Care Home: 21a King Street

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What the care home does well The home carefully makes sures that it could meet the needs, wishes and goals of any possible new residents, and that staff know all about them, before they move in. Residents say they are very happy living at king Street and think of it as their home. One care professional comments in their survey `I rate this service and staff highly`. Staff enable residents to be independant and make decisions about their lives. They share household jobs, cooking and choose their own activities, meals and holidays. Staff offer residents good support with their personal care. They also ensure they have necessary health checks and manage their medicines safely, if they are not able to. Staff and management ask for peoples` views and listen and act on them and on any complaints made. Residents also feel they can talk to staff if they have any worries. 21a King Street is in Hereford city centre so residents can get to the shops and other places, do their weekday activities and meet up with their family and friends easily. The house is homely, pleasant comfortable and kept safe and so is a good place to live. The home has a stable, committed staff team who work well together and have good training. This means staff understand how do their job and meet residents` needs. What has improved since the last inspection? Since the last key inspection of the service, which was carried out on the 5th of October 2006 the following improvements have been made. One resident wished to have a more independant lifestyle and has been supported by the home to move into their own flat. Staff have helped some residents find new work, educational and leisure opportunities to take part in. This has developed their skills and made their lives more interesting. The whole house was redecorated inside and outside. A new shower has been installed and electrical equipment, including a cooker, freezer, washing machine and tumble drier bought. This has has made the home nicer and doing household jobs easier. Staff received more training on health and safety and about residents` special needs. This means they keep the home and people in it safer and understand and know how to manage residents` needs and offer them support better. The home assesses risks in a way that looks more at residents` wishes and how risks effect them. So they still make their own choices whilst staff aim to keep them safe. What the care home could do better: Continue to make residents` care plans more `person centred`. This would help them understand and be more involved in planning their own care. Plans would also show peoples` personal goals better and how they are being supported to meet them. When each resident has a separate health care plan it will better ensure they are fully involved in managing their own health and that their good health is being promoted. Arrange for staff to have regular individual support from their manager. This will help them know if they are doing their job well and plan training and development needed. Make sure management arrangements are appropriate and that there is enough time for all the management tasks to be done and for staff to be supervised properly. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 21a King Street 21a King Street Hereford HR4 9BX     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: Christina Lavelle     Date: 3 1 0 3 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. 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. 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 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI 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 29 Information about the care home Name of care home: Address: 21a King Street 21a King Street Hereford HR4 9BX 01432269406 01432344647 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Aspire Living Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 6 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 6 The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category of service only: Care Home 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 (LD) 6 Date of last inspection Brief description of the care home 21a King Street was first set up as a care home in 1986. Aspire Living, which is a voluntary organisation and a registered charity, took over the homes management in 2006. Aspire Living runs care services just in Herefordshire, including four other care homes and a domiciliary care agency. This home provides accommodation with personal care for six adults. People using the service must require care due to learning disabilities and most of the current residents have lived there for years. The property is a Grade II listed Georgian town house, which has three storeys and is located down a short passageway in the centre of Hereford city near the Cathedral. This is convenient for the shops, services and facilities in Hereford and to access public transport links. Care Homes for Adults (18-65 years) Page 4 of 29 Brief description of the care home Aspire Living lease the property from a registered social landlord and they have a management agreement in place regarding the use and upkeep of the premises. Residents all have single bedrooms on the first floor, none of which have ensuite facilities. For everyone to use the house has a separate lounge, sitting and dining room, kitchen and laundry room on the ground floor. There are also three bathrooms (two with shower facilties), a small enclosed garden and the cellar used for storage and as a games room. On the second floor there is an office (also used by staff for sleeping in), a small kitchen, bathroom and lounge that can also be used for meetings. Information about the service is provided in a service users guide available from the home and Aspire Living. The weekly fee for the service is agreed in respect of each individual with their funding authority according to their assessed needs. Additional costs include such as hairdressing, chiropody, newspapers, personal