Care Home: 1 Upfield

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What the care home does well The home provides service users with an environment in which they can feel safe and secure and where they are valued as individuals. The atmosphere is friendly and inclusive and staff are genuinely interested in the lives of the people they support.Each person is given the support they need to lead an active and healthy lifestyle, to make choices and try out new experiences. Care plans are of a good standard and reflect the needs of individuals,risks are assessed and regularly updated and staff are provided with clear procedures to follow to minimise risks.Service users and their representatives are involved in the care planning process. The home promotes communication and has a variety of tools that they use to help service users communicate,there is a large amount of pictorial information around the home individual communication needs are catered for. Health needs are well met and the home takes preventative measures to keep people as healthy as possible and promotes equality and diversity.Medication procedures are robust and protect service users,all staff receive medication training. The organisation keeps up to date with the need to offer training on new legislation such as the Mental Capacity Act. Staff are well trained and supported and knowledgeable about the needs of people they support.They are aware of their responsibilities in keeping service users safe and receive annual safeguarding training.Staff involved in the inspection and who returned surveys were complimentary about the support they receive from the manager and the organisations management overall. The environment is homely and well presented with investment being made regularly in new furnishings and redecoration.Bedrooms are personalised and reflect the interests and personalities of the occupants. What has improved since the last inspection? There has been progress made on the signing of care plans by service users or their representatives. Staff files examined now contain all the necessary recruitment documentation including full employment histories. New communication tools have been introduced and this work is continuing with the purchase of new computer software. A member of staff has attended a nutrition training course and has been working on menus with service users.Staff have received equality and diversity training. A bedroom has been redecorated and there has been redecoration in some shared areas,new carpets have been fitted in shared areas. The home has purchased a second people carrier to maximise opportunities for activities and outings and some new activities have been sourced. What the care home could do better: No requirements have been made as a result of this inspection. Key inspection report Care homes for adults (18-65 years) Name: Address: 1 Upfield 1 Upfield Horley Surrey RH6 7JY     The quality rating for this care home is:   three star excellent 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: Deborah Sullivan     Date: 1 0 0 8 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 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) 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 28 Information about the care home Name of care home: Address: 1 Upfield 1 Upfield Horley Surrey RH6 7JY 01293782396 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: UPFIELD@HOTMAIL.CO.UK Gresham Care 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 to be accommodated is 6. The registered person may provide the following category of service only: Care home only - (PC) tos ervice users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) Date of last inspection Brief description of the care home 1 Upfield is registered to provide accommodation, care and support for up to six service users who have a learning disability. The home is located in a residential area close to public amenities and other facilities with the accommodation on two floors comprising of an office, kitchen, lounge, dining area, laundry room, bathrooms, toilets, showers and six single bedrooms. The home has a garden which is secure and accessible with private parking available. The range of fees charged by the home is £1300.00 to £1916.00. 6 Over 65 0 Care Homes for Adults (18-65 years) Page 4 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: three star excellent 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 key inspection of 1 Upfield took place over four and a half hours.During the visit time was spent with the registered manager,deputy manager,service users, all of whom were at home for all or some of the time, and support staff.The provider was present for a short while. A range of documents were read including care plans,staff files,medication records and some policies and procedures. Discussion took place with individual staff members. Information provided in the AQAA (Annual Quality Assurance Assessment) completed by the registered manager has also been used as evidence for this inspection.Survey forms were received from one service user,three members of staff,three relatives and four health and social care professionals.Some of the comments made on the forms have been incorporated into this report and are very positive about the service. Care Homes for Adults (18-65 years) Page 5 of 28 What the care home does well: What has improved since the last inspection? There has been progress made on the signing of care plans by service users or their representatives. Staff files examined now contain all the necessary recruitment documentation including full employment histories. New communication tools have been introduced and this work is continuing with the purchase of new computer software. A member of staff has attended a nutrition training course and has been working on menus with service users.Staff have received equality and diversity training. A bedroom has been redecorated and there has been redecoration in some shared areas,new carpets have been fitted in shared areas. Care Homes for Adults (18-65 years) Page 6 of 28 The home has purchased a second people carrier to maximise opportunities for activities and outings and some new activities have been sourced. 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. 