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Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 15 Oaklands Road 15 Oaklands Road Bedford Bedfordshire MK40 3AG The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rachel Geary Date: 0 9 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 37 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (20092008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 37 Information about the care home Name of care home: Address: 15 Oaklands Road 15 Oaklands Road Bedford Bedfordshire MK40 3AG 01234347822 01234352427 oaklands.manager@communitycaresolutions.com www.communitycaresolutions.com Community Care Solutions Limited care home 7 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 7 7 0 0 learning disability physical disability Additional conditions: 1. The registered person may provide the following category/ies of service only: Care home only Code PC 2. The maximum number of service users who can be accommodated is: 7 One resident may have an additional physical disability to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disability Code LD Date of last inspection 2 0 0 5 2 0 0 8 Care Homes for Adults (18-65 years) Page 4 of 37 A bit about the care home 15 Oaklands Road is a care home registered for up to 7 people whose primary care need on admission is a learning disability. It is a detached house situated in a residential area of Bedford owned and managed by Community Care Solutions Ltd. The home is in close proximity to Bedford town centre, local transport networks, shops - including a post office, public houses, places of worship, a park and a swimming pool. The accommodation is on two storeys, with two bedrooms, shower room, lounge, kitchen/diner, activity room, and conservatory on the ground floor. There are a further five bedrooms, staff office and a bathroom and shower room on the first floor. The home has a garden to the rear of the property. Information about the service, including CQC reports, is made available to prospective service users. However, the majority of it has not yet been produced in a format that would be meaningful to the people for whom the home is intended. The Service User Guide does not include details of the fees payable for this service and this information was not provided during this inspection. Care Homes for Adults (18-65 years) Page 5 of 37 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 Care Homes for Adults (18-65 years) Page 6 of 37 How we did our inspection: This is what the inspector did when they were at the care home A key inspection is a thorough type of inspection when we look at all of the key aspects of a service. For this key inspection, we looked at all the information that we have received or asked for since the last inspection of this service on 20.5.08. This included surveys which we sent to the home to give out to service users and staff. We received 5 back from people living at the home and 6 from members of staff. We looked at notifications that Care Homes for Adults (18-65 years) Page 7 of 37 we have received about the home. This is information about the service that the home has to tell us about by law. We also looked at information that we asked the home to send us following our visit. We carried out an unannounced visit to the home on 9.4.09 which lasted 5.5 hours and a follow up telephone call to the manager the next day. During the visit to the home we met most of the people who live there. Some people were able to talk about what it is like to live at the home. Some people did not use words to Care Homes for Adults (18-65 years) Page 8 of 37 communicate, so we observed the way that the staff were supporting them. We looked at some of the paperwork that the home has to keep such as care plans, risk assessments, medication charts, staff records, menus and health and safety records. What the care home does well There was a friendly atmosphere at the home, and staff and service users seemed to get on well with each other. This is a busy home with people taking part in lots of activities outside of the home. On the day of the inspection, people Care Homes for Adults (18-65 years) Page 9 of 37 were getting ready to go out to a disco in the evening. Staff support people to go out to work, college or daycare during the day if they want to do so. Feedback from people during the inspection was generally very positive. Staff felt that service users were respected as individuals and are encouraged to retain their independence. A number of staff also said that they had received appropriate training and some good support from the manager. People living at the home said that they are able to make Care Homes for Adults (18-65 years) Page 10 of 37 decisions about what they do, and everybody who was able to, said they knew what to do if they had any concerns about the home. There was good evidence that risk assessments are completed soon after things happen in the home and concerns/complaints are dealt with quickly. What has got better from the last inspection This has been a difficult year for the home with a number of changes taking place, and more planned. However there is evidence that this has been well managed and that things are more settled. The manager has Page 11 of 37 Care Homes for Adults (18-65 years) been in post for about a year and has been working hard to make improvements to the running of the home including some of the paper work. The manager confirmed that staff retention had improved with only one person leaving since she had come into post. She also said that the staff team were working well together. A new service user had been supported to sign up to a new college course and leisure pursuits. When spoken to, this person said that they were enjoying life at the home. Care Homes for Adults (18-65 years) Page 12 of 37 What the care home could do better More work is needed to make information about the home meaningful to existing and prospective service users. Some work has started on this but there is still more to be done. Care plans need to make reference to other information held on file about the people living at the home. This will help