Care Home: 1a Garth Brow

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What the care home does well Good systems are in place to make sure people`s care needs are assessed before they move in to the home and on an ongoing basis, making sure the home is suitable and safe. Detailed care plans have been developed with each person that records their personal and health care needs and describes in detail their preferences about how they like to live their lives. These include a record of people`s short term and longer term goals and aspirations. It also recorded what progress has been made toward these goals, giving both the individual and the member of staff supporting them a real sense of achievement when their aspirations were met.People are enjoying a fulfilling lifestyle and able to lead an independent lifestyle of their choosing. People are supported to pursue their individual interests and hobbies which provides them with a wide range of activities and opportunities. All the people in the home have worked closely with staff planning an annual holiday. Two people with similar interests chose to go away together whereas the other people went on their own with staff as they had their own particular interests.People are aware of how to raise a concern and there was evidence of staff listening to them and responding accordingly. The home`s policies and procedures make sure both people living in the home and the staff supporting them are kept safe at all times. The home benefits from having an experienced and well trained staff team who have developed good relationships and a good understanding with individuals. They take on an enabling role to make sure they are promoting people`s independence and helping them to achieve their goals. The manager has the respect of the staff team and values their contributions to the effective management of the home. Personal development needs of all staff are being assessed with relevant training planned for them. What has improved since the last inspection? PRN (as and when required) medication protocols have been kept under review to make sure they are up to date and accurate and help staff to administer medication safely.Care plan files have been reviewed and updated and all the old information removed making it a clear record of personal and healthcare needs and is easy to follow.Six monthly personal development assessments have been introduced to help staff review their practice and identify personal development targets. What the care home could do better: The bedroom identified must have some new flooring that is easily cleaned to make sure there are no malodours.The upstairs toilet seat should be replaced to make sure it can be cleaned effectively. Paint is flaking off around the upstairs bathroom window and is in need of remedial action to make sure it is maintained to a reasonable standard. Bars of soap should not be used in communal areas of the home as there is a risk of cross infection.The lawns and some bushes to the side of the home have become overgrown and should be maintained regularly to make sure all areas of the home are well maintained and accessible.Refused medication is being stored in the medication cabinet and should now be removed to avoid mistakes being made. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 1a Garth Brow 1a Garth Brow Kendal Cumbria LA9 5NN 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: Ray Mowat Date: 1 5 0 6 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. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 36 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) 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 36 Information about the care home Name of care home: Address: 1a Garth Brow 1a Garth Brow Kendal Cumbria LA9 5NN 01539734111 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): sally.arnold@oakleatrust.co.uk The Oaklea Trust Name of registered manager (if applicable) Miss Sally Arnold Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 4 0 care home 4 learning disability Additional conditions: 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 disability - Code LD. The maximum number of service users who can be accommodated is: 4. Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 36 A bit about the care home 1A Garth Brow is owned by Fairoak Housing and operated by the Oaklea Trust. Both are not for profit charitable organisations, specialising in services for people with learning disabilities. It is situated in a quiet residential area on the outskirts of Kendal, Cumbria. It is registered to provide a home for four people with learning disabilities, some of whom may be over sixty-five. It is a detached property in its own grounds with gardens to the front and rear, where there is a patio area with seating. There is off street parking for two vehicles. It is only a short walk from the amenities of the town centre, however the residents also have use of a people carrier style vehicle that they share. Care Homes for Adults (18-65 years) Page 5 of 36 Downstairs there is a lounge and a conservatory, which is also used as a designated smoking area. In addition there are two bedrooms, a toilet, a fully accessible walk-in shower and toilet, a large kitchen with dining area and a laundry/utility room. Upstairs there are two bedrooms, a toilet, bathroom with traditional style bath and a staff bedroom, which is also used as an office. The statement of purpose and service user guide, which are issued to prospective residents, and other interested parties and are available in the home. The fees are assessed on an individual basis depending on the level of support they require, with the only additional charges being for personal sundry expenses. The inspection reports are discussed with residents and displayed on a notice board. Care Homes for Adults (18-65 years) Page 6 of 36 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 7 of 36 How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. During the visit we (The Care Quality Commission) met with people