Care Home: 10 Southbank Close

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What the care home does well The home carefully ensures that staff know about and can meet the needs of possible new customers. People can also visit and stay at the home to check it suits them. Every customer has a plan showing their care needs, likes and dislikes. Plans help staff know the care people need and what they like so they can give them the right support. Customers are enabled to take part in activities they like and go out. Staff also support their relationships with their family and make their visitors welcome in the home. Customers receive good support with their personal care. Staff monitor their health, ensure they have regular check ups and manage their medicines safely for them. Southbank Close is in a convenient place for shops and other facilities. The home is an ordinary bungalow but has ramps, aids and equipment to help people move around. Staff are well trained, which helps them keep people safe and understand customers` needs. The staff team work well together so that people have good, consistent care. What has improved since the last inspection? This is the first key inspection of the service provided by 10 Southbank Close since it was registered in respect of Midland Heart and so this is not applicable. What the care home could do better: When customers` care plans are person centred and so focus on their personal goals and support they need to achieve them they should benefit from more individualised lifestyles. Make a plan showing how the service will develop so it is better for customers. This plan should show how and when this will be done and include the views of people involved. Key inspection report Care homes for adults (18-65 years) Name: Address: 10 Southbank Close 10 Southbank Close Hereford Herefordshire HR1 2TQ     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: Christina Lavelle     Date: 0 5 0 6 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: 10 Southbank Close 10 Southbank Close Hereford Herefordshire HR1 2TQ 01432268258 01432354552 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Midland Heart Limited Name of registered manager (if applicable) Mr John Robert Hedley Type of registration: Number of places registered: care home 4 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 4 The registered person may provide the following category of service only: Care Home Only (code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Difficulties (LD) 4 Date of last inspection Brief description of the care home 10 Southbank Close was part of a larger care home set up by the Primary Care Trust in 1989. It later transferred and was run by Herefordshire Council. The operation of the service was taken over by Midland Heart Limited in September 2008. Midland Heart is a well established national provider of services for people with disabilities. The home provides long term accommodation with personal care for four adults whose primary care needs must be due to learning disabilities. People living there may also have associated challenging behaviours and physical disabilities. Southbank Close is in a Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 4 1 1 0 3 2 0 0 9 Brief description of the care home residential area of Hereford, a short walking distance from the citys shops and other facilities. The bungalow is in a quiet cul-de-sac within a campus style site with a central parking area. There is a separate building opposite within the grounds that has offices and meeting rooms. The home is a self contained bungalow adjoined to two other bungalows now also registered as separate care homes. The premises were set up for people with mobility difficulties who may be wheelchair users and has ramps, wide doors and other aids and equipment provided. The home has four single bedrooms, which all have a wash hand basin but no en-suite facilities. It has a sitting room, kitchen/dining area and bathrooms for everyones use. Information about the service is provided in a statement of purpose and customers handbook. Fee levels are based on the assessed needs of individuals using the service who are all funded through Herefordshire Council. People living there should have a terms and conditions of residence (contract) agreed with them and/or their representative also specifying their support needs, the service they receive and any extra charges. 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 is the first key inspection of the service provided by 10 Southbank Close since Midland Heart was registered as provider in September 2008. This means all the standards that are most important to people using care services are assessed. As part of the inspection we, the commission, visited the home for four hours without telling staff or people living at the home beforehand. Midland Heart call people who use their services customers and we will refer to people as this in our report. We use a range of evidence to make judgements about the quality of the service. This includes discussing the way the home is run and plans to develop the service with the manager Robbie Hedley. Staff on duty were spoken with about customers care and lifestyles. Six staff also completed surveys we sent them asking for their views on their role, training and support. It is difficult to ask customers directly about the support they receive because of their limited communication. Time was therefore spent in their company and one customer showed us around the bungalow and their bedroom. All the Care Homes for Adults (18-65 years) Page 6 of 28 feedback we obtained is mentioned in our report. We looked at various records that care homes are required to keep. They include some of the customers care records and others on staffing, medicines and the premises. An annual quality assurance assessment (AQAA) was completed before our visit. The AQAA asks managers to say what their home does well, could do better and about their plans to improve the service. All other information we have received about the service since Midland Heart took over is considered. This includes events that had affected the health, safety and/or welfare of customers (we call these notifications). 