toiletries and clothes, activities, dry cleaning, transport and holidays. Care Homes for Adults (18-65 years) Page 5 of 29 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 a key inspection of the service provided by 21a King Street. This means all the standards that can be most important to people using care services are assessed. As part of this inspection we, the commission, visited the home for about four hours without telling the people living there or staff beforehand. People who live at the home like to be called residents and so they will be referred to as residents in our report. A range of evidence is used to make judgements about the quality of the service. This included talking to three residents about their lifestyle and the support they receive. Five of the residents also completed our surveys asking their views of the home. Staff on duty discussed their role, training, responsibilities and residents care with us. Two care professionals who are involved with the home also returned surveys. Care Homes for Adults (18-65 years) Page 6 of 29 We checked some records homes are expected to keep about the people using their service, staff and health and safety. We also looked around areas of the house. An annual quality assurance assessment (AQAA) was completed before our visit, as required. The AQAA asks managers to say what their service does well, could do better, what has improved in the last 12 months and about their plans for improvements. It also gives us numerical information about residents, staff and other aspects of the service. All other information we have been told about the home since the last inspection is also considered. This includes any events that had affected the health, welfare and safety of residents (these are called notifications). What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Adults (18-65 years) Page 8 of 29 Continue to make residents care plans more person centred. This would help them understand and be more involved in planning their own care. Plans would also show peoples personal goals better and how they are being supported to meet them. When each resident has a separate health care plan it will better ensure they are fully involved in managing their own health and that their good health is being promoted. Arrange for staff to have regular individual support from their manager. This will help them know if they are doing their job well and plan training and development needed. Make sure management arrangements are appropriate and that there is enough time for all the management tasks to be done and for staff to be supervised properly. 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 9 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 29 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 residents can be confident that 21a King Street could meet their needs. This is because a full assessment will be made of their needs, wishes and goals with them, their family and representatives involved, before they are offered a service. Evidence: The previous inspection and AQAA confirm that the home has a statement of purpose and service users guide, which provide information about the service and facilities, as is required. Each resident has been given a copy of these documents and has a Terms and Conditions and contract agreed with them, the home and their funding authority. Aspire Living has a comprehensive policy and procedures for the assessment and admission of potential new residents. One person has moved into the home since the last inspection and the processes followed are described in the AQAA and we discussed their admission with staff. We also looked at the care records of the new resident. It is evident that a full needs assessment was carried out for this prospective resident Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: and they had an extended introductory period to the home. This included them visiting the home and having overnight stays. A key worker was allocated to the person from the 21a King Street staff team and they spent time getting to know each other. Their keyworker also worked with them and the staff team at their former care home. A social worker involved in one residents admission comments in their survey that the home carried out an accurate assessment so that the right service was planned and is being given to the individual. Five residents indicate in their surveys that they were asked if they wanted to move in and had been given information about the home. One person comments I had tea here. I tried it out and spent nights here. The admission process includes people moving in for a trial period of at least three months. Their family, social worker and other significant people are all involved and they are also invited to reviews to discuss and confirm the suitability of their placement. When the decision has been made that they will live at the home terms and conditions of residence are agreed and signed by the resident. A contract is also set up with their funding authority detailing the charge and support they will receive. Care Homes for Adults (18-65 years) Page 12 of 29 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. Each resident has a care plan outlining their needs, wishes and support they require from staff, but which could better reflect their personal goals. Residents are able to make decisions about their life because staff promote their rights and choices. Risks are assessed to reduce any possible risks to residents whilst also enabling them to maintain and or develop their independence. Evidence: We looked at a sample of residents care records and discussed care planning and decision making with two residents and staff. It is clear that the home has a person centred approach, which means there is a focus on individual residents goals as well as their needs and they are able to make choices about their own lives and routines. Residents care plans need to be reviewed and updated however to reflect this better. Plans should describe how staff could support them to achieve their identified goals and develop their life skills. They should also be a in a format that residents can easily understand and agree and so be more involved in drawing up and reviewing. Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: Each resident chooses a keyworker from the staff team who offers them some personal support and gets to know them, their needs and wishes well. They spend time together and have meetings when residents can express their views, concerns and discuss anything they would like to do, outings, holidays etc. Keyworkers therefore have a key role in helping people plan their lives and get support they need. Residents told us and their surveys indicate that they decide what they do every day. They have regular meetings when they discuss how the house is run on a day to day basis, any concerns, staff and management issues. Their views are taken into account when decisions are made about changing the service and such as meals, holidays and new staff. As far as possible residents are supported to manage their own money. Risk assessments are carried out when residents may be at risk to minimise possible risks and to specify action staff need to take to support them. Plans include guidelines on how staff should react when people use behaviours that could be challenging and staff have received training on these techniques. It is good that risk assessments also focus on promoting peoples independence including areas as their time and money management, when using public transport and undertaking daily living tasks. Care Homes for Adults (18-65 years) Page 14 of 29 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. Residents pursue activities they enjoy and are part of their local community. They live their chosen lifestyle because staff respect their rights and individuality and encourage their independence. Residents are supported to maintain relationships with their family and friends. The home offers a healthy diet and people choose meals they like. Evidence: It is evident from surveys, the AQAA and discussions during our visit that residents still lead full and busy lives. They follow their own interests and can go out if and when and do what they want to. Some people attend day services, college and or are involved in community projects and have work placements. Staff have recently assisted some people to seek new opportunities and to change their weekday occupation. Most people are able to go out without staff support and their leisure activities include Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: going to social clubs, skittles, the cinema, shopping, using cafes and pubs. Some people attend Church services regularly. The homes location is very convenient for Hereford citys shops and facilities and residents also have bus passes. Whilst at home people follow their own interests and hobbies such as music, TV and using a computer. Residents are clearly self determining, choosing their own daily routines and lifestyle. They are expected to take responsibility for and share household tasks and cooking and they do such as their own laundry. They have all agreed to this and to respect the rights and privacy of other people living in the home. One person is involved in a local advocacy group that has regular meetings, produces newsletters and helped to set up a Bill of Rights for people with learning disabilities. They provide a link to the home. Residents friends and families are made welcome in the home and they are enabled to maintain contact. Staff assist individuals to obtain advice and guidance about personal relationships and if necessary they monitor and support their friendships. Regarding food provided by the home weekly menus are chosen by residents. A record is kept of the main meal they have each day. There is a cooking rota and people help staff with or do the shopping. Staff promote healthy eating, offering such as fresh fruit and vegetables and home made meals. They support people to monitor their weight and follow particular diets if they need or wish to. One person has a personal diet sheet drawn up by a dietitian. Meals and meal times are flexible, especially breakfast and lunch, although residents enjoy having their main meal together with staff. Care Homes for Adults (18-65 years) Page 16 of 29 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. Residents receive any personal support they require and staff also make sure that they obtain appropriate health care input to meet their needs. Peoples medicines are managed safely in the home on their behalf, if they are not able to manage their own. Evidence: Residents personal and health care needs and current medication are outlined in their care plans. The AQAA states that the home intends to introduce separate health plans, which would be a positive development. The new plan format will also be more person centred, as it includes pictures and simple language so that residents can be involved more easily in monitoring and promoting their own good health. Most residents are fairly independent in respect of their personal care and their plans show their hygiene routines and preferences. Staff provide any oversight or guidance each person needs or wants and will support them with such as their clothes shopping. All assistance staff give is detailed in peoples individual daily records. Residents discuss their health needs with their keyworker who monitor any issues and Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: ensure they arrange and obtain routine and specialist health care input. Records are kept of appointments, treatment and outcomes. There are also procedures in place for individuals with specific health issues such as diabetes and one resident keeps their own records of necessary checks. Staff encourage people to regularly check such as their weight and to access counseling for any emotional or behavioural issues. Regarding residents prescribed medicines the AQAA and previous inspection confirm the home has a comprehensive policy and procedures for staff to follow. They include