not know we were coming. We were helped by an Expert by Experience. This is a person who has a learning disability. She talked to some of the people who live at the home. Care Homes for Adults (18-65 years) Page 8 of 36 We looked at some care plans and other papers. We looked around the home. We talked with the manager and some staff who work at the home. Before the inspection the manager sent us some information about the home. This is called the AQAA (Annual Quality Assurance Assessment).  Care Homes for Adults (18-65 years) We decided to give the home 2 stars. This means the people who live there have good care and support. Page 9 of 36 What the care home does well Everyone told us that they are happy in the home. When the EBE asked, Are you happy at the home? the people she spoke said that they are very happy. She said that if she had to live in residential care she would like to live in a home like this. The home is very good at making information easy for people to understand. All the people who live at the home have a weekly timetable of what they are doing in easy words and pictures. Care Homes for Adults (18-65 years) Page 10 of 36 The staff support the people in the home well. They know what everyone needs and likes. The manager asks people what they think about the home, and changes the things that people are not happy with. What has got better from the last inspection Care Homes for Adults (18-65 years) Page 11 of 36 There is a new large television in the lounge. There is a new large table in the dining room, and new flooring that is easier to keep clean. There is a new menu that has pictures of the meals, so that people can choose what they like to eat. Most people go to different day services that they enjoy. Care Homes for Adults (18-65 years) Page 12 of 36 What the care home could do better The water in the bathroom was very hot, and people could be scalded. Care Homes for Adults (18-65 years) Page 13 of 36 The manager made sure that this was made safe straight away. Because the manager acted so quickly, we are sure that people in the home are safe. Some of the staff work very long hours. This means that they could be too tired to support people properly. The care plans are not easy to read. Care Homes for Adults (18-65 years) Page 14 of 36 The staff do not support people to cook food. 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 Claire Farrier CQC CPC1 Capital Park Fulbourn Cambridgeshire CB21 5XE 01223 771350 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 15 of 36 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 16 of 36 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 . The home has sufficient information on the needs of the people who live in the home, and access to appropriate services and training to enable their needs to be met. Evidence: No-one has moved into the home since 2005. The people who live in the home are aged between 23 and 32, and the Annual Quality Assurance Assessment (AQAA) stated that the assessment process would take compatibility with the existing residents and their age range into account. Although the home has not needed to carry out assessments for prospective residents within the last four years, the AQAA stated that they aim to develop the initial assessment format in a more inclusive and accessible way, and to allow prospective residents to be even more included in the process. The Statement Of Purpose contains all the relevant information on the services that the home provides. The Service User Guide has been put into a pictorial format. This provides the people who live in the home with information about Quince House that is easier to understand. Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: The home has a stable staff team who have sufficient training and information available to them to understand the needs of the people in the home, and how to support them. Care Homes for Adults (18-65 years) Page 18 of 36 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 . The people who live in the home are fully involved in all decisions about their lives in the home. The care plans provide the staff with appropriate information to enable them to meet peoples individual needs, but they are not organised so that the information is easily available. Evidence: The Expert by Experience (EBE) spoke to two people. They told her that the staff support them to have choices and to make decisions about their lives. One person responded to this very passionately. Most people have relatives who are involved with their care, and take some responsibility for their finances. One person has very little family contact. This persons finances are managed through a bank account in their name, and the staff support them to manage this. The manager is aware of the homes responsibilities under the Mental Capacity Act, for ensuring the each person makes decisions about their lives unless they are assessed not to have capacity for any specific decision. An independent advocacy service is available to support people to make decisions if needed, and has been used for individuals in the past. Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: There are regular meetings for the people who live in the home, where the staff support them to air their views about the service they receive. The Annual Quality Assurance Assessment (AQAA) gave examples of changes that have been made as a result of listening to the people in the home. A comprehensive pictorial menu is now in place at the home, which encourages people to make more of an informed choice about what they want to eat. The home has actively liaised with local authorities in order to gain a variety of day care placements for individual people. The home aims to further encourage and support everyone who wishes to, to play a greater role in the homes staff recruitment process. We carried out detailed case tracking through the files of two residents, which showed what care is provided for the people in the home and how it is recorded. The care plans contain detailed information on how to support each person, but the information is complex and disordered. One care plan was slightly easier to read than the other. But one contained 22, and the other 25, separate care plans, many of which repeat information. There are clearly written guidelines, for example for personal care, behaviour, management of epilepsy, and the care plans either repeat the information in these, or are superfluous to them. It is not easy to see the persons need that each care plan addresses, and the current situation for each person is not clear without reading the whole file. All the care plans are signed by staff as reviewed on a monthly basis, but generally with the comment, No change. There is no recorded monitoring of any progress, or for how each person is achieving their goals. There is no evidence