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Inspection on 01/07/09 for The Oaks Care Home

Also see our care home review for The Oaks Care Home for more information

This inspection was carried out on 1st July 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Each person who wants to live at the service has their needs assessed to ensure they can be met. Service users are encouraged to make their own decisions about how to spend their time and staff respect service users wishes in relation to their preferred routines within the home. Service users preferences in relation to the provision of personal care is respected. Service users are consulted about their preference in relation to the service provision at the home. The staff recruitment process promotes service users safety and staff receive training to promote service users safety.

What has improved since the last inspection?

The practise of searching service users bedrooms for cigarettes has ceased thus promoting service users right to privacy and dignity. The recording of complaints and concerns are managed effectively. New furniture has now been provided within the conservatory area so service users can now use it as a communal area. A staffing rota is now maintained which shows the hours being worked and by whom. Staffing levels have been reviewed and amended to provide an additional members of staff in the evenings.

What the care home could do better:

Due to the ongoing refurbishment programme the internal and external environment at the Oaks does does meet National Minimum Standards especially within bathroom and communal areas. We have provided specific timescales for the refurbishment programme to be completed. It is recommended that support plans include reference to the Mental Capacity Act, 2005 and the effects it has upon service users lives. Further developments are required in relation to staff supervision and quality auditing practices performed by the registered provider.

Key inspection report Care homes for adults (18-65 years) Name: Address: The Oaks Care Home 26-28 Corporation Oaks Woodborough Road Nottingham NG3 4JY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Steve Keeling     Date: 0 1 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 Oaks Care Home 26-28 Corporation Oaks Woodborough Road Nottingham NG3 4JY 01159621075 01159621075 theoaksrch@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Dr Shobhi Tiwari,Dr Prem Tiwari care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home The Oaks is a large converted Victorian house situated close to Nottingham city centre. The home is on a quiet road with no through traffic, it has a garden to the front of the property and a hard standing area to the side and rear. The home is within walking distance of local shops and places of worship and has good local transport links, especially into the City Of Nottingham. The home provides care for younger adults with mental health issues. The accommodation comprises of two lounges, a conservatory area and a dining room with a designated smoking area within the home. Smoking is not allowed in other areas of the home. The home is not fitted with a lift and has several flights of stairs, making it unsuitable for people with mobility problems. The current weekly fees for the service are £356.11 plus additional one to one payments if required. These fees do not include hairdressing, holidays, cigarettes, newspapers, personal toiletries or clothing. The registered manager gives all of the people who want to live at the service a copy of the service user guide and the statement of purpose and a copy of the last inspection report are displayed on a notice board Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 22 Brief description of the care home outside the registered managers office. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The focus of the inspection undertaken by the Care Quality Commission is upon outcomes for service users and their views on the quality of the service provided. The process considers the providers capacity to meet regulatory requirements, minimum standards of practise, and focuses on aspects of service provision that needs further development. One inspector conducted the unannounced visit. The main method of inspection used is called case tracking which involves selecting service users and looking at the quality of care they receive by speaking to them, observation, reading their records and asking staff about their needs. The registered manager and members of staff were spoken with as part of the visit, records relating to medication management were also inspected to form an opinion Care Homes for Adults (18-65 years) Page 6 of 31 about the quality of care provided. A partial tour of the building was undertaken which included service users bedrooms and communal areas they frequent to determine if the environment is homely and safe. A review of all the information we have received about the home since the last key inspection was performed on the 12.12.2008 was considered in planning this visit, which included the Annual Quality Assurance Assessment which was provided by the registered manager on the 12.12.2008. We also used the seven responses we received to ten Have your Say service user surveys and the three responses we received from the five Have your Say staff surveys which were distributed in the home prior to the site visit. