Care Home: 220 Preston Road

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What the care home does well The home always ensured that peoples` needs were assessed prior to admission. This enabled staff to be sure the home could meet the persons needs and gave them direction in how to care for them. Although the home had not had any new residents since the last inspection the process remained the same. Staff were clear about how they promoted peoples` independence and choice and provided care to people in ways that respected privacy and dignity. The staff members knew the residents well and were observed speaking to people in a courteous manner. Management and staff have developed a very relaxed and friendly atmosphere in the home. Residents enjoy a range of activities and holidays tailored to meet their needs. 220 Preston Road provides a pleasant environment for people. It is clean, warm, well presented and has plenty of communal space. There is a process of continual redecoration and refurbishment of the home. The home provides nutritious and well planned meals for people and has won a healthy heartbeat award for the last two years. Catering staff scored an, `B` in the local authority`s food safety management assessment, which was a good achievement. The home manages complaints well and always tells the Commission, or the complaints department and safeguarding teams within the local authority, of any reportable incident. This enables situations to be monitored and we can check how the home is dealing with them. The local authority has a good recruitment, induction and training programme. Staff members all say they receive the training required for them to complete their jobs. There has been a very low staff turnover in the last year, which means there is consistency for residents and the staff team as a whole. Staff members told us they received regular supervision and felt supported by the manager. The local authority has a good quality assurance system that enables people to be consulted about the way the home is managed. What has improved since the last inspection? Care plans reflect behaviour management strategies including any techniques that are required to restrict people safely. This means that staff have clear guidance. Health action plans have been completed for each resident and annual sceenings of their health takes place. Community nurses hold a clinic in the home every two weeks so they can discuss any health issues people may have. Staff have received training in infection control. The home is working with a person experienced in therapeutic crisis intervention to tailor support for one specific resident when they are distressed and may harm themselves or others. This will give staff clear guidance in how to support the person. Documentation has improved regards daily recording, medication charts and producing menus and activity calendars using symbols. What the care home could do better: Care plans could be made even more personalised as staff know the residents really well but don`t always write this information down. There are also other documents in the care files that have information about preferences. The information could all be pulled together and written in the care plans. Medication amounts should be carried forward to the new medication administration record when it is not included in the monitored dosage system. This will enable staff to monitor stock control. The manager should collate completed staff training information and update records. This will enable her to audit training more effectively. Key inspection report Care homes for adults (18-65 years) Name: Address: 220 Preston Road 220 Preston Road Hull East Yorkshire HU9 5HF     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Beverly Hill     Date: 1 2 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: 220 Preston Road 220 Preston Road Hull East Yorkshire HU9 5HF 01482706988 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: mansfieldm@hullcc.gov.uk Places for People Individual Support Ltd care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: That registration is approved with the condition that a clear CRB disclosure for the Manager is received by the CSCI. Date of last inspection Brief description of the care home People for Places, a housing asociation, own the building that is 220 Preston Road. The home is managed in partnership with Hull City Council. The councils social services department is responsible for providing the care and support to the residents by employing care and ancilliary staff. The home is registered to provide care and accommodation for up to nine adults between the ages of 18-65 who have a learning disability. The home is located to the east of Hull city centre and is purpose built. The building has two storeys and is divided into two main units with a central linked area that includes the reception area, office accommodation, the laundry room, relaxation room and kitchen. Each unit has a lounge and dining room with kitchenette Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 9 Brief description of the care home area. One unit has five bedrooms and the other has four and a sleep-in room for staff. All bedrooms are for single occupancy. Two of the bedrooms are located downstairs to accommodate people with mobility difficulties if required. There is no chair or passenger lift. There are a number of bathrooms and toilets on each floor. There is a car park area to the front and a pleasant garden to the rear and sides. Information about the home and the services it provides is contained in the statement of purpose and service user guide located in the managers office. According to information received the weekly fee charged is 950 pounds. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 star. This means that the people that use this service experience excellent quality outcomes. This inspection report is based on information received by the Care Quality Commission (CQC) since the last Key Unannounced Inspection on 14th June 2007 and Annual Service Review on 9th June 2008. It includes information gathered during a site visit to the home, which took approximately nine hours. The residents living in the home have complex needs associated with autism so it was not possible to have detailed conversations with them. However, we spoke to the registered manager and staff team. Information was also obtained from surveys received from residents (completed with assistance from their key worker) and staff members. Comments from the surveys and discussions have been used in the report. Care Homes for Adults (18-65 years) Page 6 of 28 The providers returned their Annual Quality Assurance Assessment (AQAA) within the agreed timescales. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We looked at assessments of need made before people were admitted to the home, and the homes care plans to see how those needs were met while they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We also checked with people to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them, and checked out with them their understanding of how to maintain privacy, dignity, independence and choice. We would like to thank the people that live at 220 Preston Road, the staff team and management for their hospitality during the visit, and also thank the people who completed surveys and had discussions with us. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the services are not being put at significant risk of harm. In future if a requirement is repeated it is likely that enforcement action will be taken. Care Homes for Adults (18-65 years) Page 7 of 28 What the care home does well: What has improved since the last inspection? Care plans reflect behaviour management strategies including any techniques that are required to restrict people safely. This means that staff have clear guidance. Health action plans have been completed for each resident and annual sceenings of their health takes place. Community nurses hold a clinic in the home every two weeks so they can discuss any health issues people may have. Staff have received training in infection control. The home is working with a person experienced in therapeutic crisis intervention to tailor support for one specific resident when they are distressed and may harm Care Homes for Adults (18-65 years) Page 8 of 28 themselves or others. This will give staff clear guidance in how to support the person. Documentation has improved regards daily recording, medication charts and producing menus and activity calendars using symbols. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensured that people were only admitted after their needs had been fully assessed. This enabled staff to be sure their needs could be met in the home. Evidence: There had not been any new admissions to the home since the last inspection but the manager had a clear admissions process. This involved ensuring a range of assessments from care management and health professionals were obtained to assist in deciding whether the home was the most appropriate place to meet the persons needs. The manager confirmed that trial visits would be arranged over a period of time during the new residents introduction to the home to enable them to meet other residents and staff. We looked at three care files during the visit and all confirmed that the above process had been carried out. They included a full range of assessments and care plans. The manager also completed their own assessments of activities of daily living. The information enabled care staff to formulate detailed plans of care to support the person and meet their needs. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are detailed in care plans and staff have clear instructions and good knowledge about residents in order to meet their needs, promote choices and maintain independence. Evidence: We looked at three care plans and there had been some improvement since the last inspection. The care plans covered all aspects of daily living and included information from health professionals such as specialist nurses and speech and language therapists. The documentation was in two parts. Part one detailed a list of activities at one side such as, can shave independently and can dry self with towel with a tick box selection of, always, usually, sometimes or never. There was then scope to comment in a summary. Part two detailed the individual activity and what staff had to do to assist the person to complete it. Generally these were completed well but staff could make them more personalised by adding information about preferences, likes and dislikes that are included in personal profiles and other parts of the care file. Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: Residents had completed a lifestyle plan with assistance from staff and relatives. These included lots of information about hobbies, choices and preferences and could be used to inform the care plans. There was evidence that reviews of care plans were completed with the resident, family members and health professionals present. Also the manager or senior staff audited the care plans to ensure they were kept up to date. The care plans detailed any restrictions and the reasons why they were in place. Risk assessments evidenced that any areas of activity that posed a risk were identified and managed safely to enhance and promote peoples independence. Each resident was allocated a key worker and good relationships had developed between residents and staff. From information in surveys and discussions with staff it was clear that they knew the residents well and were committed to providing an environment where choice and independence was promoted. The residents living in the home had a range of complex needs but they were involved in decisions about aspects of their lives including their health and social activities. Bedrooms were very personalised. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent 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 good quality of life for people by ensuring their inclusion in decisions about aspects of their lives, by providing social stimulation and contact with family and friends, and by providing nutritious meals. Evidence: People living at at 220 Preston Road have autism with significant needs and all require a high level of support from the staff team. Therefore none of the residents have work placements. The home employs two programme workers, each work four days a week. They specifically support people to access outside activities of their choice and they also provide an in-house activity programme. The care files identified programmes for the week and one examined included Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: activities such as, shopping, outings to local facilities and attractions, attendance at day centres, coffee afternoons, pampering sessions for hair and nails, time in the sensory room in the home, listening to music, entertainment nights, watching DVDs, visiting the local church and looking at magazines. It was evident that some people participated in more activities than others and staff explained this was down to choice. Holidays had been planned for this year based on staff knowledge of residents and their preferences. The length of the holidays had been individually tailored to meet their needs. For example, one person will have an overnight stay at Alton Towers and another person wants to have an overnight stay in Scarborough and go to the theatre. Staff