Care Home: 1 The Glade

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What the care home does well The service provides accommodation to four male residents with learning difficulties. The residents have a variety of individual needs and it has been identified that they all need different support and accommodation. The housing association have met regularly with the care providers to ensure that the proposed changes made to the accommodation are in the best interest of the current users of the service. The staff have worked with each of the residents to ensure that they have an understanding of what is provided by 1 The Glade and their rights and responsibilities. Independent advocates have also been used to support this process. The staff team are a settled team and work well together and the best interest of the residents was paramount. The home has robust medication audit processes, so that if mistakes were ever identified these could be dealt with immediately with minimum effect to the resident. Residents are supported to attend health appointments and routine screening. What has improved since the last inspection? There had been a number of improvements since the last inspection. However these initially took longer than we would have expected to be implemented. At a random visit in November 2009 we reported that the manager had addressed some areas of improvement, had produced a detailed action plan, but more work was still needed for total compliance. At that time we were unsure if the manager had the ability to move the home forward. At this inspection all areas identified in the action plan had been addressed and improvements to the quality of the residents lives noted. Staff told us that they had worked hard since November, but had an increased understanding of what was expected of them and their role in the team. Following the random inspection the manager kept us advised of progress. The improvements included an updated service users guide and statement of purpose in a format that staff could share with the residents. There was much more evidence that people using the service were asked to make decisions about their lives. The decision making process included details of the unique mannerisms and behaviours that staff knew confirmed an agreement or not. The activities available to the people using the service had not changed dramatically but better recording of peoples participation provided the evidence that people were involved in meaningful activities throughout the day. Additional furniture had been purchased and the home had a more homely atmosphere both inside and out. What the care home could do better: There were no requirements made as a result of this inspection only recommendations. These included the need to ensure all care plans were on a six-monthly review programme so that if care needs did not alter between one review date and the next the reader could be confident the information documented was the most current. Care plans also needed to be recorded in a style that clearly reflected the person centred care that was provided. Staff should be mindful that when carrying out routine assessments any deviations from the normal must be accompanied by an explanation as to how it is to be addressed. The management should ensure that the on-going review of the policies and procedures is completed as soon as possible. Key inspection report Care homes for adults (18-65 years) Name: Address: 1 The Glade 1, The Glade Bromham Beds MK43 8HJ     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: Sally Snelson     Date: 1 4 0 4 2 0 1 0 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 28 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: 1 The Glade 1, The Glade Bromham Beds MK43 8HJ 01234827068 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.fremantletrust.org The Fremantle Trust Name of registered manager (if applicable) Miss Marion Jean Gant Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category of service only: Care home Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Learning Disability -Code LD Date of last inspection Brief description of the care home 1 The Glade is a home for up to six adults with learning disabilities, managed by Fremantle in conjunction with Bedfordshire Pilgrims Housing Association - who are responsible for the maintenance of the building. The home is a large bungalow situated on the outskirts of Bromham village, approximately 5 miles from Bedford town centre. There are six bedrooms, a dining room, 2 lounges, a relaxation room, and a family room. In addition, a staff office, laundry, kitchen, bathing and toilet facilities are provided. There are no facilities for Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 6 2 3 1 1 2 0 0 9 Brief description of the care home people with a physical disability, apart from one toilet. The bungalow is set in substantial grounds, which includes a separate building, used as an activity room. Some of the people living in the home demonstrate behaviours, that challenge, and to this end, access to the home is through a secure gate, controlled by staff. High fencing surrounds the home, meaning that the people living in the home are free to roam safely, within the bungalows grounds. Parking for several cars is available to the front, and side of the building. The homes Statement of Purpose sets out that the home aims to provide a specialist service for people with Autistic Spectrum Disorder, or associated needs. Care Homes for Adults (18-65 years) Page 5 of 28 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 inspection was carried out in accordance with the care quality commission (CQC) policy and methodologies, which requires review of the key standards for the provision of a care home for adults. The methodology takes account of the views of the people using the service (residents) and information received about the service since the last inspection. Information from the home, through written evidence in the form of an Annual Quality Assurance Assessment (AQAA) has also been used to assess the outcomes within each standard. Evidence used and judgements made within the main body of the report include information from this visit. The manager was on leave at the time of the inspection. The team on duty took responsibility for supporting the inspection process. During the inspection the care of one of the people using the service was case tracked in detail. This involved reading their records and comparing what was documented to Care Homes for Adults (18-65 years) Page 6 of 28 what was provided. In addition to sampling files, people who lived at the home were observed and staff were spoken to, and their opinions