Care Home: 34 and 36 Shaftesbury Road

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What the care home does well The service is very focussed on the needs, aspirations and wishes of the people who live in the home. They are involved in all aspects of their own care and of the running of the home. The service aims to support people in developing the skills and confidence needed for moving on to more independent accommodation and six people have moved on in the past twelve months. People living in the home are supported to access a wide range of liesure, educational and work opportunities in the community and the service has a good risk management system in place to support people in those activities. Staff in the home are very well trained and supported and demonstrate very positive skills in supporting people towards independence. The home is very well managed and has developed significantly over the past two years. What has improved since the last inspection? We had made two requirments at the previous inspection concerning the cleanliness of the home and the need to replace some tiles in the bathrooms. These have both been addressed. The whole of the home has also been decorated and there were new carpets in some areas. The emphasis of the home has changed from being just a place where people live to a home that supports individuals to work towards their aspirations and move on to more independent accommodation. This change of emphasis has necessitated changes to every aspect of the service. What the care home could do better: No requirements or recommendations were made as a result of this inspection. The service continues to develop in response to the needs and wishes of the people who live there. We discussed with the Manager to ensure that some aspects of recording in the are improved in order to further demonstrate the effectiveness of the service. This included supervision notes, quality assurance recording and keeping records of monthly Provider visits in the home. However, we did note that the outcomes for service users in these areas were very positive. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 34 and 36 Shaftesbury Road 34 and 36 Shaftesbury Road Southsea Hampshire PO5 3JR     The quality rating for this care home is:   three star excellent 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: Nick Morrison     Date: 1 7 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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 31 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 31 Information about the care home Name of care home: Address: 34 and 36 Shaftesbury Road 34 and 36 Shaftesbury Road Southsea Hampshire PO5 3JR 02392294414 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : The You Trust care home 13 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: 13 The maximum number of service users to be accommodated is 13 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Mental disorder, excluding learning disability or dementia (MD) Date of last inspection Brief description of the care home 34-36 Shaftesbury Avenue is a care home registered for thirteen service users within the category of mental health. Southern Focus Trust owns the home and the manager is registered with the Commission. The home provides single room accommodation and on the ground and lower ground floors are kitchens, two lounges, and staff facilities, with bedrooms on the upper floors. To the front of the property is car parking space and to the rear is a garden accessible from the lower ground floor. The current fee scale is #57.66 per day with no additional charges except for a contribution of #10 per year towards the television licence. The building is only accessible by steps from the road and does not have a lift; access to all of the floors is via stairs. Care Homes for Adults (18-65 years) Page 4 of 31 Care Homes for Adults (18-65 years) Page 5 of 31 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: This report represents a review of all the evidence and information gathered about the service since we did an annual review of the service in 2008. This inspection included a site visit that occurred on 17th April 2009 and lasted eight hours. During this time we looked at the files of six people who use the service. We also met with the Manager and three members of staff. All records and relevant documentation referred to in the report was seen on the day of the inspection visit. We also referred to the services own self-assessment of the home (AQAA). We spoke with five service users during the inspection and observed the care and support people were receiving in the home. Care Homes for Adults (18-65 years) Page 6 of 31 Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 8 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 31 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. Service users benefit from having their needs and aspirations assessed prior to moving into the home. Evidence: The home requires a full and comprehensive assessment for each person before they move into the home. Assessments are carried out jointly with the service making the referral and involve relevant professionals and the service user. Assessments include the identification of any religious or cultural needs the service user may have. Records showed that all assessments were in place prior to the person moving in and that service users and their families had been involved in the assessment process. Places are not offered unless it is clear the service can meet the needs of the service user. There is a review of the placement after twenty-eight days. The transition to moving into the home is managed around the particular needs of the service user and timescales are adaptable to individuals. The transition process includes spending time at the home meeting other service users and staff prior to moving in. Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: The Statement of Purpose is being reviewed to ensure that it reflects the current emphasis of the service, which has changed significantly over the last two years. The service is now clearly focussed on supporting service users to develop the skills to support people to move on from the home into more independent accommodation. Care Homes for Adults (18-65 years) Page 11 of 31 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. Service users benefit from having clear care plans and risk assessments in place and from being supported to make their own decisions Evidence: We looked at the care plans of four people living in the home. The plans were written with or by service users and written from the service users point of view. The plans related to the initial assessment for the person and were very focussed on supporting people to develop the skills they needed in order to move on to more independent accommodation. Each plan was reviewed with the service user on a regular basis and progress notes were recorded. These notes demonstrated that people living in the home were moving towards their aspirations and that their needs were being met. In addition to the care plan reviews, there were also reflective meetings between staff at the home, the service user and other professionals involved with the service user. Staff told us they thought these meetings were useful in developing more creative approaches to supporting the service user. In addition to care plans, each person living Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: in the home had a Wellness Recovery Action Plan and a Relapse Prevention Plan. Service users spoken with were aware of these plans and told us they had been involved in devising them. Care plans contained risk assessments which were also devised with the service user and written to support them achieving their aspirations. The risk assessments were also reviewed on a regular basis along with the care plans and there was evidence that that they were revised as necessary. Service users spoken with were aware of their own risk assessments and of the risk assessment process. They understood that risk assessments were in place to support them to achieve their aspirations within a safe and considered framework. Care plans contained information about the limits of decisions service users could make, subject to their legal status. Otherwise service users were supported to make decisions for themselves. Staff spoken with, and observed during the inspection visit, were clear about the importance of supporting people to make their own decisions. Service users spoken with were clear about their right to make their own decisions and said that staff supported them to do this when necessary. During the inspection we observed a conversation between a service user and a member of staff. The member of staff was skilled and patient and took time to ensure that the service user was able to discuss the issue as much as they wanted to and work out their own decision about the way forward. Care Homes for Adults (18-65 years) Page 13 of 31 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. Service users benefit from having the opportunity to engage in a wide range of activities both inside and outside of the home and from receiving support to meet their own goals and aspirations. They also benefit from support and advice to choose and prepare nutritious meals and from support to maintain relationships that are important to them. Evidence: The focus of the service has changed significantly since our previous inspection in 2007. The service is now actively working with service users towards them moving on to more independent accommodation. In the past twelve months there have been six people who have moved from the home in a planned way to more independent accommodation. The support at the home is very focussed on supporting people to move on and staff identify aspirations and goals with people living in the home and Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: support them to achieve these. On the day of the inspection visit we observed a member of staff discussing with one service user how they were going to move to more independent accommodation, provided by the same organisation. This was seen as a stepping stone to even more independent living in the future. The service user involved had been working towards moving on for some time and was now at the stage of planning to move out of the home within the next week. This discussion showed how staff in the home enabled people to work at their own pace and to make their own decisions about their own lives when they felt ready to. It also demonstrated how the ethos of the home had changed significantly in the past two years. At our previous inspection people living in the home were not supported to identify their own aspirations and there appeared to be an acceptance that once people moved into the home they would stay there until heir needs changed. The ethos of the service now provides a positive atmosphere where people are encouraged to think about their futures and are supported to make the plans they need to in order to realise their aspirations. The home encourages and supports service users to be involved in a wide range of community facilities and leisure pursuits according to their own individual needs and preferences. Records of activities and discussion with staff showed that service users were supported to make use of a wide variety of local facilities and to be involved in the activities they had chosen. People living in the home were supported to access courses through local colleges to pursue things that they were interested in or things that would assist them in working towards more independence. One person living in the home had been supported to find paid employment and staff were keen to support more people to find employment that was suited to them. The support people required finding and/or maintaining employment and educational opportunities was recorded on their care plans and kept under regular review with them. Staff in the home told us they had seen how the achievement of goals for some people in finding work or educational opportunities had served as a motivating factor for other people living in the home to consider and pursue similar opportunities. The home has a lifeskills fund which is used to provide financial support for service users to be involved in community activities and to contribute to annual holidays. It also ensures that service users are supported to get bus passes so that they are able move about the community more easily. One person who lives in the home has taken on the responsibility of organising regular group activities for any service user who wants to take part. Organising the activities includes generating ideas with other service users, planning transport, costing the activity and liaising with staff at the home about risk assessments and managing the activity so that everyone involved Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: benefits from it. In speaking with this service user we found it was a responsibility he took seriously and we observed him on the day of the inspection visit encouraging other people to become involved. On the day we were there he was arranging a trip to the cinema and was negotiating with other service users about what film they might want to see and was getting support from staff to look on the Internet to find out what films were available. On the day of the inspection visit we also observed service users moving around the local community independently and observed that risk assessments we had seen in the home were being followed by service users while they were out. This demonstrated how effectively the process of identifying risks with