staff to find information quickly and to support service users in a consistent way. Care Homes for Adults (18-65 years) Page 13 of 37 Staff training must link to the assessed needs of all the people living at the home, and staff must remember to carry out important health and safety checks on a regular basis. The manager must apply for registration with the Care Quality Commission (CQC). And although there are plans to improve the environment, there must be better systems in place to stop the decor and furnishings in the home from getting so worn in the future. Some of the staff thought that care plan information could be more up to date, that training and career prospects could be Care Homes for Adults (18-65 years) Page 14 of 37 improved, that there should be more staff meetings and that sometimes there were not enough staff on duty to meet the needs of all the people who use the service. It was also said that the home could be better maintained. Finally outcomes from issues raised by service users through the homes quality assurance processes, must be clearly acted upon and recorded. Care Homes for Adults (18-65 years) Page 15 of 37 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Rachel Geary CPC1 Capital Park Fulbourn Cambridge CB21 5XE 01223 771300 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 16 of 37 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 17 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information that is currently available about the home has been produced in a standard format only, and some important information is missing. This means that prospective service users may not have all the information they need to make an informed choice about where they want to live. Evidence: A Statement of Purpose (SoP) for the home had been developed which was very informative. A Service User Guide (SUG) had also been developed, but it had not been produced in a format suitable for all the people for whom the home is intended. It did say that it could be produced in large print, audio and widgit symbols or another language if required. The SUG did not contain all the required information including details of the fees payable in respect of this service. One service user who moved into the home about a year ago confirmed that they had been able to visit the home before moving in. Care Homes for Adults (18-65 years) Page 18 of 37 Evidence: Another person was due to move out as the home was not the right place for them. A significant amount of support had been provided to the service user during their stay and in making the decision to leave. Feedback from service user surveys confirmed that people had been consulted before moving into the home and that they had received enough information to help them decide if the home was right for them. Service User Contracts were in place, but again these had not been produced in a user friendly style, so they would not be meaningful to everybody living in the home. The contract contained a statement about people possibly having to pay towards the cost of living from their state benefits. This is not clear enough and could cause concern to prospective service users. A blank contract was provided after the inspection. This did contain some pictures and photos - indicating that the home was moving towards the introduction of alternative contract formats. Care Homes for Adults (18-65 years) Page 19 of 37 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. The service understands the right of individuals to make decisions and choices. However documentation has not been developed in formats suitable for everyone living in the home. This means that it is difficult to see how people, particularly those with diverse needs, are aware of and actively engaged in all in aspects of their lives. Evidence: Care plans were in place, and those seen contained some clear information about service users needs and personal goals. Sometimes the care plan did not always link to other information held on file such as letters and risk assessments. So although information was available, including intervention/de-escalation techniques where required, there was no central point of reference bringing it all together. One example was a letter which included more detail about a service users behaviours than their care plan; including information about the possibility that they may hit others. In this case the manager said that the persons medication had been increased recently and as a consequence the behaviours had subsided. The manager confirmed that copies of care plans were sent to service users representatives as agreed with each service user. Care Homes for Adults (18-65 years) Page 20 of 37 Evidence: Person Centred Plans (PCP) were in place but these had not been produced in alternative formats. The manager confirmed that some of the service users could not read, so these would not be very meaningful to everyone living in the home. One service user had made the decision to move out of the home as it was not the right place for them. There was evidence that the person in question had challenged the service considerably in the period leading up to this decision. A lot of support had been put in place by the manager and staff team for the duration of their stay. There was a written agreement between the service user and the home, regarding appropriate behaviour, whilst they remained living at the home. The intention of the agreement was sound, but some of the content did not appear to follow Mental Capacity Act Code of Practice guidelines, which may have made it difficult for the home to enforce. Feedback from service users, including verbal discussion and surveys, was that they were able to make decisions about what they do during the day, evenings and weekends. There was evidence that risk assessments were undertaken or reviewed following incidents occuring in the home. But again care plans were not always updated with this information. Care Homes for Adults (18-65 years) Page 21 of 37 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. The service has a strong commitment to enabling service users to maintain appropriate and fulfilling