told us that two residents are supported to visit their relatives at home and one resident attends a gardening group at a local centre. One resident likes to participate in domestic tasks about the house and is supported by staff. It was clear that staff were concerned that residents had as active and fulfilled lives as possible. The manager, staff and cook continue to promote a healthy eating menu. There were plenty of choices throughout the day and peoples diets were monitored and tailored as required. For example, staff told us that one resident needs a high calorie diet served in little and often portions throughout the day. The cook was knowledgeable about residents likes, dislikes and special diets and menus rotated over a four-week period. The main meal is now served in the evening to more effectively meet residents needs and preferences. Any restrictions regarding meals and/or lack of choice continue to be clearly documented in the residents care plans with guidelines and recommendations from health professionals incorporated. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health care needs were planned for and met and medication was managed appropriately, which ensured people received the medication prescribed for them. Evidence: Records examined confirmed that service users health needs continued to be met. Residents had access to a range of health professional such as, GPs, specialist nurses, speech and language therapists, psychologists, psychiatrists, dentists, opticians and chiropodists. Community nurses held a clinic in the home on a two-weekly basis and residents attended out patients appointments as arranged. Each resident had a health action plan detailing their health needs and how these were to be met and annual health screening was carried out. Weight was monitored when required if any concerns were evident. Staff told us that they had a specifc health plan for one resident when they visited their GP. This detailed what and how the resident could contribute to the visit, what was important to him and how he needs to be treated and supported during the visit. The plan has been agreed by his GP and staff at the surgery are aware. This person-centred approach is very good practice. Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: Discussion with staff and observations confirmed that the staff promoted peoples dignity and privacy. It was obvious that staff members knew the residents well and their approach was friendly, professional and courteous. Hull City Council has medication policies and procedures that include receipt, storage, administration and disposal of medication. Medication systems appeared to be well managed in the home and there was no one self medicating at the time of the visit. The home obtained written instructions from the prescriber if there were any changes to medication mid-cycle. There were no controlled drugs in the home. Since the last inspection clear protocols for those residents requiring the administration of medication on an as and when required basis have been produced. Medication is provided by Lloyds pharmacy and is in a monitored dosage system (MDS). The manager and senior staff regularly audit, stock check and ensure that the medication is safely managed. All staff are given medication administration training which includes the completion of a workbook assessed by Lloyds and their competence assessed by the manager. To improve staff need to carry forward amounts to the new medication administration record for medication not dispensed in the MDS and ensure that it is signed each time. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home protected people from abuse by ensuring staff members adhered to policies and procedures, and by the provision of staff training. This made sure they were able to recognise the signs and knew what to do should they be alerted to concerns. Evidence: The home is managed by staff employed by the local authority. There is a corporate complaints policy and procedure and documentation to complete when concerns or complaints are brought to the attention of staff or the manager. The manager maintains a log of complaints although there have not been any in the last year. The Commission has also not received any complaints about the home. Staff members were aware of what they had to do when concerns or complaints were raised with them. Staff had all received training in how to safeguard vulnerable adults from abuse and in discussion were knowledgeable about the different types of abuse and what to do should they be alerted to any concerns. The manager had completed the more in depth safeguarding training specifically for their role in referral and investigation. The homes annual quality assurance assessment indicated that there had been four instances when a person had to be restrained because their behaviour was challenging to himself or others. The manager confirmed this was clearly recorded in their care plan including the action staff needed to take. Care Homes for Adults (18-65 years) Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with a clean, safe and well-maintained environment. Evidence: There have been no major changes to the home since the last inspection. The home is located to the east of Hull city centre and is purpose built. It is a two-storey building divided into two main units with a central linked area that includes a reception area, office accommodation, a laundry room, a relaxation/sensory room and the main kitchen. Each unit has a lounge and dining room with kitchenette area. Communal areas are nicely furnished and decorated and staff advised that any maintenance issues were reported and quickly addressed. One unit has five bedrooms and one has four, and a sleep-in room for staff. All bedrooms are for single occupancy, are personalised to the service users liking and have privacy locks to the doors. Some people choose to use the locks and have their own keys. Two of the bedrooms are downstairs can be used for people with mobility issues. There is a bathroom, a shower room and toilets on each unit. There is no chair or passenger lift so the home is more suitable for ambulant people. There is a car park area to the front and a pleasant, secure garden to the rear and sides. Staff advised that part of the garden fence is to be moved to accommodate the Care Homes for Adults (18-65 years) Page 19 of 28 Evidence: needs of one specific resident. On the day of the visit the home was seen to be clean and tidy and provided a safe, warm and homely environment for people to live in. Care Homes for Adults (18-65 years) Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were supported by an appropriately recruited and well trained staff team. This enabled residents and their