Inspection on 24/03/09 for The Retreat

This inspection was carried out on 24th March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Retreat 26/10/06

The Retreat 14/03/06

The Retreat 04/11/05

The Retreat 22/03/05

The Retreat 23/11/04

The Retreat 18/03/04

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 16/05/2010.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Retreat 64 Hall Lane Walton On Naze Essex CO14 8HD The quality rating for this care home is: one star adequate 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: Carolyn Delaney Date: 2 4 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (20102008) 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 30 Information about the care home Name of care home: Address: The Retreat 64 Hall Lane Walton On Naze Essex CO14 8HD 01255675948 01255861241 sneating@btinternet.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Reverend Graham Beresford Edwards care home 4 Number of places (if applicable): Under 65 Over 65 4 0 learning disability Additional conditions: Persons of either sex, under the age of 65 years, who require care by reason of a learning disability (not to exceed four persons) Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 30 A bit about the care home The Retreat is a home for up to four younger adults who have a learning disability. The home is situated close to the seaside town of Walton on the Naze. There is transport provided by the home. Each person has their own bedroom and access to kitchen, bathrooms and lounge areas. There is separate self contained accommodation for one person who needs less support from staff. Care Homes for Adults (18-65 years) Page 5 of 30 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: one star adequate 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 6 of 30 How we did our inspection: This is what the inspector did when they were at the care home We did not tell people we were coming to visit the home. We spent six hours in the home on 24th March 2009. When we visited the hoe we looked at how residents spent their time. We looked at how staff cared for residents. We were invited by residents to look at bedrooms and other areas of the home. We spoke with the manager and we looked at residents care plans and other important records. What the care home does well People looking for a care home are given information about the Retreat and the surrounding areas. Staff care for residents and make sure that if they are unwell that they see their doctor and that they are given the medicines they need to make them feel better. The home is clean and comfortable. If a person is unhappy staff and the manager will do their best to make things better and staff are trained to treat people well. Care Homes for Adults (18-65 years) Page 7 of 30 What has got better from the last inspection What the care home could do better 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 Care Homes for Adults (18-65 years) Page 8 of 30 please contact Carolyn Delaney 33 Greycoat Street London SW1P 2QF 02079792000 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 30 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 30 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 who move into the home can be assured that their assessed needs will be met. Evidence: The manager told us in the Annual Quality Assurance Assessment that there have been no admissions to the home for many years. They told us that there is a statement of purpose and residents guide, which provides information about the home to help people decide if they would be happy there. The manager told us that should a person enquire about a place in the home they would be provided with information and the persons family or advocate would be given an assessment to complete with details of the prospective residents needs. A copy of the social services or local authority needs assessment would also be obtained. The manager said that people are invited to visit the home before they move in and once they do a contract would be agreed. When we visited the home we looked at the way in which a persons needs would be assessed. We saw that the assessment covered details of the persons physical and health needs as well as the support the individual required to maintain personal and oral hygiene. Information about each persons communication needs, their likes , dislikes and hobbies would also be recorded to help determine that the home would be able to meet their needs. Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: We looked at the information provided about the home. The residents handbook included information in picture and photographic format to help describe the home, mealtimes and routines as well as information about the surrounding areas. Three residents completed surveys. Each of the three told us that they had been asked if they wanted to move into the home. Two told us that they had receive enough information to help them decide and the other person said that they did not understand the question. Care Homes for Adults (18-65 years) Page 12 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can make some choices about their daily lives. Evidence: The manager told us in the Annual Quality Assurance Assessment that each person had a care plan, which was reviewed every six months or year as appropriate, or where progress necessitated, an earlier review. They told us that high priority was given to ensuring choice in all that residents do, beginning with choosing clothes to wear, and breakfast cereals, etc. They told us that all staff seek to empower residents, though because of the level of disability, they are on the whole unable to take a very active role in the running of the home and changing the environment. None the less they express the choice to go to bed, go out, have a drink, a shower or a bath for example. The manager told us that the risk assessment policy recognised that everyone has a right to take reasonable risks in their enjoyment and experience of life. They said that some risks are well worth while,whilst others were too dangerous, especially when the dangers were such that the resident did not appreciate the risk. They told us that to protect the resident and the staff risk assessments need to be completed to ensure that the risk is a reasonable one which is worth while, and the ways in which the risk Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: can be minimised. They said that this permits residents to go to such places as theme parks, and one resident to make short journeys on her own. Residents who completed surveys with the assistance of staff indicated that they could make choices and do what they wished to do during the day and evening. When we visited we looked at care plans for two of the three residents living in the home. We saw that staff recorded long term and short term goals for residents. However goals set in care plans reflected more what staff wanted the individual to achieve rather than person and there was little evidence that the plans and goal setting had been carried out with residents, even those who were more independent and capable. For example in one residents care plan goals around weight