sought. Any comments received from staff or residents about their views of the home, plus all the information gathered on the day, and information from the random inspection in November 2009 was used to form a judgement about the service. The residents had limited verbal communication, but staff were able to make them aware of the inspection process. We would like to thank all those involved for their assistance with the inspection. Care Homes for Adults (18-65 years) Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: There were no requirements made as a result of this inspection only recommendations. These included the need to ensure all care plans were on a six-monthly review programme so that if care needs did not alter between one review date and the next Care Homes for Adults (18-65 years) Page 8 of 28 the reader could be confident the information documented was the most current. Care plans also needed to be recorded in a style that clearly reflected the person centred care that was provided. Staff should be mindful that when carrying out routine assessments any deviations from the normal must be accompanied by an explanation as to how it is to be addressed. The management should ensure that the on-going review of the policies and procedures is completed as soon as possible. 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. 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 28 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 28 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. There was information available to residents and their family. The documents were in formats that included picture, photographs and narrative to help people to make decisions. Evidence: The home had a statement of purpose and Service Users Guide that covered all the areas required by the National Minimum Standards. The Statement of Purpose had been updated in October 2009 and a copy sent to us. The Service Users Guide had also been recently updated. These documents were now in a format that was more suitable, as they included pictures and photographs that would be familiar to the residents. Since the last inspection some narrative had been added to the easy read versions to help staff share the information with the residents. There was evidence that staff had attempted to share the contents of these documents with the people using the service. There was a copy of the Service Users Guide and the individuals contract stored in a file in each bedroom. Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: There had been no new admissions to the home since the last inspection and currently the home had no vacancies that needed to be filled. The home was registered for up to six people but changes to the environment were planned that would reduce the occupancy to four. Staff told us how they had supported more than one of the residents to look at alternative accommodation. Therefore their understanding of peoples needs when moving, and the admission policy, indicated that any prospective new residents would be correctly assessed for the service. The staffs ability to meet the needs of the people using the service will be discussed in the staffing section of this report. Each of the residents had a contract and again we saw evidence that staff had tried to help the resident understand these. The capacity of each resident had been assessed by an independent assessor for their ability to understand or sign documents. Care Homes for Adults (18-65 years) Page 12 of 28 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. Documentation, and talking with staff, told us about the ways people living in the home were supported to ensure that their individual needs would be met. Evidence: Because we had visited the service twice in the last 12 months, and because there were only four people living at 1 The Glade, we looked in detail at the documentation and care provided to one resident. We looked at some documentation and spoke to staff about the other three residents. Staff had worked hard since the random inspection in November 2009 to ensure that the care plans included details about all the care that was needed and how the care should be provided. It was apparent that the plans were working documents, produced by the residents key worker, with detailed information for the rest of the staff team. The plans that we looked at had been altered as care needs changed. Any alterations had been signed and dated by the person making the change. However because there was nothing to suggest that a routine six-monthly review had taken Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: place, we were unsure what would happen if care needs did not alter. This was concerning as some of the original plans were dated July 2009. The plans showed that staff had some understanding of person centred care, and how to document that this is provided. This needed to be built upon. We also saw that people using the service were offered choices. A record was kept as to how the choices were received by the resident and how decisions were made. For example, we had read that a person would get his shoes if he wanted to be part of a suggested trip out, but would respond with no, no no if he did not want to participate. Staff were taking items to the recycling bank, and offered the residents a chance to accompany them; it was clear that this resident had made the choice to go, as he appeared with his shoes and coat. This decision making process was recorded in his file. Over time all the areas of the home had become unlocked and more accessible to the residents. People using the service were now supported to take risks. In the past risk assessments had only been completed for generic areas such as using the kitchen and crossing the road. Currently more specific risks were considered. Two staff had been trained to carry out risk assessments. Care Homes for Adults (18-65 years) Page 14 of 28 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. People who used this service were supported to make choices about their lifestyle and take part in a variety of social and recreational activities according to their interests and abilities. Evidence: On the day of the inspection, which was during the Easter holiday, some of the regular activities for the residents had been cancelled. However we saw residents going out with staff and assisting with tasks in the home. Each of the resident had a weekly activity plan and staff assured that these were kept up-to-date and, that when activities did not take place, the circumstances for the change of plan was recorded. For example, one resident who used to love train journeys, and was taken out regularly for a train ride