that people are involved in planning and monitoring the support that they receive in the home. The care plans and guidelines are clearly written in plain English, but they do not fully follow the principles of Person Centred Planning, which should put the person at the centre of the support they receive, and show how they make decisions about that support. The care plans do not have clear goals that are set with or by the person concerned, and that they can understand to monitor what they are doing that is different or better than before. The daily records do not provide any useful additional information. Staff write an entry for each person each day, but most state only, eg. Assisted with personal care. Had breakfast, and the activities that each person does. Most of this information is unnecessary. Important information, such as noting that one person had swollen lips, but was better by the afternoon, could be missed. A daily diary to show what each person does each day, other than daily routines, could be recorded separately, by or with the involvement of the people concerned. There are well written risk assessments for each person , which show how people are supported to do the things they want to do in as safe a way as possible. Care Homes for Adults (18-65 years) Page 20 of 36 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 . The people who live in the home are supported to live full and active lifestyles. Evidence: The Expert by Experience (EBE) spoke to two people. They told her that they can do the things they like to do, and their families and friends can visit them. One person said, We go on outings, watch TV and go out. This person said they would like to have cars and bikes to improve their life in the home. All except one person have day time activities outside of the home on four days a week. They are involved in a variety of activities, rather than being limited to a day centre. These include a drama centre and outreach activities. The manager and staff have liaised with each persons local authority to ensure that funding is in place so that people can take part in their own choice of activities outside of the home, and activities that are suitable for young people of their age group. Negotiations are continuing for one person who currently has no organised activities outside of the home. This person goes out with staff and has one to one time to do the things that they like to do. Care Homes for Adults (18-65 years) Page 21 of 36 Evidence: Most people have families who are involved in their lives and in the home. One family has bought a trampoline for the garden, and another has offered to pay for all the residents to have a trip to Disneyland. When they are at home, the staff support people to do the things they like to do. While we were in the home several people went shopping. The daily handover sheet for staff details suggestions for what each person could do each day, and the staff sign to show that the activities are completed. These include walk, manicure, prepare lunch, pub, music therapy, cinema, day out, relaxation. Both people who the EBE spoke to said that they can choose what they like to eat, and one said that they like fry-ups. There is a pictorial menu with photographs of each meal, and staff go through this with the people in the home so that they can choose the weekly menu. There is a list in kitchen of persons choice for each meal. However we saw little evidence that people take part in preparing meals, either by participating in cooking fresh food, or enjoying the experience and sensations of the process. The meals are prepared mostly from frozen food, which means that people are not able to see, feel and smell the fresh ingredients, which may add to their participation in and enjoyment of their meals. Care Homes for Adults (18-65 years) Page 22 of 36 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 . The staff support people to maintain their health needs and to consult other medical professionals to ensure their continued well being. Evidence: The care plans that we inspected provide good details of each persons personal care and health care needs (see Standard 6). We observed a good relationship between the staff and the people who live in the home. All the residents have communication difficulties, and most are either non-verbal, or almost non-verbal. The staff have had some training in the use of Makaton signing. Each person has a My health file which is in a format that they can understand and contribute to. For example, How I say I am unwell/in pain/fed up/happy. The list of each persons medication has details of each medication and the possible side effects. For example, I take it because... The healthcare records that we saw included references to hospital visits, contact with GPs and other health professionals, appropriate monitoring of epilepsy and regular weight checks. Guidelines for managing challenging behaviour are in place for each resident. Several residents need treatment for epilepsy, and may have seizures at any time. There are appropriate care plans for Care Homes for Adults (18-65 years) Page 23 of 36 Evidence: managing this, with clear protocols for the administration of rectal diazepam and when further action is needed. At night there is one waking night care worker, and one sleeping in, so that there are sufficient staff available to deal with any emergency. Medication is stored in a wooden cupboard on the landing, which provides satisfactory storage. None of the residents administer their own medication. We carried out a spot check of the recording for the two people whose care plans we had inspected. The procedures for administering and recording medication ensure that the risks of errors and minimised. However there were gaps on some of the MAR (medication administration record) charts for prescribed toothpastes and creams. These are stored and applied in each persons room, which means that the MAR chart is not available to sign immediately. The manager was aware of this and said that from next month the MAR charts for these items will be kept in each persons room so that they can be signed when they have been applied. Care Homes for Adults (18-65 years) Page 24 of 36 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 people who live in the home are encouraged and supported to make their views and concerns known, and appropriate procedures are in place to ensure that they are protected from abuse and neglect. Evidence: The homes complaints policy is written in simple English with pictures so that most of the people in the home are able to understand it. It was developed with the input of the people in the home, which ensured their understanding of what each question means. This new format has not yet been used, as there have been no recorded complaints since 2005. The home has appropriate