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: 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 8 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 9 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 customers can be confident the home could meet their needs. This is because a full assessment would be made of their needs, which they and their family and/or representatives are involved in before they are offered a service. Evidence: There has not been a new person move into 10 Southbank Close since Midland Heart took over and for some years before this. The homes statement of purpose describes how referrals for placements will always be made through Herefordshire Councils community learning disabilities team. This would involve a full community care assessment completed by a social worker. Midland Heart also has a written admissions procedure, which includes an eligibility criteria. The homes manager confirms he would follow these processes. They would arrange to meet potential customers at their current residence or day service to carry out their own assessment of peoples needs, possible risks, likes and dislikes. Based on this information an initial care plan and behaviour management plan would be set up. The AQAA confirms there is also a customer guide for the service as required, which would Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: be given to people and is also available in an easy read format. Following this prospective customers would be invited to look around the home with their family and/or social worker and then for tea, a meal and overnight. A trial stay period would be arranged next to see if they like it there and confirm that the home could meet their needs. The statement of purpose also appropriately says that careful consideration is given to the grouping of customers so that compatibility with people already living at the home is taken into account. During their trial stay staff monitor the suitability of the placement and a review would be held at the end with all parties involved to make the decision about whether they will live there. A contract would then be agreed in respect of their support and fee. Care Homes for Adults (18-65 years) Page 11 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Everyone living at the home has a care plan outlining their needs and the level of support staff should give them. Whilst plans include their likes and dislikes they could better reflect their personal goals and their choices and life skills could be promoted more. Possible risks to customers safety are assessed so that they can be minimised. Evidence: Staff clearly recognise that customers should be involved in planning their own care and make choices about their daily lives and routines. One of the staff comments in their survey that the service offers a person centred approach, which means every individual matters. Although the home clearly does have a person centred (PC) approach this still needs development and to be reflected in customers care planning better. Plans should identify customers personal goals and focus on how they can be supported to achieve them and develop their life skills. Midland Heart has a care plan format that is user friendly so that customers should understand them more easily and so can be involved in setting up and reviewing their Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: own plan. Plans we saw are based mostly on needs assessments that were completed some time ago. Whilst relevant areas are covered, and show some of their likes or dislikes, they should be updated to include peoples choices, skills and goals. Peoples families and advocates should also be more involved in care planning and as the homes statement of purpose says they should utilise a circle of support, which may be necessary especially when people have difficulties expressing their own wishes. An important part of this process is enabling customers to communicate their choices, what they would like to do, eat, wear etc. The home has started to use photographs, pictures and objects of reference more, which is a positive development. Care records include detailed daily shift records about customers actvities, mood, behaviours and events in their lives. They could also better reflect their achievements and progress to meet goals. Care workers are allocated to particular customers as their keyworker. Staff understand their keyworker role is to personalise support and advocate for them. The home also aims to allocate some one to one time and involve keyworkers in care planning and reviews. Risk assessments have been completed for each customer. They primarily identify possible hazards and how to keep people safe when doing such as bathing and going out. One person also has a detailed behavioural management plan set up by a psychologist with the staff team. This plan describes their behaviours that can challenge the service and how staff should recognise signs and use strategies to divert and deal with them proactively. Any incidents are also appropriately recorded. 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. Customers can take part in a range of activities and go out in the local community. They could benefit from more individualised support to enable them to follow their personal interests and to develop their life and social skills. Customers are supported in a respectful way by staff who also help them to maintain links with their families. The home provides healthy meals that people need and/or enjoy. Evidence: Staff clearly understand that customers should be supported to participate in a variety of developmental, social and leisure activities within the home and out in the wider community. The main stated aims of the service are to develop peoples skills, to treat them as individuals, promote their community presence and keep people safe but allow their development through acceptable risks. Customers plans include brief information about their interests and staff record what Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: they have been doing and if they seem to enjoy activities or not. We acknowledge it can be difficult for people with complex needs to have regular activity schedules but plans could better reflect how their individual social needs and personal interests are being met. They should show how the home enables people to take part in meaningful activities they like to help them achieve goals and develop their life skills. It would be difficult for most people to take up work related and/or educational opportunities because of their disabilities, but it is good that one customer did have a job placement and the home is looking for another one for them. This person is also able to be quite actively involved in household tasks and cooking. One customer has a place some weekdays at a day service, although now often refuses to attend. Other activities people take part in are horse riding, music therapy, swimming and football. They go out to a local social club for people with learning disabilities and to town shopping, pubs for meals, bowling etc. When at home staff encourage people to listen to music, arrange art and craft sessions and use the garden where there is now a greenhouse and vegetable patch. Keyworkers are matched to individuals taking into account their interests and hobbies. They arrange outings occasionally and an annual holiday. Staff comment that customers would benefit from more one to one time and that the support needs of one person can have an impact on time and staff available for others activities. We saw staff offering people support in a respectful and caring way and that they are well motivated to providing a good quality service that enhances peoples lifestyle. Customers are supported to maintain links with their family and visitors are made welcome in the home. Keyworkers send greetings cards and make calls on peoples behalf to keep relatives informed about important events and health issues. Parties are held regularly when family and friends are invited to the home. Staff had training called Relationships Matters to help them support friendships and family links. Regarding food provided by the home the AQAA states that meals are nutritionally balanced and the home has obtained a dieticians approval of their their menus. Menus are drawn up weekly and include a good variety of healthy meals. Individual records are kept of meals people have and staff know their likes, dislikes and dietary requirements. When possible customers are involved in shopping and cooking but the AQAA acknowledges more effort could be made to develop their daily living skills. 