had had a fall at the train station and currently did not want these trips. This was recorded, and the activity offered as usual, in the hope that it would be accepted again. Three of the resident had shown an interest in going to a Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: local church for the Easter service; on Easter morning only one person still wanted to attend. These changes had been clearly recorded and we could see how staff knew, that those residents without verbal communication, had made these decisions and choices. The AQAA told us that, All service users have a communication profile and passport to ensure we know how best to support and understand them. We saw these documents in the care file and staff told us they were used when a resident went to an appointment or met with someone who didnt know them. From the activity records we saw that residents attended colleges, including an art course at Barnfield College, swimming, horse riding and visits to the local pub. Some residents had been to a stay out late event, at a local nightclub, although two had chosen to return early. Residents were used to visitors in the home and they were supported by staff to keep in contact with friends and family. Two of the residents had an individual advocate and two were supported by a home advocate. One residents friend had been involved in discussions about suitable activities. Residents that wanted to, were supported by staff to have a holiday away from the home. We joined the resident for lunch. It was a sociable occasion with staff and residents sitting together in the dining room. As the meal was prepared the residents were shown two plates with the options on, and asked to make choices. The choice was ham sandwich or salad, which corresponded to the menu on display in the office. After lunch a record was made of what people had eaten and for one resident the amount drank was recorded. One resident helped clear up after the meal. Care Homes for Adults (18-65 years) Page 16 of 28 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 had access to healthcare support based on their individual needs. They were safeguarded by the medication practices within the home. Evidence: During the inspection one of the residents returned to the home following an overnight emergency stay in the local hospital. Staff had re-arranged rotas to ensure that someone from the home, who he was familiar with, was with him at all times. The AQAA told us, All service users have an All About Me document which goes with them to hospital so staff at the hospital can get to know and understand them better. This had been taken to the hospital and staff felt it had encouraged the hospital staff to address their questions to the resident in the first instance. Each person had been registered with a local GP and there was evidence that community health staff, such as community nurses visited regularly. Staff supported people to attend appointments and they had good relationships with health professionals. External health staff, for example an epileptic specialist, had supported staff to write a care plan for this condition. A variety of equipment had been sourced to support a resident with medical needs and staff accepted his right to decline the Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: support. People were regularly weighed and their weights recorded in the care files. We did note that one monthly recording showed a 3Kg weight loss. There was nothing to indicate what had been done about this. Staff were able to confirm that they had been aware of problems with the weighing equipment but they had not recorded this problem only the weight loss. The next month the lost weight had been gained. We looked at the medication records for the resident whose care we were tracking. The Medications Administration Record (MAR) sheets were all appropriately completed with signatures and omission codes, and the reverse of the sheets had been completed as necessary. We were able to correctly reconcile the medications held in the home. Staff had their own audit process for medication which identified any problems at an early stage. Care Homes for Adults (18-65 years) Page 18 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home had robust and effective complaints and safeguarding procedures, which protected the people using the service from abuse, neglect and harm. Evidence: Information provided in the AQAA and verified at the inspection confirmed that the home had a clear and effective complaints procedure and an appropriate adult safeguarding policy in place. The safeguarding policy gave clear guidance to staff about how to identify and report allegations of abuse. Staff had undertaken safeguarding training as part of their induction and as mandatory updated training. The AQAA told us and the training matrix confirmed that, All but 2 staff received 2 day NAPPI training (this is a system that supports deescalation of potential incidents) and from this training we developed Lalemand scales for each resident which show us how to support service users should they show signs of agitation and to prevent their agitation escalating. People using the service were made aware of the complaints procedure. Staff spoken with were aware of residents rights and how to refer a complainant to a senior member of staff. Service users had money held in the home on their behalf. We looked at the documentation supporting this and ensured that the money reconciled, which it did. The home had robust audit systems for personal money. Care Homes for Adults (18-65 years) Page 19 of 28 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 lived in a clean home. There were plans to make it more suitable to meet their needs. Evidence: There continued to be plans for this home to be altered to provide accommodation in flats or smaller units. There have been a number of discussions and plans for these changes, but the work has yet to be started. In an effort to help prepare residents for these change staff had fitted door knockers onto bedroom doors so that residents became used to people knocking on a knocker before entering their rooms. Despite the plans for change some repairs had taken place and some areas, particularly one toilet area, looked more homely. This was because minor repairs had been undertaken and missing floor tiles replaced. Staff had worked with one resident who did not like change to gradually introduce changes to the home. The AQAA stated, He has tolerated pictures in his room for a number of months; all of this has been achieved with the support of his key workers and other members of the staff team supporting him through the process of introducing