Inspection on 05/02/09 for The Cottage

This inspection was carried out on 5th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Cottage 02/11/06

The Cottage 14/02/06

The Cottage 27/09/05

The Cottage 08/03/05

The Cottage 05/08/04

The Cottage 23/12/03

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

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 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Cottage 51/53 High Street Brightlingsea Essex CO7 0AQ     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: Diana Green     Date: 0 5 0 2 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: The Cottage 51/53 High Street Brightlingsea Essex CO7 0AQ 01206303676 01255821629 rbellhouse@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Roy Bellhouse Name of registered manager (if applicable) Mr Roy Bellhouse Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home The Cottage is a registered care home based in a detached grade 2 listed period property situated close to Brightlingsea town centre. It has six single occupancy bedrooms and two double bedrooms, two communal lounges and a separate dining area, kitchen and laundry facilities, two bathrooms and a shower room, plus additional toilets. The home has front and rear access, with a side parking area and a rear garden. The Cottage provides 24-hour residential care and accommodation for up to ten adults with learning disabilities, both male and female. The home is not suitable for anyone with mobility difficulties as access to the first floor is by stairs only, there are no assisted bathing facilities, and the accommodation does not have level access throughout. 10 Over 65 0 care home 10 Care Homes for Adults (18-65 years) Page 4 of 31 Brief description of the care home The home is jointly owned and run by Mr Roy Bellhouse and Mrs Lynda Bellhouse, with Mr Bellhouse being the registered provider and registered manager. For the purpose of this report, the term `proprietor has been used to denote information provided by either proprietor during the inspection. Proposals for one of two senior staff members who have the Registered Managers Award to become the manager of the home have not as yet materialised. However a decision is expected to be made in the near future on this matter. The inspector was advised that the people living in the home refer to themselves as `residents, and so this term will be used in this report. A statement of purpose and service user guide are available at the home. Current fees at the home range from £400 to £700 per week. 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: This unannounced inspection took place on 5th February 2009. All of the Key National Minimum Standards (NMS) for Young Adults, and the intended outcomes were assessed in relation to this service during the inspection. This report has been written using accumulated evidence gathered prior to and during the site visit, including the homes Annual Quality Assurance Assessment (AQAA). The Annual Quality Assurance Assessment, a self assessment that focuses on how well outcomes are being met for people using the service, was returned to us prior to the visit to the home. Information received in the AQAA provided us with some detail to assist us in understanding how the registered persons understand the services strengths and weaknesses and how they will address them. Care Homes for Adults (18-65 years) Page 6 of 31 The inspection process included reviewing documents required under the Care Home Regulations 2001. A number of records were looked at in relation to residents, the premises, staff recruitment and staff training, staff rotas and policies and procedures. Time was spent talking to staff, residents and management. Surveys were sent to residents, their representatives, health and social care professionals and staff employed at the home to gain their views on how the home was operating. The management and staff were welcoming and helpful throughout the inspection. What the care home does well: What has improved since the last inspection? What they could do better: Care plans need to include more detail where there are specific needs. Medication policy and procedures need further development to include procedures for as required (PRN) medication, homely remedies and disposal. A list of homely remedies should also be agreed with the residents GP annually. A list of staff signatures and initials of those designated to administer medication should be recorded to enable any adverse incidents to be appropriately followed up. The temperature of medication room storage must be monitored and recorded to ensure it remains within safe recommended levels (25 degrees Centigrade). Radiators should be covered based on an assessment of risk and vulnerability to residents. The manager needs to undertake regular updated training. Care Homes for Adults (18-65 years) Page 8 of 31 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 planning to live at The Cottage can expect to be well informed and to have their needs fully assessed prior to admission to ensure they can be met at the home. Evidence: The homes statement of purpose and service user guide were viewed during the site visit and were confirmed to meet regulations. Each resident had a copy of the service user guide held in their own room. The admission procedures were discussed with the manager. We were informed that there had been no admissions since the previous key inspection but that these documents would be made available to potential residents and their relatives. Feedback from relatives indicated this would be the case: four of the five relatives who completed surveys when asked do you get enough information about the care home to help you to make decisions? stated always and one said usually. As there had been no admissions since the previous key inspection, it was not possible to verify admission procedures from the care files. The AQAA informed us that Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: comprehensive assessments would be undertaken prior to admission and would include communication and compatibility with other residents. From discussion with the manager it was clear that potential residents would receive an assessment from a multi-disciplinary team and full information would be obtained prior to admission. This would determine if needs could be met at the home before agreeing admission. 