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 7 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 8 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. Prospective service users have access to information about the home and can visit so that they can make an informed choice about deciding to live there. Needs are assessed before a place at the home is offered. Evidence: No new service users have been admitted since the last inspection and there no plans for any changes to the current group of people living at the home,the last new admission was in 2006,all the service users are of similar ages. The statement of purpose and service users guide are up to date and are available in text and pictorial format so that they are accessible to service users, they are offered the choice to keep a personal copy in their room. The service users guide is comprehensive and the homes policies and procedures have also been produced in an accessible format. There is a pre admission assessment procedure in place for prospective new service Care Homes for Adults (18-65 years) Page 9 of 28 Evidence: users, relatives and health and social care professionals involved contribute to the process.Introductions to the home are personalised and include visits and opportunities to meet existing service users.Survey forms received from relatives confirmed that information was available to enable them and the service user make a decision about moving to the home. Care Homes for Adults (18-65 years) Page 10 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home each have a plan of care that is up to date and reflects their needs and preferences. Risks are assessed,reviewed and clearly recorded. Involvement in the daily running of the home is encouraged and service users are supported to make decisions about their lives and the service. Evidence: Each person has an individualised care plan which they are involved in compiling,the care plans of three service users were read.Service users can access their care plans at any time and one person has chosen to keep theirs in their room.Information is held in two folders for each person,the main person centred care plan folder and the health action plan. The plans are well maintained they contain information on the personal background of Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: the service user and on their preferences,aspirations,interests and activities.Risk assessments are in place, are regularly reviewed and there are guidelines for staff to follow, including clear guidelines for the management of behaviours that may challenge.Staff sign that they have read the updated guidelines. There is pictorial information included in the care plans and progress has been made on the signing of care plans by service users or their representatives. The care plans and discussion with the manager and staff showed that service users are supported to make decisions about their lives,to take assessed risks and are valued as individuals with differing needs and personalities. A relative wrote on a survey form that Residents are well cared for,respected as individuals,and given every opportunity for personal development and a social and health care professional wrote that the home had a person centred approach to care,support and reviews,excellent staff team with a focus on communication,use of symbols,PECS(Pictorial Exchange Communication System), and creative ways to involve service users. Written information examined about service users was securely stored,up to date,written in respectful language and well presented. Service users are supported to make informed choices and take acceptable risks.Staff use a variety of tools to communicate with service users who mostly have very limited verbal communication skills.Examples of methods used are Widget and other pictorial symbols and PECS.Staff understand the signs and gestures used by service users and the communication observed during the visit between service users and staff was very effective.The use of pictorial information is promoted by the home and was in evidence throughout the building, for example pictures of food or crockery on cupboards in the kitchen showing what is kept in them and a pictorial shopping list reminder. Service users have key workers and individual key worker meetings are held,it is agreed that one person does not have a designated key worker due to issues relating to their personality,the evidence seen was that this does not detract from the personal knowledge staff have about them or support they receive and the manager said it worked well. Staff spoken with and observed were knowledgeable about the individual needs of service users,genuinely interested in their lives and how best to expand their experiences and support them. Service users are supported to take part in the daily running of the home,they choose the menus at Sunday menu meetings,are encouraged to keep their own bedrooms clean and tidy with support and to take their washing to the laundry and collect it.They are offered the opportunity to be involved in recruitment of staff,applicants are Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: invited to visit the house to meet them.During the visit one person was busy at their daily tasks and there is a list of tasks up in the kitchen,these are geared to the ability of service users and the amount of support they need. Care Homes for Adults (18-65 years) Page 13 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. Service users have opportunities to take part in a range of activities at home and in the community and each has an individual activities plan. Contact with friends and relatives is promoted. Meals are well balanced and healthy and menus chosen by service users. Evidence: Each service user has an individual activities programme that records their daily routine fully and the social,educational and leisure activities they take part in at home and in the community. Activities are geared to peoples interests and abilities and the organisation has a placement officer who sources new opportunities. One service user went out to their voluntary work for a charity during the visit,others went out for a Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: walk,this took the place of a swimming session that only takes place in term time as as the pool is too busy in holidays.Two people went out to a session in another homes sensory room and three were to attend a music group in the community in the afternoon. Some other activities provided in the community are college,trampolining,art therapy,line dancing,social clubs and dance groups and a disco.One person has a tricycle that they go out for regular rides on and the AQAA tells us that service users take part in a weekly paper round.Community presence is promoted and the home includes neighbours in its annual survey circulation. The home has two people carriers one is new this year and there is always a driver on duty. At home service users pursue their own interests,one person who is very computer literate has assisted in producing some of the homes pictorial information. Contact with friends and relatives is supported,service users are helped to keep in touch and some spend regular weekends with relatives.Five service users are having holidays this year,one prefers to stay at home and have supported days out. The routines of the home are flexible,service users can choose when to get up and go to bed and they are offered keys to their rooms,three people currently have keys. Meals are healthy and nutritious,healthy eating is promoted,service users choose the menus from a wide range of pictures of meals and foods.One person has been supported to loose weight and another has their weight monitored as they need a high calorie diet.Staff said one service user who used to only accept a very limited range of food to eat now accepts vegetables and potatoes and is widening their choice of meals.A staff member had recently been a nutrition course and planned the meals with service users,advice from a dietitian is sought as well. The lunch on