and accepting change. We noted that pictures were now displayed in many areas of the home and some ornaments had been introduced to communal Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: areas. A low small sofa had been replaced with one that was much more suitable for one of the residents who was frail. It was a pleasure to see him lying on the sofa in the lounge looking comfortable. Curtains and blinds had been put up in areas where peoples privacy could be compromised, particularly bathrooms. Staff, with the help of some of the residents, had worked to make the garden attractive with flowering plants in pots. A fence, that divided the home from another building that was used for activities, had been reduced in height, again making the premises more homely. There were plans for for further developments in the garden, including growing more vegetables. Residents had helped a carer plant, dig up, and eat a crop of potatoes last year. Areas of the home were much more accessible to all of the residents. The gate at the front of the house and the front door was kept unlocked during the day, allowing residents the opportunity to go into the front garden. Staff now only locked the kitchen when they were cooking, although it was still necessary to have some kitchen cupboards and drawers locked. Care Homes for Adults (18-65 years) Page 21 of 28 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. Staff were trained, skilled and in sufficient numbers to support the people who used this service. Evidence: There had been a change of roles of responsibility in the home, but not a change of staff. Duty rota showed that there were three staff on duty during the day. Staff were observed to work well as a team and to be aware of their particular responsibilities to the residents and to each other. Each member of staff had an individual development plan, that reflected training completed and planned. Staff confirmed that there was a programme for mandatory training and that additional training was regularly discussed as part of the supervision process. The training matrix confirmed that where a certain member of staff had not completed, or updated, a specific training there were sufficient staff with the necessary training to ensure that the staff team, on any shift, had the necessary skills and competencies. Well over 50 of the staff team had an NVQ level2 or above we saw that there was a commitment to training within the home. On the day of the inspection the manager was on leave. The only area of the inspection that the staff on duty could not support was to confirm that recruitment Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: practises were sound. This was because personal files were locked away. There had been no new staff recruited since the last inspection. In the past sampling of recruitment files had not identified any problems in this home, or the other homes in the area under the same management. Therefore as the management regular audited staff files we did not return to sample these. The AQAA told us that staff were considering ways in which the residents could be involved in staff recruitment. The manager had a supervision plan that highlighted a supervision date for each member of staff every six weeks. Staff told us that they received supervising at least every six weeks and up to an hour and half of dedicated time was allowed for this. One member of staff said, it is a very useful time, I can talk about support issues, training, or problems outside of work. Care Homes for Adults (18-65 years) Page 23 of 28 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 manager had the required qualifications and experience to run the home. The staff team were working to continually improve the service. Evidence: Since the last inspection the manager, Marion Gant, had successfully completed our registration process to become the registered manager of the service. Staff told us that they felt the manager was fair, and that she listened to them and respected them if they had an opinion that was different to hers. We were disappointed when we made a random visit to the home, that despite the manager having produced a detailed improvement plan, the necessary improvements had not all been made. At this visit it was clear that the manager had worked with the staff team and that the team were aware of why changes had been introduced and why paperwork had to be completed. The manager completed the AQAA when we asked for it. The information provided was clear and relevant. The AQAA informed us about changes that had been made to Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: improve the service and identified where further improvements needed to be made, and how these were to be implemented. There was a quality audit system in place that ensured the home provided a good quality of care. An audit had recently been undertaken by the operational manager and a manager from another home. The staff team had regular staff meetings at which minutes were taken. Families and friends were invited to be involved in a residents care and asked for feed-back. Records examined at the inspection, and information provided in the AQAA, confirmed the home took the appropriate action to safeguard the health, safety and welfare of people living and working in the home. Records showed that all equipment including the fire alarm system and emergency lighting, were regularly checked and serviced. Following the inspection the operational manager confirmed that all policies and procedures were being reviewed and that this work was being given priority. Care plans contained detailed incident and accident report forms, the recording on the forms was good with detailed information about the incident. These were reviewed by the manager. Care Homes for Adults (18-65 years) Page 25 of 28 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 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 6 6 19 Care should be taken to record that plans are routinely reviewed at least every six months. Care should be taken that the care plans are written to reflect that the care is delivered in a person centred way. Care must be taken that if the reason for a deviation in regularly monitoring is known that this reason is recorded. If not advice should be sought. This refers to the weight loss associated with faulty scales. Management should ensure that the on-going review of policies and procedures is completed as soon as possible. 4 40 Care Homes for Adults (18-65 years) Page 27 of 28 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). 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. 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