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 living at the Cottage can expect to be fully involved in all aspects of life at the home and to be supported to make decisions as part of an independent lifestyle. Evidence: The care planning process was discussed with the proprietor who explained that a key worker system had been introduced since the previous key inspection. One relative told us the key worker and I are in regular contact. The care documentation had been revised with residents and new care plans were now in place. These identified needs and included long and short term goals with reviews undertaken at six monthly intervals with the resident, family and social worker. The care plans for two people living at the Cottage were viewed. The records included care plans for accommodation, health and well being, family, friends and relationships, life/independence skills, day activities/social and leisure activities, finance and money management, specific needs etc. Records generally included good detail of the residents needs to enable staff to understand how to provide appropriate support to them. However some needed to Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: include more detail, for example where a continence need had been identified there was no detail of the type of pad to be used or how and when it was to be applied. Both care plans had been reviewed. The proprietor had attended training the previous week on person centred care planning and said she planned to develop these further for the home. Discussions had taken place with residents and staff on how to progress person centred care plans and residents had chosen to have them kept in their own rooms. We were informed that one residents person centred plan had been developed with them. This was viewed during the site visit with the resident explaining why they had chosen to include photographs, who they were of and what they represented. Photographs of their friend who had lived at the home (see standard 21) prior to their death were a feature of the care plan and the resident clearly found comfort in being able to remember them in this way. The AQAA informed us that residents are supported to make their own decision as they are able and that that the home now acknowledged the need for residents to take risks to enable them to live full and independent lifestyles. Each of the care plans seen included an assessment for ability to make decisions for themselves. One relative told us the care service certainly meets X needs and x is always included in decision making. Risk assessments (i.e. risks to self and others) for different needs were seen in the care plans, for example nutritional, seizures and mobility with guidance to staff on how risks were to be managed. Policies and procedures in place demonstrated the homes commitment to minimizing risks and hazards and promoting the health and safety of residents. A relative who completed a survey told us The Cottage operates as a large family unit. Although there can be disagreements between some of the residents, they are encouraged to be caring and supportive of each and this shows in the behaviour of most of the residents. 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. People living at the Cottage can expect to be enabled to take part in a full programme of peer and culturally appropriate activities as part of the local community and to be supported to maintain their family links and friendships. Evidence: We were informed that several residents attended local colleges and that transport was available to take them there. This was also confirmed from a wall plan on display that indicated who attended which course and on which day. Examples of those attended by residents included flower arranging, cookery, pottery, teaching others, sensory sport, local history, travel awareness and dance. One relative told us x feels important and involved in college life and gaining x certificates. It was evident from discussion with the proprietor and residents that there were strong Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: links with the local community. Residents were observed going out to the local shops and we were told they also went out to the pub, to the Gateway and Busby clubs ( learning disabilities clubs). We were informed that three residents were planning to join a drama group. Photographs were seen displayed in the home showing the various activities and events residents had taken part in. The home had two beach huts which residents were able to use during the summer and visits had also been made to the zoo, train ride to Ipswich, to the pie and mash shop in Walton and Charity events at the local hospice. Holidays were arranged each year to the Proprietors house in France and to a Butlins holiday camp. A relative who completed a survey told us the care home provides a happy family lifestyle with involvement of the local community. The statement of purpose included the homes policy on visiting arrangements. We were told that residents were supported to maintain links with their families by sending cards and presents for birthdays and at Christmas. Relatives who completed surveys also confirmed this. One told us cards and presents are sent to sister, brother and nephews, and me, for birthdays and Xmas. Another relative told us I speak to my X on the phone once a week and they bring X home once a month. The atmosphere of the home was very much that of a family. Daily routines were observed to be relaxed and flexible to accommodate individual needs of residents. Residents who were able were responsible for helping with domestic tasks, laundry, cleaning, setting tables for meals etc. and this was recorded in their care plan. Staff were observed to address residents by their preferred name and to be friendly but respectful towards them. Some residents chose to spend time in their rooms and follow their own interest rather than take part on organised activities and this was respected. Residents rooms had locks which some chose to keep locked when they went out. A relative told us the staff at the Cottage look after the care needs of my X with respect and professionalism. The homes kitchen was domestic in size and well fitted with a cooker, microwave, fridge/freezer and dishwasher. A well stocked small pantry provided easy access for residents food. We were told that residents had a choice of cereal, toast and fruit for breakfast and three stocked fruit bowls were observed in the kitchen. Residents were observed to have coffee in the dining room and to come and go throughout the day. The proprietor said that the menus were discussed with residents and changed daily. Roast dinners were provided twice per week and fish and chips on Fridays but other main meals varied as residents had chosen. The lunchtime meal was observed and comprised curried chicken or lentil stew with rice and vegetables, followed by fresh fruit. Residents were able to take their time eating and one resident who had been out shopping had his lunch some time later. 