service users and involving them in devising plans to manage those risks had proved positive. Service users observed in the community appeared confident, obviously knew other local people and were able to have discussions with them. We also observed a service user being supportive to other members of the community in helping someone who was having difficulty parking their car. Staff in the home recognised the need for some service users to have the opportunity for stimulating activities within the home, as they were reluctant to go out very much. Service users were encouraged to continue to pursue activities they had been interested in prior to moving into the home, including playing musical instruments. There were newspapers around the home as well as books and videos that service users were encouraged to make use of. Staff were also aware of the need to spend time with service users to ensure that they were not bored. On the day of the inspection visit we observed the Manager talking to service users and encouraging them to make use of the staff available on the day to go out if they wanted to or to get involved in activities in the home. People living in the home were supported to maintain contact with their friends and families. Service users were encouraged to have visitors at any time that was suitable to them. Staff spoken with said that understood that this is the service users home and they should have visitors whenever they wanted to. There was a payphone in the hall which received incoming calls for service users. The home had a very positive approach to supporting people with their relationships and, through policies and staff training, recognised that relationships were important to people. Most of the meals in the home were planned on an individual basis with people living there. As the home was focussed on supporting people to become more independent, people were involved in planning their own meals and supported in budgeting and shopping. Staff in the home understood that service users needed to make their own decisions about what food they chose to eat, but were also aware of the need to Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: provide information and support so that people could choose healthy options for themselves. To support this there was also regular input from Occupational Therapists who ran two cooking and nutrition sessions in the home each week and also provided one-to-one support and advice for people who wanted it. The balance between service users choosing their own food and them having healthy and nutritious diets was a difficulty for staff in the home in situations where service users might be insistent in choosing a very unhealthy diet. Where this was the case the home demonstrated that it has supported people to access services and advice and has followed up any resultant health issues by supporting people to access relevant healthcare services. Care Homes for Adults (18-65 years) Page 17 of 31 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. Service users are protected by the homes medication practices and benefit from having their other healthcare needs addressed. Evidence: Care plans contained information on how people preferred to be supported with their personal care. The files of people living in the home demonstrated that healthcare needs were monitored and that people were supported to use healthcare services as necessary. There were comprehensive records relating to each persons health. Where people had used healthcare services there were records of the visits and all issues appeared to be followed up. Care plans contained specific information about responding to individual healthcare needs where they had been identified. One persons file contained a care plan in relation to his epilepsy and there was also information for staff on the usual pattern of his seizures. There were records of each occasion where a seizure had occured and the action the member of staff needed to take. The homes medication policy was clear and the Manager had detailed the procedure Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: for administering medication and put it on the wall next to where the medication was stored in order to ensure that staff were aware of how they were expected to administer medication. All staff involved in administering medication had received training. The storage of medication was safe and there were weekly audits of the medication in the cupboard and the records. We identified three problems with medication during the inspection visit. There were some gaps in the records of medication that had been administered and these were unaccounted for. Also, we observed a service user being given her medication and it was put in front of her at the dining room in a pot. The homes policy states that staff must observe service users taking their medication and then record that the medication was taken. In the case of this person, the member of staff left the medication on the table and failed to observe the person taking it. The member of staff recorded that the person had taken their medication but, in reality, did not know whether or not this was the case. A further problem with this is the fact that the medication could have been consumed by any of the other service users who walked through the dining room at that time. The member of staff had also failed to give the service user a drink of water to take her medication with and she had to ask for this. There were processes in place to identify when people needed as required medication and these were recorded in peoples care plans. Some of this medication was to assist people in claming down when they became distressed. The Responsible Individual told us that other ways of responding to the persons distress were also in place, but these had not been detailed and ordered in the plans. The plans need to clearly describe the range of interventionsthat need to be tried and these need to be in the order they need to be tried, with the administering of medication being after all other responses had been tried. Care Homes for Adults (18-65 years) Page 19 of 31 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. Service users benefit from being able to make complaints where necessary and are protected by the homes safeguarding policies, procedures and practices. Evidence: The home has good policies and procedures in place for dealing with allegations or suspicions of abuse. Staff had received relevant training and had read the homes policies. Staff were aware of the importance of potential abuse issues and of the need to ensure that incidents were well recorded. Service users spoken with were clear about their rights and had no concerns about abuse within the home. The home had clear procedures in place for responding to any allegation of abuse and staff spoken with, including the Manager, were clear about their role within this. In addition to the homes procedures, there were individual procedures for each service user that were aimed to assist staff in identifying any potential concerns regarding whether the person might become abusive to other people or might be experiencing abuse. Each person living in the home had a copy of the house rules and there was evidence, in discussion as well as in the meetings from house meetings, that people were aware of these rules. Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: Staff in the home supported some service users with their finances where this had been agreed with the service user and with the placing authority. There was a risk assessment in place for this along with clear guidance as to the amount and kind of support each person required. Good records were kept to demonstrate that finances were dealt with in a transparent manner. Most people in the home managed their own money. The home gave information to service users about other services they may wish to access and this included information on advocacy services. This was also posted on the notice board in the hall along with contact details. The home has a complaints policy in place and a system for recording and responding to complaints. Service users spoken with on the day of the inspection visit were able to describe the complaints procedure and said they felt happy about making a complaint if necessary and felt confident that it would be dealt with. It was clear from complaints records that service users were supported and encouraged to make complaints. Records also showed that the service responded to complaints in a timely manner and communicated with the complainant throughout. The complaints recorded were mostly to do with people being occasionally unhappy about the way the behaviour of other people living in the home impacted on them. Service users were also encouraged to discuss and resolve these issues in house meetings. Care Homes for Adults (18-65 years) Page 21 of 31 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. Service users benefit from living in a clean, safe and homely environment. Evidence: We had made two requirements at the previous inspection. One concerning the need for the service to consider employing a cleaner, and the other concerning the need to replace tiles in the bathrooms. Both of these requirements had now been met. The service is provided in two large, old houses that have been joined together internally. The age and type of the premises means that maintenance is a continual task. When we last inspected the service in 2007 the building was not in a good state of repair or decoration. At this current inspection we found that each area of the building had been decorated and that the home was looking much fresher and much more appealing. A lot of maintenance and decoration had been carried out. Service users were involved in choosing the decoration of their own rooms prior to moving in and, where they chose to, were supported to decorate their own rooms. Service users spoken with on the day of the inspection visit told us they were happy with their rooms and felt they had the facilities they needed. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: The house is very homely and comfortable. There are pictures of service users throughout the house. Service users are able to move freely around the home and appeared to feel comfortable and at home. The house is very large and there were sufficient rooms so that people could spend time with each other when they wanted to but could also have personal space when they wanted to as well. The garden area had been improved and service users had been involved in this. One person living in the home had planned and created a small pond in the garden and there were plans to use a part of the garden to grow vegetables. The service includes people living in the home in identifying ways in which the environment and facilities could be improved. New, comfortable furniture has been purchased for communal areas and there are plans to purchase a computer for service users to use. Since the previous inspection the home has employed cleaner who works for three hours each day. This has made significant improvements to both the hygiene and cleanliness of the home as well as freeing up the time of care staff so they can spend more time with people living in the home. Hygiene policies and practices in the home were observed and monitored and no hygiene issues were identified through the course of the inspection visit. The manager had introduced a weekly monitoring check of the building and records from this showed that any issues identified were dealt with in a timely manner. Care Homes for Adults (18-65 years) Page 23 of 31 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. Service users benefit from being supported by adequate numbers of well trained staff and are protected by the homes recruitment policies and practices. Evidence: Staffing in the home was, as far as possible, arranged around the needs of the people living there. Additional staff were on duty on specific days of the week to ensure that support was available to enable service users to be supported with activities, particularly outside of the home, that had been identified with them during the assessment and planning processes. At night there was one member of staff sleeping in, but this was also flexible depending on the needs of the people in the home at any particular time. We looked at the recruitment records for three members of staff and found that all the information required to be kept about staff was present. The records showed that all necessary pre-employment checks had been undertaken prior to people beginning work in the home. People living in the home were encouraged to be involved in the recruitment of new staff. This ranged from general discussion about the kind of people they wanted as Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: staff, to involvement in planning questions for interviews and also being involved in the interviewing process. A service user who had been involved in interviewing staff told us it was a positive experience and that they thought more service users should get involved in the process. Effective systems were in place for managing staff training. The organisation has an annual training programme in place and this is devised by identifying core training essential to providing a good care service and by identifying and responding to the individual training needs of staff working in the home. The staff induction programme is based on the national common induction standards and staff spoken with said they thought the induction process was thorough and informative. The induction lasts for six weeks. Each member of staff in the home has their own Personal Development