procedures for safeguarding vulnerable people. The staff who we spoke to were aware of the safeguarding procedures, and of their responsibilities for whistle blowing. Everyone has training on safeguarding vulnerable people. In the Annual Quality Assurance Assessment (AQAA) the manager said that there are plans to produce a simpler and more readable and easier to understand adult protection policy. Care Homes for Adults (18-65 years) Page 25 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home provides a comfortable and well maintained environment for the people who live there. Evidence: The building is an ordinary detached house, furnished and decorated in domestic styles that produce a homely, comfortable environment that allows the people who live there to relax and feel very much at home. Everyone has their own room, which is arranged and decorated to reflect their particular interests and tastes. Five of the six bedrooms have en-suite shower rooms, and there is a communal bathroom with a Jacuzzi bath. The lounge, dining room and kitchen are domestic in style and are comfortably furnished and well equipped. The home has an enclosed garden a patio area, lawn and flowerbeds. The home appeared to be clean and generally well maintained. Since the last inspection new flooring has been laid in the dining room that is easier to clean. There are now automatic door closers on all doors in the home, to make sure that people are safe in case of fire. The wallpaper on the landing is scuffed and dirty in some areas, and the panels on the radiator covers on the landing and hall are missing. The radiator in the dining room does not have a fitted cover. There is no risk assessment in place for the risk to people in the home from the hot surfaces of radiators. Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: We used the homes thermometer to measure the temperature of the running hot water of the bath in the first floor bathroom. The temperature was above 50 degrees Centigrade, which is the highest temperature marked on the thermometer that was used. This may cause a risk of scalding. The recording of water temperatures shows only the temperature of the water when people have a bath or shower, and there is no record of or monitoring of running water temperatures. We made an immediate requirement while we were in the home, that water temperatures of all baths and showers need to be regulated to a safe temperature in order to avoid the risk of scalding. And that hot water temperatures of throughout the home must be tested on a regular basis to make sure that they remain at a safe level. Following the inspection the manager informed us that regulatory valves have been fitted to all hot water taps. There is a separate laundry room, fitted with a domestic washing machine and tumble drier. The washing machine has a pre wash 90 degree programme, but no sluice wash. The Department of Health Infection Control Guidance for Care Homes (2006) states that an industrial washing machine with sluice and hot wash cycles is required. The manager should seek professional advice to make sure that the domestic style machine complies with this guidance. Care Homes for Adults (18-65 years) Page 27 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The people who live in the home are supported by a stable staff team who have the experience and training to understand and meet their needs. However some people are working excessive hours, which may affect the quality of their work. Evidence: The staffing rotas show that there are three support workers on duty throughout the day, and one during the night, with a second support worker sleeping in in case of emergencies. This is a reduction form four support workers as reported in our last inspection report in 2007, and four to five as reported in our inspection report in 2006. There are eight permanent staff in addition to the manager, and regular bank workers make up the staffing complement so that there is no need to use agency staff. The staffing levels are sufficient to meet the needs of the residents. However in 2006 we reported that the high level of staff to residents should be sufficient to ensure that the residents are involved in tasks in the home, such as cooking, but little evidence was seen during the inspection that this was happening. There is still little evidence of this happening (see Lifestyle). The Annual Quality Assurance Assessment (AQAA) stated that staffing levels at the home continue to be very high in comparison to other similar services, and that staff turnover has continued to remain at a low level, resulting in a continuity of care for the people in the home. The manager should continue to monitor staffing levels and ensure that additional staff are available if there should be a need for them. Care Homes for Adults (18-65 years) Page 28 of 36 Evidence: We saw the staffing rotas for the current week and the previous week. One member of staff is working excessive hours, of 84 hours and 72 hours, with similar high hours seen in previous weeks. This person has worked two 12 hour shifts this week without a break, and two 14 hour shifts. The manager said that staff have an informal break, but this is not documented. The person has worked 2 sleepover shifts, with a full shift before the sleepover, which means that the total time they are expected to be at work in the home without a break is 24 hours. The European Working Time Directive of an average maximum 48 hour week is voluntary, and the person concerned has signed a waiver to say that they agree to work hours that do not comply with the Directive. However people who work excessively long hours may be too tired to provide a good quality of care for the people who live in the home, and there is a risk of errors due to poor concentration. The home currently has no full time vacancies, but they will still recruit bank staff to ensure that enough staff are available to cover absences. The manager also hope to recruit an additional senior support worker. The home does not have a deputy manager, and the manager delegates some areas of responsibility to the senior support workers. We looked at the files of three members of staff who have recently started to work in the home. They contained all the required information to show that they are fit to work in the home. The supervision records show that every member of staff has had a formal one to one supervision, to discuss their work and any training needs, once or twice in the last three months. The manager is aiming to provide supervision for everyone six times a year, but has not achieved this aim in the last three years. However she works closely with the support workers in the home and she is available to speak to if they have any concerns. All the staff have had an annual appraisal of their work during the last year. We saw individual