lifestyles inside and outside of the home. Evidence: On the day of the inspection the majority of service users were at home because of the Easter holiday. There was evidence that people normally went out to college, day care or work during the day. Some of the service users were visiting, or planning to visit, family and all service users were getting ready to go out that evening to a local disco. Those that were able to, indicated that they were looking forward to this. One service user who was seen had a hearing impairment. There was limited obvious interaction from staff with the person who was sitting in front of the television for a while. Staff did say that the service user could use Makaton sign language and could also read and write (the subtitle option was not switched on on the television). When the manager came on duty, she used some Makaton and the service user visibly Care Homes for Adults (18-65 years) Page 22 of 37 Evidence: changed and responded positively to this. Staff said that each of the service users took turns to cook and also had a phone night. It was said that the phone night was to help remind people to maintain family links outside of the home but that people could make calls at other times if they wanted. A cordless phone was available to allow people to make calls in private. An activity chart was in place and from speaking with some of the service users and staff, lots of regular activities take place outside of the home. Service users contribute part of their benefits to fund the use of the home vehicle. One service user said that they enjoyed weekends because they got to visit their parents. Information provided by the manager indicated that the home had been proactive in supporting service users, as required, to access appropriate support and guidance regarding relationships. All of the service users had been on holiday in the past year. Some had been supported by the home, and others through day care. The home makes a contribution annually towards holidays, and information about this is included within the Service User Contract. The evening meal was seen. There was a good quantity of food and the meal looked appetising. During the afternoon of the inspection, staff had said that it was tuna pasta bake for tea. The meals seen actually included spaghetti, carrots and what looked like meatballs. The menu for the day recorded that the meal should have been savoury mince and dumplings with vegetables. Although it is perfectly acceptable to make changes in agreement with service users, there does need to be an accurate record to determine whether the diet on offer is satisfactory in relation to nutrition and any special diets required by individuals. For example records and feedback during the inspection showed that one person needed to watch their sugar intake. Menus had not been developed in alternative formats and there was only one choice of meal for each meal time. A copy of the homes annual quality of care report for 2008 was seen. This included feedback from service users about the food in the home. 66 thought that the food was always good or was good most of the time. This aspect had not specifically been included in the resulting action plan, so it was not clear how improvements had been planned or implemented in this area. Care Homes for Adults (18-65 years) Page 23 of 37 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. Appropriate systems are in place to promote good personal and healthcare support for service users, but some small changes are required to the homes recording systems to evidence this. Evidence: At the time of the inspection, the home was accomodating male and female service users. There was one male member of staff on the rota. The manager said that she tries to organise personal support for service users by a person of the same gender where possible and if requested. There were plans to interview for staff the following week and the manager said that she was specifically looking to appoint another male support worker to work opposite shifts to the existing male support worker. One service user was seen walking around the home looking distressed. Staff said that the person was sometimes like this but that the situation was being monitored. Another service user who used a wheelchair was seen being helped to transfer from the wheelchair to the sofa after lunch, rather than remaining in the wheelchair. Records showed that some behavioural intervention/de-escalation techniques had been used for some of the service users. As stated before, care plans sometimes didnt contain the detail of these techniques, or sign post where this could be found - for example a risk assessment. There were staff on duty who were trained in the required Care Homes for Adults (18-65 years) Page 24 of 37 Evidence: techniques but training records for others had not been updated or verified by the manager. So it was not always clear if everyone had received the correct training. The white paper Valuing People sets out the governments plan for making the lives of people with a learning disability better through a number of things including individual health action plans (HAPs). It is the responsibility of the medical or clinical services to which the person is entitled, usually through the persons GP, to make sure that each individual has a HAP. This has not happened so far for the people living at 15 Oaklands Road so the company has introduced their own plans. The most recent version: health and personal information packs were seen duirng the inspection. Good attempts had been made to make these accessible to the service users through the use of pictures and photographs. Records for one of the service users showed that they were at risk from developing diabetes if their diet was not controlled. However the persons care plan did not include this specific information and just referred to the person needing to manage their weight. The service user in question was heard talking with staff about only eating a small amount of an Easter egg because they needed to be careful about their sugar intake, which showed that they were aware of the