Audit as well as a Role Competency Assessment. These combine to establish the training needs for each member of staff and are used by the organisation in planning future training. Staff spoken with told us they had very good access to the training provided and also that the organisation was supportive in enabling them to attend any training they needed that was not provided through the organisations training calendar. We looked at the support and supervision files for staff working in the home. These showed that there was a lack of recording for formal support and supervision sessions. We discussed with the Manager the need to provide and record formal support and supervision sessions on a regular basis. Staff spoken with in the home were very clear that the Manager provided very good support and supervision for them and that they were able to access this whenever they needed it. They told us the Manager was very approachable and helpful and that she was always available to provide guidance and advice for them. Despite the lack of recorded supervision sessions, it was clear that staff in the home are well supported. However, regular and recorded support and supervision sessions would help to demonstrate how effectively people are supported. Staff also told us that the wider organisation was very supportive in providing practical support, advice and referral to other agencies at times when individual staff were experiencing personal or work related difficulties. Staff in the home told us they had been fully involved in the developments within the service, felt positive about the change in emphasis of the service and found more job satisfaction in supporting people to work towards achieving goals and moving on to more independent accommodation. Care Homes for Adults (18-65 years) Page 25 of 31 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. Service users benefit from living in a very well managed home that is safe and responsive to their needs. Evidence: The Manager of the home is registered and has demonstrated that she has the skills, knowledge, experience and qualifications to manage the service. The development of the past two years has been significant. The home has moved away from just providing a place for people to live to being a service that is very focussed on supporting people to achieve their own goals and to move on to more independent accommodation when they feel ready to. This new service ethos has required changes to every aspect of the service including assessment and planning with service users, staff training, a change in staff roles, development of policies and procedures and clear changes in service delivery so that the emphasis is on being clear about peoples needs in the context of their own personal development and moving on to greater independence. The Manager has achieved all of this with the support of the staff team who have been involved in the process throughout and developed and changed their Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: practices to reflect the change in the direction of the service. All staff and service users spoken with during the course of the inspection visit were very positive about the Manager and about the developments in the service. It is significant that, over the past twelve months, there have been six people who have moved on from the service into more independent accommodation and this demonstrates the effectiveness of the way the service is currently operating. The service is clearly provided in the interests of the people who use it. This is evidenced through the formal processes in the home such as service user involvement in care planning, risk assessment and reviewing, staff recruitment and the minutes of house meetings. We also observed the informal ways in which the service responds to the needs and wishes of service users, such as enabling people to be involved in decorating their own rooms and planning and improving the garden area. The minutes of house meetings show that the meetings have, over time, moved away from being a forum where house rules are re-emphasised and people are constantly reminded of what they should and should not do, to the present situation where the meetings are used by people living in the home to express the things they want to do and the developments they would like to see in the home. Staff and service users spoken with told us they feel totally involved in the changes and developments in the service and that the way the service has developed has been a positive experience. The Manager has a good understanding of the process of quality assurance and spends her time monitoring the service and involving others in discussions about what is happening well and what may need improving. There are some clear, formal processes in place that support this, such as weekly checks and monitoring of the building and of the medication system, monthly reviews of service users care plans and risk assessments, staff support and supervision, monthly Provider visits and also less formal processes such as feedback from service users and staff and the Managers own observations of the delivery of the service. The Manager uses all of these in identifying improvements for the service and in producing developmental plans. We discussed with the Manager that there was a lack of formal quality assurance processes in recording how the plans for the service linked to the information gathered through the formal and informal monitoring processes. Attention to this would serve to further demonstrate how the service responds effectively to service users in planning the development of the service. We aslo discussed the fact that the records of the Providers monthly visits to the home, under Regulation Twenty-Six of the Care Homes Regulations need to be kept in the home. Despite both the above points, the outcomes of quality assurance in the home for people who use the service are very positive. Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: There were systems in place for monitoring and managing health and safety issues in the home. Records were kept of all health and safety issues including fire, appliance servicing, substances hazardous to health, accidents and electrical testing. All staff received initial training in health and safety as part of their induction as well as regular updates. Regular checks and records were kept relating to health and safety aspects of the home. No outstanding health and safety related issues were identified as a result of this inspection. Care Homes for Adults (18-65 years) Page 28 of 31 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 29 of 31 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 Care Homes for Adults (18-65 years) Page 30 of 31 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. 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