training records for the staff in the home, that show that everyone has a good level of training. All the staff have regular mandatory health and safety training. and other courses are available to provide them with the information and skills to meet the needs of the people who live in the home.These include disruptive behaviour, mental health and learning disability. Everyone completes a basic first aid training, and there are sufficient staff with full first aid certificate for one to be on duty on most shifts. Nine support workers have a qualification at NVQ level 2 or above. Care Homes for Adults (18-65 years) Page 29 of 36 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 managed for the benefit of the people who live there, and their views are actively sought and acted on. Evidence: The ethos of the home is that it is the home of the residents, and the staff support them to live their lives as they wish to and to make their own decisions about every aspect of their lives in the home. The manager communicates a clear sense of direction and leadership, and she is available to both staff and residents when they wish to speak to her. There is a commitment to equal opportunities and people have their cultural needs addressed within the care plans. The manager holds the NVQ Level 4 in care and care management, the Registered Managers award and has a degree in care management. She has worked in care settings for the whole of her career, and she had nine years experience of management before being appointed to Quince House when it opened. There is no formal supervision structure for the manager, as the proprietor has only a limited knowledge on care. The managers of the Complete Care Services homes provide professional support for each other and carry out Regulation 26 monitoring visits to Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: each others homes. The manager feels this works well and that she and her colleague can contact each other at any time for help and support. The manager has implemented a new quality assurance system to monitor the quality of the services provided by the home. This includes a regular audit of the homes procedures, environment and activities, and annual questionnaires for residents, relatives and visiting professionals. The report of the responses to the questionnaires in February 2009 shows that there were positive answers to all the questions, and responses for the very few that raised concerns. For example, one person felt that inadequate hair washing had taken place. As a result all care plans have been updated with step by step actions for staff to take to support each person with their personal care. The Regulation 26 monitoring visits (see above) include a tour of the premises, views of the residents and staff, and a check of records. The manager said that she uses the Commissions Annual Quality Assurance Assessment (AQAA) as a tool for self assessment. Her comments in the AQAA show that she is aware of improvements that can be made in the home, and has plans to achieve these. She said that the outstanding barrier for the home in improving has been the lack of commitment from one particular local authority in not providing or funding the day care provision for one person. The impact of this barrier has been reduced by an activity programme in the home (see Lifestyle). However the manager still feels that the person would greatly benefit from some form of structured day care provision, and she is continuing to with negotiations to achieve this. All the staff have training in moving and handling, fire safety, food hygiene and infection control as part of their induction. The home maintains appropriate records for the health and safety of the residents and staff in the home, and staff follow the homes policies and procedures. Water temperatures were not monitored effectively to ensure that there was no risk to the people in the home from excessively hot water temperatures. We made an immediate requirement while we were in the home (see Environment), and the manager has informed us that all water temperatures will now be checked and recorded on a regular basis. There are regular fire drills in the home so that the staff know how to keep the people there safe in case of fire. These take place at different times of the day, and include a full evacuation, so that the people who live in the home are used to the procedures. Care Homes for Adults (18-65 years) Page 31 of 36 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 32 of 36 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 1 24 13 Running water temperatures 22/04/2009 of all baths and showers need to be regulated to close to 43 degrees Centigrade in order to avoid the risk of scalding. Until this is completed, measures must be put in place to ensure that no-one in the home is at risk of scalding from the high water temperatures. The temperatures of all water outlets, and especially baths and showers, must be tested on a regular basis to make sure that they remain at a safe level. The people who live in the home should be confident that all parts of the home are free from possible risks to their health and safety. 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 Care Homes for Adults (18-65 years) Page 33 of 36 1 6 12 Measures must be put in place to ensure that residents are involved in planning the support that they need, and monitoring their progress. 31/08/2009 The care plans and risk assessments contain appropriate information on personal and health care needs, but there is little indication of the involvement of each person in setting up and reviewing their care plan in accordance with the principles and practice of person centred planning. 2 33 18 The staffing rotas show that 08/08/2009 some staff work very long hours. The registered person must ensure that sufficient staff are employed in the home in order to comply with the Working Time Regulations. People who work excessively long hours may be too tired to provide a good quality of care for the people who live in the home, and there is a risk of errors due to poor concentration. 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 17 Staff should be encouraged to prepare meals from fresh ingredients, and to involve the people in the home in the preparation of meals. People may be involved more either Page 34 of 36 Care Homes for Adults (18-65 years) by participating in cooking fresh food, or enjoying the experience and sensations of the process. Support and encouragement for people to see, feel and smell the fresh ingredients may add to their participation in and enjoyment of their meals. Care Homes for Adults (18-65 years) Page 35 of 36 Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 36 of 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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