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Adults (18-65 years) Page 8 of 31 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. Prospective service users have their needs assessed prior to moving into the home so they can be assured they can be met. Evidence: Information provided by the registered manager within the Annual Quality Assurance Assessment states Before meeting any prospective new resident we ensure we receive a copy of their care plan and risk assessment to enable us to assess whether we can meet their needs. We invite the prospective service users to visit the home along with any representatives they wish to bring. The Have your Say pre inspection questionnaire asked service users Did you receive enough information to help you decide if this home was the right place for you before you moved in, Six respondents stated Yes and on respondent stated Dont know. Service users spoken with on the day of the inspection confirmed that they had received information about the service, had visited the service prior to gaining residency and felt that the admission process was effective in determining the Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: suitability of the home in meeting their needs. The Have your Say pre inspection questionnaire asked staff Are you given up to date information about the needs of people you support or care for, all four respondents stated Always. Staff spoken with on the day of the inspection confirmed that they are fully informed of the needs of service users both verbally and through reference to service users risk assessments and care planning documentation. 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. Service users are involved in decisions about their lives and are consulted about the care and support they receive. Evidence: Information provided by the registered manager within the Annual Quality Assurance Assessment states We develop a structured care plan for each individual based on their needs. We support service users to make their own decisions and take risks and Key workers consult with service users to enable them to play an active role in planning their care. Service users spoken with on the day of the inspection confirmed that they are involved in the revision of their care planning and risk assessments and felt fully involved in the process. We looked at two care plans during our inspection and found the care plans and risk assessments had been reviewed on a regular basis. The documentation addressed service users mental health needs together with person preferences and cultural and religious needs. The current care planning format does Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: not make reference to the Mental Capacity Act, 2005 and the effects it has upon service users lives. Service users spoken with on the day of the inspection said that the home offers a flexible service and comments included I can do what I want, I can stay in bed if I want to, which I often do, and the staff respect my wishes and I dont like going out much, I have been on holiday to Skegness which I enjoyed, but I usually spend time in my room listening to my music which I really enjoy, I love it to bits here, Im so happy. Service users also confirmed that they can have baths when they wish. Records showed and service users confirmed that service users meeting are performed to provide a forum for service users to contribute to developments within the home. Service users said they are consulted about the provision of meals and the social activities programme. One service user told us, We can discuss anything at all and I feel the manager values my opinion. There was no evidence that indicated that service users are restricted unnecessarily and staff were observed to be very respectful to service users and appeared to value their wishes and preferences at all times. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are able to make choices about their life style and their choice is respected by the staff at the home. Evidence: Information provided by the registered manager within the Annual Quality Assurance Assessment states We support service users to live an ordinary meaningful life and to enjoy the rights and responsibilities of citizenship. We consult the service users about planned activities such as outings and planned holidays and we change routines and activities to meet service users needs and wishes. The registered manager on the day of the inspection said that difficulty has been experienced in motivating service users to fully develop their life skills. This was confirmed within the Annual Quality Assurance Assessment which states The service could do better in motivating and encouraging service users to fully develop their life skills. To address the issue it was documented within the Annual Quality Assurance Assessments that We plan to have Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: more staff trained in person centred thinking to equip them with the skills to assist personal development for the service users. The Have your Say pre inspection questionnaire asked service users Does the home arrange activities that you can take part in, four respondents stated Always, and three respondents stated Usually. A member of staff said The staffing levels have been amended and now three care staff are on duty in the evenings which has made thing easier, we have more time to spend with the service users to provide social activities. Service users said that the social activities have improved recently and now include arts and crafts, guest entertainers, bingo, a darts competition and a big movie night in the lounge area, on a recently purchased plasma television. Service users spoken with also confirmed that staff respect their wishes if they dont wish to attend the planned social events. One case tracked service users documentation contained a care plan to develop her independent living skills, the service user stated and records showed that staff do attempt to promote her skills in this area with varying degrees of success. The home has a small kitchen area in which service users can further develop their living skills. One service user told us that she has used the area in the past to make herself hot drinks but has not used it recently. Due to the extensive refurbishment programme currently being undertaken (see environment section within the report) throughout the home the independent living skills area was not being fully utilised but once the refurbishment has been completed the facility will be re-introduced. One case tracked service user said I have been asked if I want to attend college, I went for an interview but felt that I did not want to go anymore, I do some cooking and wash own clothes sometimes. The service users also stated that she has been to a local African Caribbean centre but has not attended recently, which is her choice and the staff respect her wishes. At a previous inspection it was established that staff searched service users bedrooms for cigarettes before service users retired to bed. The manager was informed at the previous inspection that this type of action was an infringement of service users human rights and their rights to privacy. We discussed this issue with the registered manager, care staff and service users and it was established that the practise had ceased. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: The Have your Say pre inspection questionnaire asked service users Do you like the meals at the home, Two respondents stated Always, three respondents stated Usually and two respondents stated Sometimes. Service users confirmed that they are consulted about meal provision and a choice is always provided. We observed the lunch time meal, two choices were available which were well presented and appeared appetising. Service users spoken with on the day of the inspection said The food is very good, today its home made steak pie which I love and I like all the food, sometimes I have a salad as I am watching my weight but not today, its my favourite. Both service users confirmed that hot and cold drinks are readily available on request. 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. Service users health and personal care support is of a good standard. Medicine management promotes the service users safety and wellbeing. Evidence: Information provided by the registered manager within the Annual Quality Assurance Assessment states We ensure the health and personal care that service users receive is based on their needs, our staffing structure allows service users the choice of a male and female staff to deliver their care. We support our service users to make choices in relation to General Practitioners and support them to access the full range of NHS facilities and We ensure our staff are fully trained in aspects of medication administration. The Have your Say pre inspection questionnaire asked service users Does the home make sure you get the medical care you need, Six respondents stated Always and one respondent stated Usually. The care plans examined on the day of the inspection showed that service users have access to a comprehensive range of health promoting facilities such as Community Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: Psychiatric services, General Practitioners, Podiatrists, Dentists and Opticians. Service users spoken with said they are generally well but confirmed that staff act promptly if they need to see their doctor. Service users are continually assessed under the Mental Capacity Act by a Community Psychiatric Nurse who would instigate a Deprivation of Liberty assessment/referral should it be required. Service users spoken with stated that on the whole they were independent in relation to personal care needs but one service user stated I only have to ask for help and staff will be there. Both case tracked service users said that personal support is provided in accordance with their preference and requirements and expressed no concerns in this area. We asked service users if they get their medication on time. The response was Yes in both instance. A service users told us The care staff sort my tablets out for me and bring them to me in my room if I am not downstairs, both service users confirmed that a drink is provided and the staff make sure they take their medication. We observed the lunch time medication round and it was shown that it was performed in a competent manner by a suitably qualified member of staff. Records relating to the administration of medications were filled in appropriately, well maintained and stored in a safe environment. 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. Service users feel safe within the home and are able to express their concerns and are safeguarded from abuse. Evidence: Information provided by the registered manager within the Annual Quality Assurance Assessment states We provide a clear and easy complaints procedure and we protect service users with comprehensive policies and procedures. We would document and respond to any complaints and provide staff with suitable training on Safeguarding Adults and Whistle-Blowing.The registered manager also told us in his Annual Quality Assurance Assessment that there have been no Safeguarding Adult referral since the previous inspection was performed and the Care Quality Commission has not received any complaints about the service. The Have your Say pre inspection questionnaire asked service users, Is there someone you can speak to informally if you are not happy, all seven respondents stated Yes. The questionnaire also asked Do you know how to make a formal complaint, five respondents stated Yes and two respondents stated No. Service users spoken with on the day of the inspection said I feel safe here, I have never made a complaint, I am happy here, its the first place I have settled, I have been to several homes before this one, I did not like them but I am really happy here and have nothing to complain about, if I did, I feel the staff would sort it for me and Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: I have no complaints, the staff are very good and helpful, they always respect me, I am so happy here, it would break my heart if I had to leave. We looked at the record of complaints and found that four complaints had been made since the previous inspection, each had been recorded and managed effectively. We saw evidence that staff have been provided with Safeguarding Adults training, staff spoken with on the day of the inspection demonstrated a good understanding of what is defined as abusive behaviour and