living in the home and spent time with the acting manager. We also met with care staff individually and talked to them as they went about their duties. Care Homes for Adults (18-65 years) Page 8 of 36 The acting manager completed a self assessment questionnaire called an Annual Quality Assurance Assessment (AQAA) and sent it to us before the inspection visit. This provided us with information about how the home is run and the managers views on what the home does well, where they have improved and plans for the future. There is also information about the people who live in the home and the staff working there. Surveys were sent out as part of this inspection to people living in the home, staff and other professionals with their views being used to formulate the judgements in this report. We also examined records relating to the running of the home that are required by legislation, which included care plan files that guide staff in supporting people to achieve their goals and lead independent lives. We examined staff files and records relating to the maintenance and safety of the home. The last inspection on this service was completed on 26th June 2007. Care Homes for Adults (18-65 years) Page 9 of 36 What the care home does well Good systems are in place to make sure peoples care needs are assessed before they move in to the home and on an ongoing basis, making sure the home is suitable and safe. Detailed care plans have been developed with each person that records their personal and health care needs and describes in detail their preferences about how they like to live their lives. These include a record of peoples short term and longer term goals and aspirations. It also recorded what progress has been made toward these goals, giving both the individual and the member of staff supporting them a real sense of achievement when their aspirations were met. Care Homes for Adults (18-65 years) Page 10 of 36 People are enjoying a fulfilling lifestyle and able to lead an independent lifestyle of their choosing. People are supported to pursue their individual interests and hobbies which provides them with a wide range of activities and opportunities. All the people in the home have worked closely with staff planning an annual holiday. Two people with similar interests chose to go away together whereas the other people went on their own with staff as they had their own particular interests. Care Homes for Adults (18-65 years) Page 11 of 36 People are aware of how to raise a concern and there was evidence of staff listening to them and responding accordingly. The homes policies and procedures make sure both people living in the home and the staff supporting them are kept safe at all times. The home benefits from having an experienced and well trained staff team who have developed good relationships and a good understanding with individuals. They take on an enabling role to make sure they are promoting peoples independence and helping them to achieve their goals. The manager has the respect of the staff team and values their contributions to the effective management of the home. Personal development needs of all staff are being assessed with relevant training planned for them. Care Homes for Adults (18-65 years) Page 12 of 36 What has got better from the last inspection PRN (as and when required) medication protocols have been kept under review to make sure they are up to date and accurate and help staff to administer medication safely. Care plan files have been reviewed and updated and all the old information removed making it a clear record of personal and healthcare needs and is easy to follow. Care Homes for Adults (18-65 years) Page 13 of 36 Six monthly personal development assessments have been introduced to help staff review their practice and identify personal development targets. What the care home could do better The bedroom identified must have some new flooring that is easily cleaned to make sure there are no malodours. Care Homes for Adults (18-65 years) Page 14 of 36 The upstairs toilet seat should be replaced to make sure it can be cleaned effectively. Paint is flaking off around the upstairs bathroom window and is in need of remedial action to make sure it is maintained to a reasonable standard. Bars of soap should not be used in communal areas of the home as there is a risk of cross infection. The lawns and some bushes to the side of the home have become overgrown and should be maintained regularly to make sure all areas of the home are well maintained and accessible. Refused medication is being stored in the medication cabinet and should now be removed to avoid mistakes being made. Care Homes for Adults (18-65 years) Page 15 of 36 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 Ray Mowat CQC northwest Citygate Gallowgate Newcastle upon Tyne NE1 4PA 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 36 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 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People have their needs assessed before moving in and on an ongoing basis so they know their needs can be met at the home. Evidence: No new people have moved in to the home since the last inspection. Care needs assessments are in place for all the people living in the home, in addition to specialist assessments by other professionals and health agencies when needs are identified. These ensure a comprehensive person centred care plan can be developed to guide and support staff in meeting peoples individual needs and preferences. There are clear policies and procedures in place that make sure the assessment process is thorough and people have the opportunity to visit and try out the home before deciding to move in. This enables people to make informed decisions and also is an opportunity to check out compatibility with people already living there. Care needs assessments are held on the care plan file and are used to develop person centred care plans. This ensures the assessments are kept under review and updated as changes occur. There is a core group of staff