the day of the visit was well presented,freshly cooked and healthy,the mealtime was relaxed with staff chatting with service users. Care Homes for Adults (18-65 years) Page 15 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. The personal and healthcare needs of service users are well met and are provided in ways that they prefer. Medication procedures are thorough and protect service users. Evidence: The people living at the home all have complex needs including autism,challenging behaviour, limited verbal communication,hearing loss and epilepsy.Service users vary in the amount of support they require with their personal and healthcare.Some people are more independent with their personal care just needing some prompting,whilst others need much more or total support. Independence with personal care is promoted and preferences are respected.Each person has a daily planner showing their activities for the whole day including the times they prefer for getting up and going to bed,mealtimes and activities.One person is supported with personal hygiene by a staff member of the same ethnic background. Health action plans record health needs in detail.They include background information,information about which health care professionals are involved and Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: recording of health appointments and assessments.Service users are supported to access a range of health care specialists such as an epilepsy nurse,the GP,art therapist and psychiatrist. Regular health checks take place such as dental appointments and a dentist commented on one of the homes 2009 annual surveys on how good the service users teeth are.A service user with poor hearing has a loop system fitted in their bedroom and a special mattress designed to alert them in the case of fire. Staff and the manager explained how they promote good health by providing a healthy diet and exercise, one service user who had been overweight had lost a considerable amount of weight and another persons weight is carefully monitored. The home had acted on recent concerns about swine flu and is supplying hand gel for everyone entering the home and was monitoring the health of an especially vulnerable person closely. Communication needs are well recorded and staff demonstrated that they understood the best way to communicate with service users,they had identified triggers for difficult behaviours or causes of anxiety for service users and as far as possible procedures were in place to avoid these.The deputy manager was due to attend NAPPI(non abusive psychological and physical intervention) training shortly and would then be qualified to train other staff in the technique. Comments on surveys returned to the commission by relatives and health and social care professionals included,Heath monitoring of our son is excellent and from a health professional Appropriate sensitive support for the individual I see.....interest in their well being...good communication. Medication is securely stored,the manager said that a new larger medication cabinet is to be purchased.Medication recording sheets were sampled,there were no errors on them and each persons section in the medication folder includes their photograph and information in pictures and text as to how they prefer medication to be given. All the staff have medication training and there is an up to date list with their names and signatures. Communication needs are well recorded and staff demonstrated that they understood the best way to communicate with service users,they were very aware of any triggers for difficult behaviours or causes of anxiety for service users. Care Homes for Adults (18-65 years) Page 17 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. Service users and others have access to a complaints procedure and can feel confident that any concerns will be taken seriously and addressed. Service users are protected by the homes policies and procedures and staff are aware of safeguarding procedures. Evidence: The home has a complaints procedure that is available to service users pictorially.No complaints had been received since the last visit.Most service users would need support to raise any concerns,staff understand their methods of communication and all the service users have relatives and/or other advocates such as care managers.One service user sent in a survey and said they knew how to make a complaint.Discussion with the manager and staff showed that they understood how service users would display anxiety or unhappiness.Staff work hard to reduce anxieties and prevent situations that cause them so that service users are more settled, evidence shows that there is less incidence of challenging behaviour as a result which promotes safety. There is a safeguarding procedure and all staff receive safeguarding training,it is renewed annually.No safeguarding alerts have been raised since the last visit.Staff involved in the inspection confirmed they had been on the training and knew who to go to if they suspected abuse. Recruitment procedures and vetting of applicants is thorough and protects service users. Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: Clear guidelines are in place for the management of behaviours that may challenge so that service users and others are protected from harm when they are at home and in the community. 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. Service users benefit from living in a homely environment that is well maintained and and safe. Bedrooms reflect individual interests and personalities. Evidence: The house is homely,well furnished and decorated,clean and hygienic.There have been improvements made to the environment since the last visit,some radiators are now guarded,new carpets have been fitted to communal areas and some redecoration has taken place including in one bedroom that was visited with the occupant.They had chosen the colour scheme to match their interest in the fire service and it had been done in a variety of colours very attractively.The bedrooms visited were all well decorated and reflected the interests and personalities of service users.One person who can have difficulty sleeping has had blackout curtains fitted and records show this is having a positive effect.For those that benefit from having pictorial information on their wardrobes and cupboards, storage in bedrooms is labelled pictorially with the content, for example socks or underwear.If specialist equipment is needed this is provided such as a hearing loop system in one bedroom. There is one bathroom upstairs and one downstairs,there is also a shower downstairs.All bedrooms have Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: wash hand basins fitted. The lounge was being well used during the visit,it is large and comfortable,people who were at home during parts of the day were using it to relax and spend time with staff. After lunch a member of staff sat in the lounge with a service user supporting them with a picture recognition game which they were enjoying.There is a computer for service users to use in the lounge with headphones so they do not disturb others.The lounge has patio doors onto the garden which is well maintained,attractive and is safe and secluded,some new shrubs had recently been planted.There is patio furniture and a swing. The kitchen is large and well equipped,with a dining area.Early on in the inspection breakfast was still being taken by one or two people and the majority were present for lunch.Breakfast times are flexible and service users can help to prepare it themselves.They are supported to help with preparation of other meals if they choose. The laundry is hygienic and each person brings down their washing and takes it back to their room,one person does their laundry mostly independently, including ironing. 