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. Customers receive the personal support they each need. Their health care needs are met and when necessary there are procedures in place that staff follow. Peoples medicines are also managed safely in the home by staff on their behalf. Evidence: Plans include customers personal and health care needs and prescribed medication. Each person also has a health action plan (HAP). HAPs should provide a comprehensive overview of their medical condition, health care and emotional and behavioural issues and promote a healthy lifestyle. They also help to ensure that any changes or problems are identified, monitored and are dealt with properly as well as increase peoples involvement in managing their health care to the extent they can. Plans show that most customers need a lot of support from staff in respect of their personal care. Daily checklists are completed by staff showing the aspects of care each person has been given. We saw that people were appropriately clothed and well presented and some hygiene issues were dealt with sensitively and promptly. Individuals specific needs, for example in respect of epilepsy and moving and Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: handling are described in more detail in their plans and staff have received relevant training. The bungalow is also suitably adapted and individuals are provided with any aids and equipment they need to promote their mobility. Records are kept of all the routine and specialist health care input customers receive. Keyworkers arrange and support them to attend appointments. When necessary staff carry out physical checks on such as their weight and food intake, with records kept, Behaviour management plans are in place for behaviours that can challenge a care service and staff are trained on the management of potential and actual aggression. Regarding customers prescribed medication there are appropriate policies and procedures in place for staff to follow and there is suitably secure storage space available. Medication records homes are required to keep are being maintained appropriately. Staff are only designated to administer medicines when they have completed a formal training process on safe handling. Regular checks are carried out by the home with records kept so there can be an audit trail and all medicines in stock and administered can be accounted for. A community pharmacist regularly checks the homes medication system. 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. If people have concerns about the service they know how to complain and can be confident they would be listened to and action taken to deal with them. There are systems in place to safeguard people and to follow up any allegations. Evidence: Midland Heart provides a comprehensive complaints procedure that has been given to customers and/or their representatives and is displayed in the home. If any concerns are raised about the service there is a log to record them in the home, as required, with details of their investigation, actions taken and outcomes. No complaints have been made to the home or commission since Midland Heart took over the service. The AQAA says customers are supported to express their views and concerns by staff and keyworkers on a one to one basis. An external advocate would be accessed if necessary. The home plans to update staff training on complaints and make customers continually aware of procedures individually and through meetings. Staff confirm in their surveys they would know what to do if any concerns are raised with them and one comments our complaints procedure is clear and transparent. Staff receive training on indicators of abuse and neglect and understand their responsibility to promote the welfare and safety of vulnerable adults. The home has updated protection of vulnerable adults procedures and a whistle blowing policy. Staff we spoke with are clear about them and know how to report any suspicion or Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: incidence of abuse or neglect to external agencies if necessary. There have been no referrals about the home through local multi-agency safgeuarding procedures. Staff are trained to manage challenging behaviours and it is good there have been no incidents needing physical intervention. Medications that can be given as required to control behaviours are said to be used sparingly and there is a protocol in place so their administration has to be agreed by two trained staff and a senior or manager. 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 living at 10 Southbank Close have accommodation that suitably meets their needs, is pleasant and comfortable and kept safe and clean for good infection control. Evidence: 10 Southbank Close is owned by the Primary Care Trust (PCT), which leases out the property including the two adjoined care homes and offices/meeting rooms to Midland Heart. The PCT retains responsibility for some aspects of the premises upkeep. The home is in a convenient place within walking distance of Hereford city. The bungalow is in a quiet cul-de-sac and fits in with the local community. There are ramps and rails around the building and garden and aids and adaptations are provided to meet the needs of people with mobility difficulties who may be wheelchair users. The sitting room is comfortable and homely and the kitchen, dining area and bathrooms have recently been upgraded. They have new flooring, furnishings and fittings, an assisted bath and shower facilities. The open plan dining area has been partitioned, which is more homely and the telephone, records etc can be kept out of sight. Bedrooms are fairly small and do not have en-suites but are well personalised. All areas we saw were clean, tidy and fresh. It is apparent, as the AQAA confirms, that Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: staff follow Midland Hearts infection control policy and procedures to ensure that good hygiene is promoted, which prevents cross infection. This includes providing staff with disposable gloves and aprons. Liquid soap and paper towels are also available. Laundry facilties are suitable and soiled waste is disposed of appropriately. Staff receive necessary training on infection control and food hygiene. 