procedures for homely medicines and one person has a protocol as part of their behaviour management plan for medication that can be administered when required. There is suitably secure storage for medicines in the home, a lockable box in the fridge and cabinets in residents bedrooms if they are able to manage their own. Staff who are designated to deal with medicines have undertaken safe handling training and went through a formal induction process. We saw records of medicines that are administered by staff are being maintained appropriately. This includes records kept of all medicines ordered and received so there can be an audit trail. A community pharmacist also checks the homes medication system annually. Care Homes for Adults (18-65 years) Page 18 of 29 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 that they will be listened to and action taken to put things right. There are systems in place to safeguard residents from abuse, neglect or self harm and any allegations are followed up. Evidence: The home has a written complaints procedure and residents all have a copy. They also have complaint cards so they can raise concerns directly with Aspire Living. Residents confirm in their surveys that they know who to speak to if they are not happy about anything and how to make a complaint. They also have opportunities and are encouraged to express their views in home meetings and to their keyworker. Residents spoken with clearly relate well to and have trust in staff. There has not been any complaints made to the home or commission since the last inspection. Aspire Living provides policies and procedures on abuse and whistle blowing and the home has a copy of local multi agency safeguarding procedures. All staff received training recently on safeguarding and staff we spoke with clearly understand their responsibility to protect vulnerable adults and know how to report incidence or suspicion of abuse or neglect. The home has appropriately referred people who have made allegations or can be at risk when out in the community through safeguarding procedures and sought input from and follow the advice of relevant professionals. Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: Care Homes for Adults (18-65 years) Page 20 of 29 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. Residents have a safe, well maintained home that is homely, comfortable and pleasant. The house is kept clean, which helps promote good hygiene and infection control. Evidence: 21a King Street is conveniently situated in the centre of Hereford city. This means that shops, services and facilities can be accessed easily, as well as public transport links. Residents appreciate this as most of them are able to go out without staff support. They do need good mobility however as bedrooms are up a rather steep stairway. The property is a listed Georgian town house with three storeys. Whilst having a very central location it is down a short passage way, which provides more privacy. The home is homely and comfortable and has a friendly relaxed atmosphere. The house has a good sized separate lounge, dining and sitting room, one bathroom, two shower rooms, four toilets and a small enclosed garden. Although bedrooms do not have ensuite facilties, and four are quite small, current residents accept this and the size of the communal space compensates to some extent. The property is leased to Aspire by a social housing landlord and arrangements have Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: been agreed in respect of their responsibility for upgrading and some maintenance. Although there have been few improvements made in the last 12 months we observed that the accommodation overall is reasonably kept and furnished. Since the previous inspection the house has been decorated throughout, some kitchen and electrical appliances replaced and a more accessible shower installed. Recently new thermostats have been fitted to washbasins, showers and bath taps for safety. The garden was also changed to provide more space and they are planning to give it a makeover. All parts of the home we visited were found to be fresh, clean and tidy. Most residents indicate in their surveys that the home is always fresh and clean. There are suitable laundry and hand washing facilities, waste disposal arrangements and policies and procedures in place to promote good infection control. Staff have also received appropriate training in food hygiene and infection control. Care Homes for Adults (18-65 years) Page 22 of 29 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. Residents receive safe, appropriate support from an adequate number of competent and qualified staff. People can be confident in staff because checks have been done to help to ensure they are suitable to care for people. Staff complete relevant training so that they can give residents the right support, meet their needs and keep them safe. Evidence: Residents told us they like the manager and staff and value their keyworkers input. Their surveys further confirm that they have confidence in the staff team at 21a King Street and we observed there is an open and caring rapport between them. One external care professional comments in their survey there is good communication and responsive high quality interventions with clients, other agencies and myself. The home has a stable staff team with a low staff turnover and absence levels. This helps to promote consistency of care and means staff and residents know each other well. Agency staff are being deployed to provide additional support that one person needs but a regular team is used so this does not impact at all on staff effectiveness. However another resident needs extra input and there is a staff vacancy currently, which it is reported is having an impact on management time available for administration and to support staff with formal individual supervision. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: Most staff have achieved or are working towards the social care qualification NVQ (National Vocational Qualification) and new staff are expected to complete a learning disabilities qualification (LDQ). The AQAA confirms that Aspire keep a training programme, which makes sure staff complete training and updates in all mandatory health and safety areas. The staff team have also received training relevant to residents specific needs such as autism, management of challenging behaviours and for administering one particular type of medication. Regarding staff recruitment the AQAA and last inspection confirm that Aspire Living operate thorough procedures. Staff say they had two written references and a criminal records bureau (CRB) taken up before starting work at the home. New staff have to complete an induction programme and a six month probationary period before their appointment is confirmed and they then sign an employment contract. It is good that residents are directly involved in interviewing and selecting new staff. Staff we spoke with are positive about the service and there are clearly good working relationships and communication within the team. A communication book, daily reports, handovers and regular staff meetings are part of this process. All staff have an annual appraisal and can access the manager and Aspire for advice and support when they need it. Although formal individual supervision sessions should be arranged so their work performance, training and developmental needs can be reviewed. Care Homes for Adults (18-65 years) Page 24 of 29 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 have confidence in the care residents receive at 21a King Street because the home is run well. There are ways of making sure that service quality is reviewed regularly, continues to be good and improves. The home environment is kept safe for residents and staff because good health and safety practices are carried out. Evidence: There is not a registered manager at 21a King Street currently, the previous manager having transferred to manage another Aspire Living care service in January 2009. Since then the registered manager of another of their homes has been overseeing its day to day management, normally spending three days a week there. Whilst the evidence from our inspection shows the service is still running smoothly time is limited for administration, individual staff support and development plans. This could eventually have an adverse impact on the service and so management arrangements need to be settled and a permanent manager registered with the commission as legally required. Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: It is clear that the key principles of the service are understood and being followed. Staff respect residents individuality and encourage them to make choices and have full and active lives, providing support they need to do so. The ethos of the home and staff team is open and approachable and staff are well trained and competent. Aspire Living operates formal processes to monitor, review and assure the quality of their services. This includes the required monthly visits made by their representative when all relevant aspects of the service are checked, people interviewed and written reports made on the conduct of the home with any shortfalls identified and action plans set up to address them. An annual health and safety audit is also undertaken and each service has its own business plan with aims and objectives. The AQAA is completed clearly with detailed information about how what the service does well results in good outcomes for residents. It also outlines the improvements they have made and what still needs improving. This should now be formalised into a plan showing actions needed, by whom and with timescales. Their plans for the next 12 months include making the garden more accessible and pleasant, seeking more training and work opportunities for residents and implementing an annual developmental plan. It is good that residents feedback on the home is obtained through their meetings and staff are receptive to them expressing their views and making decisions. One resident is now a member of Aspire Livings quality network review team, which is promoting the involvement of people using its services. They also plan to send out annual questionnaires to peoples families and advocates to obtain their views. Regarding health and safety in the home staff have received necessary training. The AQAA and previous inspection confirm that comprehensive health and safety policies and procedures are in place, which staff follow in their practices. The home keeps records of all accidents and incidents affecting residents and tell the commission about them, as required. The AQAA confirms that necessary checks, tests and maintenance are carried out. This includes electrical appliances, the fire safety system and regular servicing of the heating system and gas appliances. The home has risk assessments for the control of substances hazardous to health (COSHH). Care Homes for Adults (18-65 years) Page 26 of 29 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 27 of 29 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 Progress to implement person centred planning should continue so that residents are more involved in setting up and reviewing their own plans which focus on identifying and supporting them to achieve their personal goals. Each person should have a separate health plan. These plans would better ensure their involvement in managing their own health and promoting good health. The home should arrange for staff to have regular formal supervision sessions. This would better ensure that their work performance is monitored and their individual training and developmental needs are identified and met. Aspire Living should ensure that there is sufficient time available for the management task and administration so the home continues to run well, provide a good quality service and staff receive appropriate support. 2 19 3 36 4 37 Care Homes for Adults (18-65 years) Page 28 of 29 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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