situation. Medication Records did not always make clear where prescribed medications were to be taken as required (PRN). The home had a system of highlighting medications in a certain colour to make clear to administering staff that these were PRN medications. Unfortunately on the MAR sheets seen during the inspection, PRN and evening medications had been highlighted in the same colour because a highlighter pen had run out. There was no evidence that any medication had been given incorrectly and the manager did say that there was a double signature procedure in place for PRN medication which would ensure that checks were carried out before administration takes place. New highlighter pens were purchased after the inspection. It was not clear from one persons care plan what their prescribed medications were for. This information was available in their HAP but the two documents did not clearly link together. Care Homes for Adults (18-65 years) Page 25 of 37 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. Appropriate systems are in place for responding to concerns about the home, and service users are protected from abuse. Evidence: A small number of complaints had been received by the home since the last inspection, including some from neighbours. There was evidence that the manager and the companys Quality and Compliance manager had dealt with these appropriately responding to each of the complainants in a timely manner through letters and/or personal visits. A large print complaints and compliments procedure was seen, but as the manager confirmed that not all of the current service users could read, this would not be meaningful to everybody living at the home. However, feedback from staff and service user surveys received, indicated that people knew what do if they were not happy and had a concern about the home. One compliment was seen from the parents of one service user thanking the home for taking their relative on holiday. Clear records were in place for service users who were being supported by the home to manage their monies. Each person had a seperate bank account managed by the companys Service User Monies Officer (SUMO). One service user was managing their own money and another had family input to manage theirs. For those service users whose money was held by the home, only the manager and senior support worker (SSW) have access. Although the manager and SSW do try to work alternate Care Homes for Adults (18-65 years) Page 26 of 37 Evidence: weekends, this does mean that service users would need to make requests through the SUMO in advance, should they wish to access large sums of money. Small amounts of money are held in the home only. There was evidence that appropriate systems, policies and procedures were in place for ensuring that service users are protected from abuse. Care Homes for Adults (18-65 years) Page 27 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a physical environment that meets the needs of the people currently living there and there is a programme in place to improve some of the decoration and furnishings. Evidence: A partial tour of the building was undertaken. The paint work in some of the communal areas including the entrance hall, stairs and communal lounge had seen better days, as had the sofas in the lounge. The manager advised that decorators were due to begin refreshing the paintwork in all communal areas, and two of the bedrooms the following week. She also said that the ceiling in one of the bedrooms had been repainted and the cause of a reoccurring leak, moved. The manager said that she hoped the entire house would be redecorated eventually. There were no definite plans to puchase new seating for the lounge but the manager did have a brochure to hand, which indicated that that this was being planned. One service user had purchased a new recliner chair which arrived during the inspection. The manager helped the person to sit up and get out of the chair when it was tea time because they had not yet learnt how to use the chair. There was no bath available on the ground floor. One service user who used a wheelchair and had a bedroom on the ground floor, only had access to a shower. The person confirmed that they were happy with this arrangement. Care Homes for Adults (18-65 years) Page 28 of 37 Evidence: Another service user said the house was sometimes a bit noisy but they knew that they could go to their bedroom or another part of the home if they wanted to be quiet. Communal space consisted of a large lounge plus a kitchen and a conservatory/dining area. The dining area was not big enough to sit all the service users together, so some people ate at a table in the kitchen. The manager said people make a positive choice about where they want to eat. Some prefer a quieter place to eat, so this arrangement works well for this home. The home does not have a designated smoking area, so people wishing to smoke are asked to do so in the homes garden. Feedback from staff and service surveys was that people felt the home was fresh and clean. Care Homes for Adults (18-65 years) Page 29 of 37 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. The home recognises the importance of proper recruitment checks and training and there are plans underway to fill gaps in the training programme for staff. Evidence: Staff training records were being maintained but did not always correspond to service users assessed needs. For example records for one service user showed that they had BiPolar disorder but there was no evidence to show that training had been arranged for staff to help them to provide appropriate support to the person in question. The manager immediately put a request in through the companys training department about this. Similarly, care plans recorded that some of the service users required some behavioural intervention techniques. There was evidence that some of the staff had received this training but not all. The manager was advised to verify any training recorded as being undertaken, where only copies of training certificates are seen. Some staff were in need of refresher courses and action had been taken by the company and manager