who have developed a good understanding of the people who live in the home and what is important to them in their lives. The staff are well Care Homes for Adults (18-65 years) Page 18 of 36 Evidence: trained and knowledgeable completing suitable training that supports and guides their practise. When regular staff are absent the home uses regular relief staff who are familiar with the routines of the home and the people living there, which ensures a good continuity of care is maintained. The people living in the home have many similar needs but also enjoy a very independent lifestyle that suits them. All the files we examined had social work contracts in place and a contract of terms and conditions, which is agreed and signed by the individual or their representative. This makes sure people are aware of the fees they will be charged and the terms and conditions of their occupancy in the home. Care Homes for Adults (18-65 years) Page 19 of 36 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Peoples health and personal care needs are being met by well trained staff who have a good understanding and insight to each persons individual needs and aspirations. Evidence: All the care plans have been transferred to a new format with the master copy being an electronic version that can be updated more effectively. The care plans are detailed and have been put together and agreed with the person or their family/representative. The my life, my choice format is based on the care needs assessment including key areas such as Daily living skills, personal care, lifestyle and cultural needs, communication and health/medication. Each individual also has a health action plan completed that records and monitors all aspects of a persons healthcare and medication needs. The care plans contain an informative pen picture and personal history written in the first person that gives a real insight to someones personality, what is important to them and makes them fulfilled and significant events in their lives. Risk assessments are completed in relation to the activities identified in the care plan making sure both the person and the staff supporting them are kept safe. Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: There was evidence the care plans are kept under review and updated with the staff working closely with families and other professionals to make sure care needs are constantly assessed and appropriate adjustments made to the care plan. Short and longer term goals are agreed with individuals and recorded, which help staff to focus their support to help people achieve their goals and aspirations giving them and the staff a real sense of achievement. How people communicate their needs and make choices in their lives is well documented helping staff to promote independence by taking on an enabling role. Ongoing consultation through the key worker role and regular house meetings also help to promote an independent lifestyle and encourage people to be involved in all aspects of decision making in the home. The manager gave an example of how staff are using visual aids including pictures and symbols to help people make choices in their lives on a day to day basis. All personal and confidential information was securely stored in locked cabinets or password protected on the homes computer system. Staff we met were aware of their role and responsibilities in the importance of maintaining confidentiality and only sharing information with consent on a need to know basis. Care Homes for Adults (18-65 years) Page 21 of 36 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People are enjoying an independent and fulfilling lifestyle and are achieving their personal goals and aspirations. Evidence: Through the detailed care needs assessments and person centred care plans individual needs and abilities are recorded including daily living skills. This gives staff a good insight to a persons support needs in different aspects of their lives and helps them to take on an enabling role therefore encouraging an indpendent lifestyle. This helps people to maintain and develop their daily living skills. The activities and lifestyles of the four people living in the home are varied and reflect their age, ability and personal preferences. One person does not attend any formal day services but prefers to pursue his own interests and likes to join in community groups and activities including a walking group and a church group. Two people attend a local day service which they continue to enjoy and is an important part of their social life. It gives them the opportunity to mix with their peers and take part in a wide range of Care Homes for Adults (18-65 years) Page 22 of 36 Evidence: both educational and leisure activities. The other person prefers a more sedentary lifestyle that is planned around their interests and hobbies and at a pace that they dictate. They also enjoy socialising by attending different community groups and activities of their choice on both a regular basis and one off events. All the people living in the home have either been on or have planned a holiday for the year. Again this was chosen by the individuals, with two of them deciding they would go together as they have similar interests. One person showed me a scrapbook that staff had helped them to compile on their return from their holiday. There was a real sense of pride as they showed me the pictures and memorabilia they had collected at different points of interest and had obviously enjoyed a well planned holiday. Based on our own observations and discussions with people and the staff supporting them people have a lot of autonomy in choosing how they spend their leisure time. Staff are skilled at taking on an enabling role by encouraging and prompting people to help themselves rather than doing things for people. The menus we looked at reflected a balanced and nutritious diet with suitable alternatives and choices made available on a daily basis. Care Homes for Adults (18-65 years) Page 23 of 36 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 