specified appropriate actions they would take to protect service users at the home. Staff said I would report any abusive behaviour to the manager, if I was not happy with the response I would report it to the Social Services or the Care Quality Commission and I would refer to the homes policies and procedures. There is a financial agreement in place for each service user who needs support to manage their personal finances. Records showed that service users money is individually stored within a secure area. All transactions are recorded and signed by the care staff and service users, receipts are also obtained to ensure that service user are protected from financial abuse. At the previous inspection a recommendation was made that the registered provider initiates regular independent checks on service users financial records as part of the monthly quality auditing visits. Following a discussion with the registered manager it was established that the recommendation had not been actioned as the registered provider was not undertaking the required quality auditing checks on a monthly basis. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The internal environment does not meet National Minimum Standards at this time but a significant upgrade and refurbishment programme is currently being undertaken to ensure standards are met. Evidence: Information provided by the registered manager within the Annual Quality Assurance Assessment states We provide a safe secure smoke free environment for service users to live in, with appropriate fixtures and fittings. We respond to service users wishes and provide the type of environment they desire. We provide single rooms for all those that require them and encourage all individuals to personalise their rooms. The Have your Say pre inspection questionnaire asked service users Is the home clean and fresh. Four service users stated Always, one service user stated Usually and one service user stated Sometimes. Service user bedrooms were homely, safe and personalised with family pictures, small items of furniture, a television, radio and ornaments. An extensive upgrade and refurbishment programme is currently in progress and it is evident that the service provider is in the process of invested significant expenditure Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: on the environment. The planned refurbishment programme, which is due to be completed within three months should provide service users with a homely, clean and safe environment. At the time of the visit the following areas did not meet the required standard: During our visit we saw that the carpet in the large lounge area and in some corridors were very stained and in need of replacement. Bathroom areas were in a very poor state of repair, especially the bathroom adjacent to the dining room. The majority of the homes communal environment were in a poor decorative condition due to the work involved in upgrading the homes electrical circuits. These issues were discussed with the registered manager who stated that the refurbishment programmed will address the concerns identified in relation to the bathroom facilities. In addition the lounge carpet will be replaced with a non slip laminate flooring and all areas that have been affected by the electrical upgrade will be redecorated, this was confirmed by the handyman on the day of the inspection. Some external areas are, as a result of the ongoing refurbishment were untidy, the registered manager confirmed that these issues will be addressed once the refurbishment has been completed. Service users spoken with on the day of the inspection said I am not bothered that all this work is happening, in fact I am looking forward to it all being done, it will be lovely, I like living here and lots of work is happening and it will be nice once it has been finished. We examined the kitchen facility which showed that the service has responded well to a food safety inspection report by the Environmental Health Department as various requirements and recommendations have been addressed effectively. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported by competent and qualified staff and staff recruitment practises promotes service users safety. Evidence: Information provided by the registered manager within the Annual Quality Assurance Assessment states We follow National Minimum Standards regarding recruitment requirement, including all pre employment checks to ensure service users are supported by well trained knowledgeable staff. We examined staff recruitment records, they were well maintained, stored securely and showed that members of staff only commence employment once Criminal Record Bureau checks have been obtained, together with two satisfactory references, proof of identity and the individuals qualifications, thus promoting the safety and wellbeing of service users. The Have your Say pre inspection questionnaire asked service users Do staff listen and act on what you say, four respondents stated Always, two respondents stated Usually and one respondents stated Sometimes The Have your Say pre inspection questionnaire asked service usersAre staff available Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: when you need them, Three respondents stated Always two respondents stated Usually and two respondents stated Sometimes. Service users spoken with on the day of the inspection said Staff are available when I need them, they are all very nice, The staff are very good and always there for me when I need them, it has improved and I do my own thing most of the time, I watch television or just chat with the staff, which I like. Information provided by the registered manager, within the Annual Quality Assurance Assessment showed that 55 of the care staff have a National Vocational Qualification (NVQ) level two and above in care to ensure a suitably qualified workforce is employed at the home. Staff training records showed, and staff confirmed that a stafftraining programme is also provided. A service