loss, improved communication and increased participation in occupational activities were recorded. This person views about these goals or how they could be achieved was not recorded in the plan. We saw that residents were involved in making some limited choices such as what meals they had and choice of clothes to wear. In other areas there was little evidence that residents were supported in making decisions, participating or contributing to the running of the home. The manager said that residents meetings were not held and we saw that the policies and procedures were not available in formats, which would help to enable residents understand them or to express their views about how the home was run. The manager told us that meetings were not held as residents were unable to communicate with each other. They told us that staff obtained residents views on a one to one basis. However there was no evidence to show how or when this occured. However one more able resident lived separately in a cottage annexe. We spoke to this resident and they showed around their accommodation. We saw that they could exercise choice in how their accommodation was furnished and managed. Risks to residents health and safety were well managed while allowing residents to participate in activities such as preparing meals or accessing the community. Where the level of risk to a person was assessed as high and there was the likelihood that the person may injure themselves (such as risks associated with handling sharp kitchen items or risks associated with hot water) then staff imposed some limitations on access to these items or areas and supervised residents as needed. Where this was necessary then it was recorded (though there was no evidence that this had been agreed with the individual or recorded within an infringement of rights process) within the plan of care. The manager told us that one resident would be capable of being involved in planning their care with staff. However when we looked at the care plan for this person there was no evidence that the person had been involved and their views, preferences and wishes were not reflected within the care plan. Care Homes for Adults (18-65 years) Page 14 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are not always supported in living their lives as they might choose and the routines of the home are suited more to the staffing arrangements. Evidence: The manager told us in the Annual Quality Assurance Assessment that residents are supported to develop skills and to participate in activities of their choice both in and outside of the home. They told us that when relatives visit they are invited to take meals with residents. The manager said that they could encourage residents to be interested in more age appropriate pastimes and motivate those who are reluctant to participate more effectively. When we visited the home we looked the care plans for two of the three residents. We saw that both residents had a plan of care which described their wishes for the activities they wish to participate in. One of the two residents was more capable of living a more independent lifestyle and this was reflected in their care plan. We saw that this person attended college one day per week to learn skills to improve living skills. They also accessed activities such as clubs and pubs within the local community. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: This person also went to the owners other home each day to participate in occupational activities. There was no evidence as to whether residents were offered alternative opportunities for occupation during the day or that they could choose to stay in their own home should they wish to, rather than spend their days at the providers other home. We looked at records kept by staff there about the activities this resident participated in. These were not completed fully and referred to projects carried out during the afternoon. It was not clear as to whether the activities were suitable for the resident and whether they included pursuits, which the resident liked to participate in. It was recorded in this persons care plan that they enjoyed music, dancing and outings. We saw that with the exception of going out a club one evening each week that there was little evidence of the person being supported to participate in these activities. The manager told us that this person had been on over one hundred outings within the previous twelve months. When we looked at records we saw that these related to trips out shopping, attending a club once a week and college. There was no evidence of any other outings. In the other care plan we looked at it was recorded that the person had a job rota for domestic chores in order to give them a sense of purpose. This included activities such as setting places at the table for meals. However staff told us that the person no longer carried out these tasks and had not done so for some months. The care plan had not been updated to reflect this and there was no evidence to suggest that other forms of occupation has been considered. We looked at the daily routines for the home. It appeared that these were tailored to suit the staffing structure within the home. For example all residents leave their home to go to the owners other home each day. The manager said that residents were very happy to go and that this was agreed as part of the contract for their care package. The manager said that they did not have a copy of the contract to evidence this. Taking this into consideration there was little evidence that residents had any choice as to whether they went or not. It appeared that this practice had become the norm rather than one, which has been reviewed so as to promote individual choices for residents. In one residents care plan it was recorded that staff were to support the resident in choosing the clothes they would like to wear. It was recorded (resident name) should be offered a choice of clothes before dressing in the morning. Letting her choose the previous evening can give more time. It was not clear that this was the residents choice or as to why they could not spend time choosing clothing in the morning. The manager told us that supporting residents to choose clothing can be a lenghty process and requires one to one staff support and that this time is greater in the evening. We looked at the arrangements for supporting residents with choosing and preparing food and meals. We saw that staff supported resident in buying and preparing food and that there was a planned menu, which reflected residents likes and dislikes. Each resident had a care plan which described the support the individual needed. Staff told us that one resident could read the menu and the others were supported in choosing meals through the use of picture cards. Care Homes for Adults (18-65 years) Page 16 of 30 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 in the home are well looked after and their health care and personal care needs are met. Evidence: The manager told us in the Annual Quality Assurance Assessment that the health and personal care needs of residents are met and that staff are trained to administer medicines safely. He also told us that the home