individuals are well documented and closely monitored making sure they receive the care and attention they need. Evidence: Health care needs are assessed as part of the initial care needs assessment when a person moves into the home. This is in addition to any specific health assessments by other professionals involved with them such as Physiotherapy and Psychology. Based on these assessments an informative care plan can be developed. Health action plans are then completed with the person, which records in detail their medical and healthcare needs and their involvement with health professionals and agencies. All health interventions and appointments are recorded making sure all staff are aware of individual and changing needs. The records we examined confirmed that appropriate referrals have been made when needs were identified, these included referrals to the the community nurse team, Psychiatry services and individual GPs. Again personal care needs are assessed as part of the care needs assessment, which identifies a persons level of independence and how they like to be supported in different tasks. Key workers play an important role in working with the individuals they support and their families and significant others to make sure individual needs and preferences are clearly recorded and a good continuity of care is achieved. Care Homes for Adults (18-65 years) Page 24 of 36 Evidence: We looked at the medical records held in the home and checked the contents of the medication cabinet against these. All the records were examined were clear and up to date and made sure medication was stored and administered in a safe manner. Medication stock control sheets are completed on a daily basis ensuring an accurate record of medication held in the home. The only weakness noted though was the storage of different tablets that were refused medication in a generic bottle. Refused medication should not be stored in the home in this way and should be returned to the Pharmacy on a regular basis. PRN (as and when required medication) protocols are in place that ensure staff know how, when and what quantity of medication people require ensuring it is administered as prescribed and in a consistent manner. Care Homes for Adults (18-65 years) Page 25 of 36 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 . People living in the home are protected by the complaints and safeguarding procedures, which were understood by staff. Evidence: The home has a suitable complaints policy and procedure in place, which is issued to people when they move in to the home as part of the service user guide. In addition they also receive an audio version making it more accessible to people. The procedure is clearly written and easy to follow, with timescales identified informing people when to expect a response to their concern or complaint. There were no formal complaints recorded since the last inspection visit to the home. Safeguarding policies and procedures have been developed in line with local strategies and guidelines and the latest legislation. Through the induction training programme and ongoing refresher training staff are made aware of what constitutes abuse and how to report any concerns or actual abuse they witness. Feedback from staff we met and from staff surveys confirmed that staff have a good awareness of their role and responsibilities and are confident their concerns will be acted upon. Care Homes for Adults (18-65 years) Page 26 of 36 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 . Some aspects of the environment are in need of attention to make sure the home is clean, comfortable and safe. Evidence: Some aspects of the home environment are in need of attention to make sure the home is safe and comfortable for the people living and working there. The grass lawns were overgrown and looked unkempt. This was discussed with the manager who has planned to have them regularly cut by a contractor. The path to the side of the house is blocked by an overgrown shrub making it difficult for people to stay on the path, which is a fall hazard to some of the people living in the home. This should be cut back to enable easy and safe access. Although there was a dispenser of anti-bacterial soap in the downstairs bathroom there was also a bar of soap on the sink, which is a communal bathroom. This is not good infection control practice as there is a risk of cross infection and it should be removed. The toilet seat in the upstairs toilet is wooden and has split meaning it cannot be properly cleaned, this should now be replaced with a suitable alternative. There is flaking paint around the window in the upstairs bathroom that is in need of repainting as it looks unsightly. The hall stairs and landing carpet is a light colour and is badly stained in places and should be cleaned or replaced. There was a strong malodour in one of the bedrooms Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: identified to the manager. She was aware of the problem and is working with the person whose room it is, to look at alternative flooring that can be easily cleaned and remain odour free. However the cost of replacing the flooring is clearly the responsibility of the provider under the Care Home Regulations. Care Homes for Adults (18-65 years) Page 28 of 36 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 . Garth Brow benefits from having a well trained and committed staff team who have a good understanding with the people they support, helping them to lead a fulfilling lifestyle. Evidence: The organisation has good recruitment policies and procedures in place making sure staff are both safe and suitable for their role. They are issued with a clear job description, staff handbook and contract ensuring they have all the relevant information relating to the role and responsibilities. People who use the services are involved in the interview process, which one member of staff we met said was a positive experience that showed the organisation value the people they support. There is a core