families to be sure their needs would be met and provided staff with the skills, knowledge and confidence to support vulnerable people. Evidence: Discussions with the care staff team highlighted that shifts had staggered start times throughout the day and evening to ensure staff were available at peak times. The rota usually consists of a senior care officer and three care officers during the day and two staff at night with a senior on a sleep-in shift. In addition to this there are two programme workers to provide activities Monday to Saturday. Some residents require two care staff when they access community facilities and extra staff are planned into the rota for this. The manager is supernumerary. All staff spoken with stated that staffing was adequate to meet the needs of the residents and they did not feel rushed when supporting them. One survey from a resident completed with assistance from their key worker did state that they would like better staffing levels so they could go out when they wanted instead of when staff were available. Staff retention is good and the home continues to benefit from a consistent staff team. Care Homes for Adults (18-65 years) Page 21 of 28 Evidence: In discussions with staff it was clear they were very committed to ensuring good quality of care for people living in the home. They were focused on the needs of residents, took pride in the relationships developed between them and residents, and clearly enjoyed their jobs. Comments from staff were, we have a good rappor with residents and their families, we have a consistent and reliable staff team, we are always striving to give better care to clients, we work as a team to promote person-centred care, we support each other to work well together and we assist residents to be involved in local activities in our community and support them to try new things. The local authority had a training department which was responsible for providing a range of training and development opportunities for staff. Each staff member had a personal development plan and information regarding training gathered during supervisions and annual appraisals was forwarded to the training section to inform the corporate plan. The training plan included a range of mandatory and service specific courses and staff spoken with said the training received equipped them for their roles. The training matrix was difficult to audit fully, as although staff had completed training courses it wasnt reflected in their individual records. This information was only inputted when certificates of attendance were received and logging was a little behind. However we did see evidence of the training and the certificates. Staff confirmed their attendance in discussions. Since the last inspection the manager and senior care staff have completed a management course in infection control. There was also a requirement from the last inspection that therapeutic crisis intervention training (TCI) must be tailored to meet the specific needs of individual residents. The manager confirmed that a TCI trainer is working with the home to develop a specific holding technique for one resident and this is to incorporated into their support plan. According to information in the homes annual quality assurance assessment 86 percent of care staff have gained a national vocational qualification in care at level 2 and 3. One senior has completed the course at level 4. This is an excellent achievement and demonstrates the commitment to a trained workforce. Staff received formal supervision with the manager or a senior care officer and stated they were well supported by management. The local authority had corporate recruitment policies and procedures. All checks were carried on on new staff members to ensure they were suitable to work with vulnerable Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: adults. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed by an experienced manager and the home is a safe place for residents to live in and staff to work in. Evidence: There has been no changes to the management of the home since the last inspection. The registered manager has many years experience of working with adults with a learning disability and she has completed a National Vocational Qualification at level 4 in care and management. She keeps herself up to date with relevant training including mental capacity legislation and deprivation of liberty training. Staff members describe the manager as having an, open door policy and is quick to sort out any problems. They stated communication was good between management and staff and morale was high. Regular staff meetings, visits by senior managers, formal staff supervision and the appraisal system, all ensure that staff have avenues to comment on practice issues and how the home is managed. Hull City Council has a formal quality assurance (QA) process that includes audits of Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: systems in the home, such as medication management, accidents, finances, health and safety, cleanliness, sickness monitoring etc and questionnaires to residents, visitors and staff. Different outcomes for residents are analysed as part of the process, for example, any weight loss or gain, health issues, quality of life, how residents can make a positive contribution, and decisions and choices they make. Staff comment on what they have done to ensure the outcomes and what was achieved by their actions. The key worker system, which enables close relationships to develop between staff and residents ensures that staff get to know the residents very well. Residents have the opportunity to influence the way the service is delivered to them through the key workers knowledge of them and their needs. An annual service review is produced at the end of each QA year. In discussion staff advised that any maintenance issues were resolved straight away. Fire alarm checks and drills were carried out and equipment in the home serviced appropriately. Mandatory training in moving and handling, first aid, infection control, health and safety, fire safety and basic food hygiene is included in the training plan. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 Staff should make the care plans even more personalised by detailing the preferences about care support that is known to them and located in other documentation in the care file. Staff should carry forward amounts of remaining medication, not supplied in monitored dosage systems, to the new medication administration record. The manager should collate information on completed staff training and update records. This will assist with auditing. 2 20 3 35 Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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