is occupied by three females who are supported by an all female team of care staff. Residents completed surveys with assistance of staff and said that they staff treat them well and act on what they say. When we visited the home we looked at how the personal and health care needs of the residents were assessed and how residents were supported. We looked at the care plans for two of the three residents. We saw that they way in which both people wished to be supported in maintaining good oral and personal hygiene was recorded and kept under review. We saw that both residents were supported in attending routine appointments for health care monitoring and that had access to medical, dental and optician services when needed. Generally it was recorded that residents enjoyed good health and residents looked well cared for. At the time of the inspection none of the residents living in the home were capable of safely keeping and administering their medicines. We spoke with one member of staff Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: and looked at training records and saw that staff had appropriate training in the safe handling and administration of medicines. We looked at medicine administration records and these were completed accurately to show that residents received the medicines, which were prescribed for them. Care Homes for Adults (18-65 years) Page 18 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are treated well by staff. However residents may not to understand or use the complaints procedure as it is not is a format, which they can easily understand. Evidence: We were told in the Annual Quality Assurance Assessment that any complaints or safeguarding alerts would be dealt with openly and thoroughly. The manager told us that residents relatives are provided with information on how to complain and how their concerns would be dealt with. They also told us that staff received information about dealing with complaints and whistle blowing when they commence work at the home. When we visited the home we looked at the policy and procedure in place for recording and dealing with complaints. There was a procedure in place for residents which said We hope you will never have anything to be unhappy about. If you do we want to know. If you are unhappy about anything you should tell your Key worker... We observed that while the policy was written simply that residents would still be unable to understand it. We advised the manager that a pictorial audio or video format may be of more use to residents. The manager told us that residents living in the home would not be capable of making a verbal complaint, but that they would be able to express displeasure and that staff would be able to pick up on this. We looked at care plans to see if there was any information recorded about the way in which residents express displeasure and what signs staff should look for, but there was no information recorded. The manager told us that there had been no formal complaints made about the service within the past twelve months. They told us that one resident had complained about their bedroom being cold and that this was dealt with. No records Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: were recorded for this. Staff completed surveys on behalf of residents and told us that residents knew how to complain and who to speak with if they were unhappy. There was a safeguarding policy and procedure in place and the manager told us that all staff were given this information when they commenced work at the home. One member of staff was on duty during the inspection. They told us that they had received safeguarding training and they demonstrated that they understood their responsibilities if they witnessed or suspected any ill treatment of residents. There was a whistle blowing policy which staff had access to. This helps assure staff that they will be protected from harassment should they need to raise concerns about the home or other staff. We saw that staff were recruited thoroughly and all the relevant checks to a persons fitness were carried out before they started work at the home. We saw that not all staff had received recent safeguarding training to keep them up to date with local policies and procedures and help ensure that all concerns would be treated properly. There have been a number of changes around safeguarding people who may be vulnerable and two members of staff had not received training since 2006. Care Homes for Adults (18-65 years) Page 20 of 30 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 is clean, safe and generally well maintained. Some areas of the home are not furnished or decorated to reflect residents choices. Evidence: The manager told us in the Annual Quality Assurance Assessment that some general refurbishment had been carried out to the home. He said that home was clean, residents bedrooms were individually personalised and the home was safe. Three residents completed surveys with assistance from staff and they said that the home is always fresh and clean. We carried out a brief inspection of the premises when we visited the home. One resident lives more independently in a cottage adjacent to the main property. They invited us to look around. The cottage was clean and comfortable and was decorated and furnished with items which reflected the persons personality and likes (such as soft toys, posters and a selection of music and DVDs). The main house was more sparsely decorated and some of the furniture and fittings looked worn and tired (this was commented upon at the last inspection). One residents bedroom was personalised however the other was very bare. The manager said that this was due to the fact that this resident tended to stack items on top of each other. We advised the manager that a more appropriate way of managing this behaviour should be considered, which would not detract from the persons comfort and enjoyment of their surroundings. The manager told us that this resident had been throwing their personal belongings out of their bedroom and that staff had decided that they were making it clear that they did not want them. However there was no evidence of this in the residents care plan or that other options had been explored. Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: Residents spend the majority of each day (9.30am to 4.30pm) rather than being able to spend time in their own home environment. Care Homes for Adults (18-65 years) Page 22 of 30 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. Residents are supported staff who are recruited thoroughly and supported. Staff have not received training so that they can support residents assessed needs. Evidence: The manager told us in the Annual Quality Assurance Assessment that the home did have never used agency staff. He told us that staff are recruited thoroughly and trained to meet the needs of residents. Residents who completed surveys said that staff listen to them and act on what they say. When we visited the home residents were out of the home for the majority of the day and returned from Peter House at approximately 4.30pm. We saw that one member of staff was employed between the hours of 4.30 in the afternoon until 09.30 the following morning. Staff slept from 10pm till 07.00. During the day no staff were employed in the home unless residents were unwell and stayed at home. We looked at how staff were recruited to work in the home. We reviewed the information for one person who had been employed at the home since the last inspection. We saw that before the person commenced work that they had provided information about their previous employment and satisfactory references had been obtained. Criminal Records Bureau disclosure and PoVA First checks had been carried out and the person had been interviewed in the presence of one resident. This helped to involve residents in the process of selecting people to work in the home. Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: Once staff commenced work at the home they undertook a period of induction to help familiarise themselves with policies, procedures and the needs of residents. The manager told us that they were implementing the Common Induction Standards induction. This is a set of nationally recognised standards and helps to ensure consistency in the delivery of care and support to people who receive social care. The manager told us that he was completing a training and development analysis for staff working in the home. We saw that staff had received training in safe moving and handling, administration of medicines, communication, infection control and health and safety. Staff had not received training in respect of caring for people who have learning disabilities, communicating using makaton or training around supporting people to make choices. The manager told us that they intended providing more training specific to the needs of people who have learning disabilities. Following the inspection the provider supplied us with evidence of staff training, which was not available on the day of the visit. We saw from records provided that staff had not had updated training since 2006 or 2007. Regular training is required so as to keep staff up to date with new ways of working and to ensure that they can support residents for their individual health, social and personal care needs. Care Homes for Adults (18-65 years) Page 24 of 30 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 adequate 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 but not always run in the interests of residents. Evidence: The manager told us in the Annual Quality Assurance Assessment that there was a system in place for monitoring the quality of the service, including obtaining the views of residents. He told us that where less positive comments were received that an action plan would be put in place to address the issues raised. They also told us that regular staff meetings are held to discuss and consult people on matters affecting them. When we visited the home we looked at the arrangements in place for obtaining the views of the people who live in the home, people who are important to them such as family and advocates and other people who are involved in their care. We saw that people were provided with questionnaires and that residents were asked if they were happy with their surroundings, lifestyles and opportunities available. They were also asked if staff allow them privacy, dignity, independence and choice. Residents used pictures of happy or sad faces to express their views. However it was not clear whether all residents would understand the questions in the format used in the surveys and the use of pictures, photographs or other symbols may have been more appropriate. We saw that surveys completed by relatives indicated that they felt that Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: residents were well looked after. The manager told us that there were no resident meetings. Staff meetings were held at the owners other care home (Peter House) the minutes for some of these. We saw that issues such as staff training, residents behaviour and making a residents bedroom more age appropriate by removing toys as they had no interest in them. There was no evidence of any discussion or consultation with the residents regarding this decision. It was noted that in the minutes of meetings that the home was referred to as the annexe. This gave the impression that the home was not being managed separately from Peter House. We looked at how the home was managed and maintained. There were records and certificates to show that the home was maintained and fit for purpose. Checks were carried out to ensure that systems and equipment such as heating and hot water systems, fire detection installations and electrical equipment were maintained in good safe working order. We saw reports from the local environmental health officers and these indicated that the manager complied with their regulations. We looked at accident records and there had been no accidents or incidents affecting the health, safety or welfare of residents within the previous twelve months. Care Homes for Adults (18-65 years) Page 26 of 30 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 27 of 30 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 35 18 Staff must receive training, which is relevant to their roles and the specific needs of residents. 29/05/2009 This will enable staff to support residents in a better way and to meet their individual needs. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 7 8 Residents could be supported more to make decisions about the way they spend their time and live their lives. The policies and procedures, which affect residents should be summarised in a format so that residents could better understand them. This would make it easier for residents to participate and be better involved in making decisions about the day to day running of the home. Care Homes for Adults (18-65 years) Page 28 of 30 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 3 4 13 16 Residents could be supported more to access amenities and activities within the community. The routines of the home and they way in which residents are supported should be more flexible to maximise each persons choices. The complaints procedure should be developed in formats which residents would be able to understand more easily. This would help to ensure that residents understood how to say if they were unhappy about something. Information about how residents express satisfaction and dissatisfaction should be incorporated into their care plans so as to ensure that all staff can recognise and deal with any dissatisfaction in a consistent way. All staff working in the home should undertake periodic training in safeguarding people from abuse. The homes environment could be improved and made more personalised to reflect the wishes and interests of the people who live there. The tools used to obtain the views of residents (as part of the homes quality monitoring and assurance process) should be appropriate the needs of residents and should be based upon the things that matter to them. 5 22 6 22 7 8 23 24 9 39 Care Homes for Adults (18-65 years) Page 29 of 30 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 © (2010) 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 30 of 30 - 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!