of experienced staff who have worked in the home for a number of years and some permanent staff who have been recruited more recently. We examined staff rotas, which confirmed that all shifts had been covered either by permanent staff working additional hours or relief staff who are familiar with the routines of the home and the people living there. A male member of staff was recently recruited which has helped to address the gender imbalance in the staff team who are supporting four men. A suitable training programme is in place to make sure all staff receive appropriate training for their role, including the acting manager who is registering for the NVQ 4 Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: award. We spoke to staff, looked at survey responses they had returned and examined staff files. A good range of training courses were being provided including core subject areas as well as more specialist training, such as equality and diversity, challenging behaviour and autism awareness. NVQ training is well established with the organisation committed to maintain a well trained workforce. Staff talked about being well supported by the manager and senior managers as the following comments reflect. The management team are really good and always there for you. The staff work well as a team. Staff are well motivated and feel valued. We can talk to the manager about anything. Regular staff meetings are taking place, which provides staff with the opportunity to share good practice or raise concerns and any other relevant information such as changes to the care plans. The meetings have an open agenda and are recorded with actions agreed. We examined supervision records and found these to be up to date ensuring staff meet regularly with the manager and discuss their practice and personal development. The manager explained that six monthly performance and review meetings are taking place, with staff and the manager completing an assessment of the care staff performance before coming together to agree personal development targets. The double up staffing on the staff rota are used flexibly to make sure people get the support they require to achieve their goals and aspirations. The manager works closely with the person and their support staff to plan rotas around their chosen activities, which appears to be working effectively. Care Homes for Adults (18-65 years) Page 30 of 36 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 home is well managed so that it is run in the best interest of the people living there. Evidence: The registered manager is currently on maternity leave so the organisation have appointed an acting manager. She is suitably experienced and is about to start working toward her NVQ 4. She has a good insight to the management of a small care home having acted up on two previous occasions. Based on our discussions with her and the staff team she provides a clear sense of direction. There is a mutual respect and a real sense of teamwork among the staff team to help the people living in the home enjoy a good quality of life. In addition to ongoing consultation with individuals through key worker contact and care plan reviews, annual quality assurance questionnaires are used to get feedback about the quality of the service provided. We examined the most recent returns and our own survey responses, which included the following comments. My life has been happier since moving here. I like going to church and enjoy the Care Homes for Adults (18-65 years) Page 31 of 36 Evidence: walking group. Its good to plan my holidays and trips out. I am very happy here the staff are good to me. Regular meetings, at least every six weeks, are held with the people living in the home This gives people the opportunity to raise any concerns and contribute to the running of the home. Meetings are recorded and actions agreed to make sure their voice is heard. A management audit was recently completed that evaluated the effectiveness of the systems and procedures in place in the home. In addition monthly management visits take place in line with Regulation 26 of the Care Home Regulations ensuring the home is safe and responding to peoples needs. Information from the quality systems is used to develop the homes annual business plan targets making sure they reflect the needs of the people living in the home. Good systems are in place to monitor all aspects of health and safety in the home and make sure routine servicing of equipment and services are completed. In addition the organsations health and safety officer completes a regular work place risk assessment with the manager to identify any areas of concern or potential hazards. An action plan is agreed as part of this visit with actions signed off when they have been completed. Care Homes for Adults (18-65 years) Page 32 of 36 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 33 of 36 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 24 16 The flooring in the bedroom identified must be replaced to make sure the home is free from offensive odours. 18/08/2009 Currently there is a malodour in this room despite efforts to clean it. Replacement flooring must be provided that can be cleaned and remain free from offensive odours. 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 20 Refused medication should not be stored in the home for longer than is necessary and should be returned to the Pharmacy on a regular basis. The upstairs toilet and bathroom are in need of routine maintenance to make sure they are decorated and maintained to a reasonable standard. Page 34 of 36 2 24 Care Homes for Adults (18-65 years) 3 4 24 24 The hall, stairs and landing carpet stained and is in need of cleaning or replacement. Regular maintenance of the garden should take place to make sure all areas of the home are safe and accessible. Care Homes for Adults (18-65 years) Page 35 of 36 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). 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. 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