user stated, when asked, that she felt that all the staff are very well trained and had every confidence in their abilities. We examined the staff rota which has now been amended to reflect catering and domestic hours. The rota showed that the service is now staffed by three care staff throughout the day with two waking night staff. A recreational therapist is also employed twice weekly between 10am and 3pm. The staff rota shows that a cook is employed for five days per week (Monday to Friday) which means that the care staff would be providing meals for the service users at the weekend. This could compromise the care staffs ability to provided sufficient care promoting interventions due to conflicting demands on their time. Staff spoken with said, The staffing levels have increased, we now have three carers on duty in the evening which is much better, Its easy to provide the care now. A staff training matrix was available which showed staff receive training in basic food hygiene, first aid, infection control, the management of violence, safeguarding adults, mental health awareness, medication safety and dementia awareness. Staff spoken with confirmed that the training had been provided and felt that the training equipped them with the knowledge and skills to provide a safe service. Records showed and staff confirmed that a regular staff supervision process has not been provided. We discussed the issue with the registered manager who stated that it was intended that the supervision process would be performed by the staffs line managers but the system had not worked. To resolve the situation the registered manager has initiated a staff supervision rota which he will complete personally, records were available to support this in the managers office 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. The service continues to demonstrate improvements but further developments are requires in relation to quality auditing procedures and staff supervision. Evidence: Information provided by the registered manager within the Annual Quality Assurance Assessment states Both the manager and the deputy manager have Registered Managers Awards (RMA). The manager has a sound knowledge of the homes financial system. We have a robust policies and procedures in place which all staff follow, we have effective record keeping systems that ensures safeguarding of individuals in all aspects of their care. All relevant safety checks are up to date. The Have your Say pre inspection questionnaire asked service users What do you think the home does well comments included Cooking and trips out, Good food and good organised trips, The staff are always their for you and very supportive, I like the food, it is always clean and the staff are lovely and Excellent food, kind helpful staff and good opportunities to go out. Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: Staff spoken with on the day of the inspection were asked if they felt supported by the registered manager and if they felt the home was well run, comments included, The manager is the best thing to happen to this place, he is so supportive and Yes, I feel fully supported. Staff also confirmed that regular staff meetings are performed and they felt fully informed of any developments within the home. Service users spoken with on the day of the inspection said that they attend service users meetings, one service user said We discuss holidays, the food and social activities, we can talk about anything really, anything to do with our home. At the previous key inspection a recommendation was made that the registered provider should check the financial records and balances of service users on his monthly quality auditing visits to the home. As discussed earlier in the report the registered manager stated that the recommendation had not been actioned as the registered provider was not undertaking the required quality auditing checks on a monthly basis as stipulated in the Care Standards Act (2000), furthermore staff supervision was not being undertaken on a regular basis to provide formal support. Information provided by the registered manager within the Annual Quality Assurance Assessment shows that policies and procedures are available and have been reviewed appropriately to ensure they are pertinent. Staff confirmed that the policies are accessible at any time for reference and guidance. 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 24 23 The registered provider 30/09/2009 must ensure that the refurbishment programme is completed. To ensure the environment is homely, comfortable and safe. 2 27 23 The registered provider must ensure that all bathrooms within the home are upgraded. To ensure the bathroom facilities meet the needs of service users. 30/09/2009 3 32 18 The Registered provider must ensure that sufficient staff are on duty at the weekends which included catering staff. To ensure that the care provided to service users is not compromised. 31/08/2009 Care Homes for Adults (18-65 years) Page 29 of 31 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 4 38 26 The registered provider must perform quality auditing procedures in accordance with legislation. To ensure effective quality auditing procedures are in place so service users have the opportunity to let the provider know what is good about the home and what improvements are required. 31/08/2009 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 7 It is recommended that support plans include reference to the Mental Capacity Act, 2005 and the effects it has upon service users lives. This is to ensure that service users rights and choices are protected. The registered provider should ensure that the refurbishment programme does not compromise the standard of cleanliness within the home. The registered provider should ensure that staff receive formal supervision sessions as stipulated within the National Care Standards Act. 2 30 3 36 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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