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 excellent 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 a well trained and confident staff team who enjoy working with them. The recruitment procedures in place protect service users. Evidence: The home is staffed by the registered manager,deputy manager and support staff. The manager,deputy manager and three support staff were on duty during the visit.Staffing is flexible depending upon the activities of the day and the need for one to one or two to one support.There was a mix of male and female staff and of ages and ethnic backgrounds,one staff member from the same ethnic background as a service user has joined the staff team this year. Staff work a long days and sleep ins followed by whole days off to provide continuity for service users, two staff members spoken with said they were happy with this arrangement.There is little staff turnover and most staff have worked at the home for a number of years.Agency staff are not used,if necessary bank staff who know service users are on shift.Photos of the staff on duty that day were displayed so service users knew who would be supporting them. Four staff files were examined,all contained the required recruitment documents and Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: there was supervision recording.Service users have the opportunity to meet applicants for posts,the applicants are invited to visit the home and the manager said service users can be very good judges of who is suitable or not. It was clear from reading recruitment records that the process is robust and any information that is unclear or incomplete is looked into. The training plan was seen,all staff have core training renewed each year,most training is provided by the oranisation.Service specific and other courses are available such as autism,report writing,Mental Capacity Act and deprivation of liberty,bereavement and recently a person with the condition had given training on dyspraxia,staff said they found this very helpful.The majority of staff hold an NVQ in care at level two or above. New staff have a period of induction and do not work on their own until they feel confident to do so. Staff records and staff involved with the inspection confirmed that regular supervision and staff meetings are held and recorded. Staff observed during the visit were respectful and attentive towards service users and had a very good rapport with them. A survey form from a relative stated They (staff) are quick on their feet adapting to changing needs and situations and have the rare ability to think outside of the box. A social care professional wrote on a survey Stable and consistent staff team who are user focused,good communication between all parties. Staff spoken with and who sent in surveys said they enjoyed working at the home and providing a good quality of life for the people who live there,comments included, Its like my second home,I love it Compared to other homes I have worked in,this is exceptionally good,it is the best home I have worked in since I started working with vulnerable adults,-----the good work at Upfield is reflected in the service users health and well being. Staff also put on surveys under the question ,what does it do well?, that the home Treats all staff and clients with equal opportunities,Communication between the team and outside professionals and Training staff and managing shifts. 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 excellent 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 and run in the best interests of service users and staff and the policies and procedures in place promote safety. Internal quality assurance takes place and the views of service users are sought and acted upon. Evidence: The home is inclusive,has a welcoming atmosphere and is organised so that the needs of service users are central to its day to day running and it is responsive to changes in needs. Since the last inspection the manager has become registered,the manager is well qualified for the post and experienced in working with the service user group. Comments from staff who were involved in the inspection or who sent in surveys were positive about the management of the home,one said that the manager is always there to listen to staff and clients and another that there is such good management. A social care professional commented on a survey that they were very pleased with the service received by their service user and keep up the good work. Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: A relative wrote on a survey that The management are knowledgeable,professional,and experienced.All layers of management are easily approachable and it is obvious that every resident is not only well documented but highly valued . The provider and senior managers support the registered manager and deputy and visit the home weekly as well as for required regulation 26 visits undertaken by the provider.The provider was present for a short while during the inspection.Examples of regulation 26 visits were seen and they identify any actions needed. The AQAA(Annual Quality Assurance Assessment) was completed on time and was clear and informative. Regular maintenance checks such as fire equipment and vehicle checks take place and are recorded. The views of service users are sought via individual keyworker meetings and on a day to day basis.The manager explained that service user meetings, other than menu meetings, are no longer held as they raised anxiety levels for service users.Care plans contained evidence of service user consultation for example where they wished to go on holiday.The home sends out annual quality assurance forms to relatives and other advocates and health and social care professionals annually,the results of this years survey were sampled and they showed that there was a good level of satisfaction with the service. Policies and procedures are updated annually or as required and some are produced in widget to make them more accessible for those living at the home. All the records and documentation seen were completed to a good standard and kept confidentially. Safe working practices are observed and all staff have training in topics such as manual handling and food safety renewed annually.Substances that could be a risk to service users are stored safely and staff were observed to be using safe working practiced during the visit. 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 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. 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