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. Customers have safe, appropriate personal and health care support as there are enough competent and qualified staff. Their needs are met by suitably trained staff who are well supported by their manager. People can have confidence in staff because checks are carried out to make sure new staff are suitable to work in a care service. Evidence: 10 Southbank Close has its own core staff team, which the AQAA says is cohesive with a good skills mix. Although three staff have left in the last 12 months, and there are vacancies for a senior and night care worker currently, they are being recruited and the manager is hopeful the staff team will be stable. Staff in their surveys indicate there is usually or sometimes enough staff but say staff shorages can mean they are unable to give customers one to one support or take them out but this does not affect their personal care or safety. Rotas do aim to provide some flexible keyworker time. Regarding recruitment staff surveys confirm they had checks taken up including a criminal records bureau (CRB) police check and two written references before starting work at the home. Midland Hearts recruitment and selection procedures are satisfactory, although it is advised that a second employment reference could be more creditable than the personal reference their application form currently requests. New staff complete a six month probationary period before their appointment is confirmed. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: All staff completed a full day induction when Midland Heart took over the service and were expected to read and sign up to all their policies and procedures. For new staff there is a six week induction programme that includes training in all the mandatory health and safety areas, adult protection and equality and diversity. New staff then complete an accredited learning disabilities qualification (LDQ). Staff are expected to move onto National Vocational Qualification in social care and all but one staff have already achieved NVQ. Staff surveys confirm they have completed training relevant to their role and have training opportunities. One comments that training is often put on for staff and refreshers. Training includes topics related to customers special needs such as epilepsy and autism, which are to be updated. The AQAA and staff say that communication within the team is good. Regular team meetings are held and they have regular individual supervision. Midland Heart have a supervision format to ensure their work performance is monitored and staff have an anual appraisal. Each staff also has a training and development plan showing how their individual needs will be met and the home has a staff team training profile. 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. People can be confident customers are receiving good quality care because the service is managed appropriately. Practice is developing to individualise their support and plans being made to improve the service, taking into consideration what customers and/or their representatives want. The home environment is safe for people because staff follow health and safety procedures. Evidence: The manager Robbie Hedley was previously senior support worker in this bungalow when it was part of the larger care home and has other management experience. Mr Hedley has achieved the Registered managers Award and is working to complete a National Vocational Qualification (NVQ) level 4 in social care. He has also undertaken much other relevant training in relation to health and safety, care practice and staff management including on risk assessments, effective communication, staff recruitment, selection, review and development. Midland Hearts care managers meet regularly with their regional manager and the homes manager has received some one to one support from his manager, as he Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: should, and further supervision sessions are planned. Mr Hedley understands the managers role and responsibilities and the homes management approach seems to be open and transparent. There is always a designated person left in charge of the home. It is evident there is a commitment to the key aims of the service and the main objective is to fully implement a more person centred service. Midland Heart provide a full range of policies and procedures for staff to follow to promote good practice. The AQAA contains clear, useful information with evidence about how what the home does well results in good outcomes for customers. The manager has identified areas needing improvement, which include setting up personal bank accounts for customers, using more communication techniques and accessing external advocates. Another positive plan is to involve customers and their representatives more in service development by obtaining their views through meetings, user involvement forums and questionnaires. Quality assurance and monitoring is a requirement for care services and a system is being set up, albeit somewhat slowly. Audits of aspects of the service were carried out in January and there are to be further peer audits. The required monthly visits by a representative of the provider to check the service, interview people and write a report on the conduct of the home have also started. The information from audits and customer feedback should now be analysed and included in an annual development plan showing the action necessary to achieve them with timescales. Regarding health and safety staff receive training in all mandatory topics and required policies and procedures are in place that staff follow. The AQAA confirms that necessary checks are carried out on the fire safety and water systems and the electrical, gas and heating are serviced and/or maintained regularly. Risk assessments are also completed, including for substances hazardous to health (COSHH) and there were no safety hazards observed in the environment during our 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 1 6 The home should continue to implement more person centred care planning. This means there will be more focus on identifying customers preferences and personal goals and support needed to meet and/or achieve them. There should be an annual development plan for the home showing how the service needs to improve and how and when. This plan should also be based on the views of customers and other stakeholders to ensure the home improves as they want and/or for customers benefit. 2 39 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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