to ensure that this was taking place. A training data base was being maintained by the company and this was being monitored to see when new and refresher courses were due for staff. The homes Statement of Purpose sets out that: Community Care Solutions are holders of the Investors in People Award and are fully committed to staff learning and Care Homes for Adults (18-65 years) Page 30 of 37 Evidence: development and actively encourages career progression. In addition to all staff receiving TOPSS approved induction training, the companys training co-ordinator ensures that all staff receive at least five days training per annum to develop their core skills and to assist them to work towards achieving their relevant NVQ qualifications. Staff recruitment files were seen for some of the staff on duty that day. Original recruitment records were being held at the companys head office but there was a check list in place for each member of staff to indicate that appropriate checks had taken place. Rotas, and from speaking with staff and service users, showed that there are two to three staff on each shift depending on planned activities for that day. There is one sleep in and one waking member of staff on duty each night. The manager has two care shifts per week so service users and staff have regular access to her and she can monitor care practices and any issues that may arise. Feedback from service users was that on the whole staff treated them well and listened to them. The majority of the staff who provided feedback, felt that there was not always enough staff on duty to meet the individual needs of all the people who use the service. There was evidence that staff were receiving regular support and supervision from the manager. Care Homes for Adults (18-65 years) Page 31 of 37 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 has a good understanding of the key principles and focus of the home and continues to work, supported by the staff team and company, to make important improvements to the service. Evidence: The manager has been working at the home since March 2008. At the time of this inspection she had not yet applied to register with the Care Quality Commission (CQC) but confirmed that she was in the process of doing so. She said that she had completed an NVQ 4 in Care and was looking to do the RMA/Leadership and Management for Care Services Award next. The manager also spoke about some regular management development training which was being organised by the company for all managers covering a number of areas designed to update knowledge, skills and competence for managing the home. The manager was very busy on the day of the inspection but she coped well under pressure and made time for the service users as well as contributing to the inspection. A copy of the homes most recent (2008) annual quality assurance questionnaire response report was seen (the 2009 report was in the process of being compiled). As Care Homes for Adults (18-65 years) Page 32 of 37 Evidence: part of the process, questionnaires had been distributed to service users, staff, service users next of kin and social workers. One family member wrote that caring has improved over the past year but added comments about wanting to see a more settled staff and management team as they didnt believe that recent changes had been good for the service users. The manager spoke about this during the inspection and confirmed that staff retention had significantly improved in the past year. Feedback from the majority of the service users was that they were happy, settled and that they were happy with the staff team and life at the home. 66 of service users thought that the food was always good or was good most of the time, but this had not specifically been included in the resulting short action plan. So it was not clear how improvements were being planned in this area or if they had happened, as the action plan had not been updated. Some positive responses were received from the staff team with regard to the management of the home and the quality of lifestyle on offer to the service users with 83 stating that service users have good opportunities to be included in community activities. There was evidence of systems being in place to promote the health, safety and welfare of service users. The most recent regulation 26 (visits by the registered provider) report was seen for April 2009. This had been completed by the companys Quality and Compliance manager and it highlighted a number of envionmental deficits, the fact that some health and safety checks had not been taking place regularly, and that some of the service user records were in need of review. An accident book was being maintained however entries did not all contain the required information. This was discussed with the manager. The most recent reports from the local Fire Authority and Environmental Health Department were seen. Some requirements and recommendations had been made which the manager confirmed had been actioned. These included carrying out an assessment for the risk of legionella and reviewing the homes fire risk assement. Care Homes for Adults (18-65 years) Page 33 of 37 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 34 of 37 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 1 5 Information about fees payable in respect of this service must be made clear in the Service User Guide. 04/06/2009 This is so that people have all the information they need about the home. 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 1 The Service User Guide and other information about the home, should be available in a format suitable for the people for whom the home is intended. Care plans, and in particular Person Centred Plans, should be available in a format suitable for the people for whom the home is intended. The homes complaints procedure should be available in a format suitable for the people for whom the home is Page 35 of 37 2 6 3 22 Care Homes for Adults (18-65 years) 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 intended. Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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