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 living at the Cottage can expect to have their health and personal care needs met. Further development of medication policy and procedures will provide assurance they will be appropriately safeguarded. Evidence: We were informed that a key worker system had been introduced since the previous key inspection and all residents had their own key worker. Two residents spoken with knew who their key worker was. The AQAA informed us that key workers support residents with their personal care and keeping in contact with their family. One relative told us my X s key worker is very caring and does a lot more than the job requires. Care plans viewed showed that residents were able to choose what they wore, how they had their hair or make-up done and how they spent their day. Access to community nurses, occupational therapists etc was confirmed from the records viewed during the site visit. The healthcare needs of residents was discussed with the proprietor and evidence obtained from the records. Each resident had a health information file that included all Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: their health needs. Some were seen regularly by their GP and practice nurse. Access to dentists, opticians, chiropodists and continence nurse was also seen in the records viewed. The AQAA informed us that staff escorted residents to the GP and to outpatient appointments. This was confirmed from a relative who told us the staff are very caring and look after my x well. They take x for medical appointments. The home had medication policy and procedures for staff guidance that were last reviewed during 2007. These required further development to include additional procedures for example for ordering, recording omissions, as required (PRN) medication, homely remedies etc. Medication was supplied in monitored dosage systems and in individual containers from the local supplying pharmacy. The procedures did not refer to the need to store within safe recommended levels and temperature monitoring of storage was therefore not undertaken. We were informed that all staff had undertaken medication training. The training records of two staff members confirmed they had attended medication handling training and one had recently attended updated training. A further five staff were booked to also attend updated training. There was no current list of staff signatures and initials available to enable follow up in the event of an untoward incident. Two residents medication records and supplies were checked. Medication was available as prescribed and the records were found to be accurately recorded. However one resident was self-medicating for inhalers but there was no risk assessment recorded to ensure risks were minimised. We were informed that one resident had died suddenly while on holiday with the other residents and staff. This had been traumatic experience for all concerned and following a request from the proprietors to delay the inspection this had been agreed by the commission to enable the residents to come to terms with their loss. During the site visit one resident was able to talk about their friend by showing photographs of them and the various activities and events they had been involved in. It was good to see and hear how sensitively residents had been supported following their bereavement. The residents had all been involved in planning their friends funeral and had been actively involved, walking behind the funeral car, two speaking at the service, choosing flowers and helping to plant flowers and a tree in their memory. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the Cottage can expect to have their concerns and complaints listened to and acted upon and to be protected by safeguarding adults procedures. Evidence: The home had a complaints procedure that was on display in the entrance of the home. We were informed that there had been no complaints received since the previous key inspection. The AQAA informed us that all residents were encouraged to raise any concerns at the regular meetings held with them or on an individual basis to their key worker or the proprietor. One relative told us the Cottage is well run and meets all our x needs, we are able to bring up any matters with the owners and staff if we feel they need to be addressed and another told us we have always been happy with the level of care which x receives at the Cottage. The home had safeguarding procedures in place for the protection of residents from abuse. All staff had attended training in safeguarding adults that was updated annually and confirmed from the records. The home had whistle blowing procedures that were promoted with staff enabling them to report any allegations should they arise. The systems for handling residents monies were discussed with the proprietor. We were informed that the proprietor was appointee for all residents at the home. Each resident had their own bank account which they managed with support of their key Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: worker. Weekly allowances were received and recorded and records made of all expenditure with receipts held. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at The Cottage can expect to live in a clean, comfortable and homely environment that is appropriate for their needs and is well maintained. Evidence: A tour of the premises was undertaken during the site visit. The premises were domestic in size. There was an entrance hall which led to two separate lounges, one with large TV screen that residents were seen watching during the day. A computer was also available which we were told could be accessed by residents. The home had a dining room, kitchen and laundry and bathroom and two toilets on the ground floor. Residents were observed to have free access throughout the home. When asked what do you feel the care home does well? A relative told us understands x needs, personality, limitations. The home is like x home, not just a place to exist. The premises were clean and comfortably furnished. Residents rooms were very well personalised with personal items (Pictures, posters, TV, Cds, videos, soft toys etc.). Records viewed confirmed that fire safety equipment was appropriately maintained and fire safety practices were in place to meet the requirements of the local fire services. The premises were clean and free from odours throughout. Liquid soap and paper Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: towels were provided for staff hand washing and to reduce the risk of infection. Residents had their own soap and cotton towels in their rooms/en suites, however tablets of soap and towels were used by all residents in the shared bathrooms, posing a risk of infection. This was discussed with the proprietor who agreed to review arrangements to minimise the risk of infection. The laundry room was housed in an external building. There were three washing machines, one with sluice cycle (ability to wash at 65degrees centigrade for a minimum of 20minute) to minimise the risk of infection, and one drier, all confirmed to be in working order. Staff hand washing facilities and disposable gloves were available for safe practice. We were informed that staff and residents do the laundry as part of their daily routine. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at The Cottage can expect to be cared for by skilled and experienced staff who know them well and are clear of their role and responsibilities. Evidence: From discussion with the proprietor and an inspection of records it was evident that care staff are skilled, experienced and competent to meet the need of residents. We were informed that all staff with the exception of one have an NVQ level 2 qualification, two staff have NVQ level 4 qualification and one was undertaking NVQ level 3. This therefore exceeds the recommended standard for 50 of staff to have an NVQ level 2 qualification. In addition to the proprietors (registered manager and his wife), there were four care staff (including one senior) on duty. We were informed that night staffing levels comprised one care staff plus one sleeping and one on call. Residents appeared well cared for and were observed to be well supervised during the site visit. The turnover of staff was low with some staff having worked at the home for a number of years, meaning that residents were cared for by staff who knew them well. One Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: staffs personal file was inspected. This included all the required checks (identification, two satisfactory references, full employment history, CRB/POVA check etc.). The proprietor said that residents are able to be involved in staff interview. The training records for the same staff member were inspected. We were informed that a training and development portfolio had been established since the previous key inspection. This was seen to include all training undertaken by the staff member together with evidence of induction to Skills for Care standards. The AQAA informed us that contact had been made with another care home in the locality which had provided opportunities to share training courses. Training in health and safety, first aid, safeguarding, diversity and medication handling had been provided since the previous key inspection, showing that staff were updating their skills and knowledge. Supervision arrangements were discussed with the proprietor who explained that supervision was undertaken monthly and recorded. An annual appraisal was also undertaken with each staff member. Informal supervision meetings were also held where residents needs were discussed. Records of supervision seen included care issues, fire safety, policies and procedures and development opportunities and training needs. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the Cottage can expect to live in a well managed home with good standards of health and safety that protect them and staff. Evidence: The management arrangements were discussed with the proprietors of the home. Mr Bellhouse was the registered manager. However an initial proposal for a senior care worker to take over the manager position had not worked out as planned and both owners were jointly managing the home. They were supported by a deputy manager who together with another senior care worker had an NVQ level 4 qualification. The training records viewed confirmed that updated training had been undertaken by Mrs Bellhouse and the deputy manager. However Mr Bellhouse had not attended any updated training in the last year. The homes quality assurance programme was discussed with the proprietors. Service user questionnaires were last sent out in January 2007. The proprietor said that some relatives had requested not to have surveys sent to them as they also receive then Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: from other sources (CSCI, local authority etc.) Feedback was given individually when they visited the home. The home had an annual development plan for 2009 that was on display and included developments for residents, staff and the home (premises). Monitoring systems were in place to review progress made in each area. The AQAA informed us that the quality monitoring systems were in place to measure the success in achieving their aims and objectives and the views of residents were also included. Records held on behalf of residents were kept up to date and stored safely in secure facilities in a locked office in accordance with the Data Protection Act 1998. Records viewed at this inspection included: care plans, medication records, statement of purpose, service user guide, a sample of policies and procedures, staff recruitment and staff training records, maintenance and fire safety records. The home had a health and safety policy and procedures for staff guidance. The AQAA informed us that all staff are trained in moving and handling, first aid and food hygiene and infection control. This was also confirmed from the training files seen. Evidence of a sample of records viewed showed that there were systems in place to ensure the servicing of equipment and utilities (e.g. gas electric, annual PAT testing etc.) and there was evidence of appropriate checks being carried out on fire equipment, smoke alarms, hot tap water temperatures. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 Residents who choose to self 30/04/2009 administer their medication must have a risk assessment undertaken and recorded. Without a risk assessment there is no evidence to demonstrate that risks to the resident have been minimised. 2 20 13 Comprehensive medication policy and procedures for safe receipt, storage, administration, recording and disposal need to be developed for staff guidance. Without detailed guidance residents cannot be assured they will receive their medication as prescribed. 30/04/2009 3 20 13 The medication room temperature must be monitored to ensure it remains within safe recommended levels 30/04/2009 Care Homes for Adults (18-65 years) Page 29 of 31 (minimum 25 degrees Centigrade) Medication that is stored above 25 degrees Centigrade may have deteriorated and therefore may not be safe to administer. 4 37 10 The registered manager must undertake regular updated training. Without regular training being undertaken it cannot be assured that the manager has the skills and experience necessary for managing the home. 14/06/2009 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 20 A list of staff signatures and initials of those staff who are designated to administer medication should be maintained to enable appropriate follow up in the event of an adverse incident. Radiators should be covered based on an assessment of vulnerability and risk to residents. 2 42 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!