Care Home: 49 Oakdale Road

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What the care home does well There was evidence that all residents are admitted with a full assessment of care needs and only admitted if the home feels they are able to meet the residents needs. The registered manager and staff continue to make the home as comfortable and homely as possible. Residents are able to be individual and make daily choices about how their day will be and are encouraged to become more independent, both in the home and the community with staff support. Support plans, risk assessments and goals are all reviewed, evaluated and are written in an accessible format. These reflect the residents` health and social care needs and give information about how the resident likes their care to be given. Residents are encouraged by the staff who what food the residents like to choose and eat a balanced healthy diet. Staff have regular one to one supervision and additional training needs are being identified and training accessed. What has improved since the last inspection? The home has worked hard to comply with the regulations and to meet all the requirements from the previous inspection in March 2008. The home has developed a second bedroom downstairs that is accessible to wheelchair users. The organisation continues to develop and produce more of their documents in an easy to read format. What the care home could do better: The service must ensure they discuss with the pharmacy about having dosset boxes made up with residents medication so they can safely take medication to their day centre with out staff having to decant medication. Key inspection report Care homes for adults (18-65 years) Name: Address: 49 Oakdale Road 49 Oakdale Road Streatham London SW16 2HL     The quality rating for this care home is:   two star good 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: Lynne Field     Date: 1 5 0 9 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 30 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 30 Information about the care home Name of care home: Address: 49 Oakdale Road 49 Oakdale Road Streatham London SW16 2HL 02086779509 02086969855 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.caremanagementgroup.com Care Management Group Ltd (trading as CMG Homes Ltd) Name of registered manager (if applicable) Venise Marlene Browne Mr Saheed Olaniyi Kolapo Type of registration: Number of places registered: care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 9 The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection Brief description of the care home 49 Oakdale Road is a small residential care home that aims to provide 24-hour support in an independent living setting in the community. It can take up to eight residents, men or women aged 18 -65, who have learning difficulties and need support to live in the community. The whole house has been completely refurbished and meets all environmental standards. It is very well decorated and furnished. Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 9 Brief description of the care home There are eight single bedrooms, all with en suite facilities of a bath, shower attachment and toilet. One bedroom is on the ground floor, but all the other bedrooms need to be accessed by stairs, so the majority of the bedrooms would not be suitable for residents with a physical disability. The lounge and dining area are large, bright, comfortable, welcoming rooms. The garden is large and is a lovely area. It is safe and secure. The dining room and the domestic style kitchen, which is a bright and spacious room, both overlook the garden. There is a small laundry room with appropriate equipment next to a downstairs cloakroom. The home has its own car and parking space is available at the side of the house. The registered manager said the current fees payable for each resident is in the range of £1390-39p according to the assessment of needs of the residents. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection took place over two days in September 2009. The registered manager returned a standard form, the Annual Quality Assurance Assessment (AQAA) to CQC and this was used as part of the inspection process. The deputy manager facilitated the first day of the inspection at the home. The registered manager and regional director were at the home on the second day of the inspection and we were able to speak to them about the service and how it was developing. We checked records on care plans, medication records and the complaints book and were able to access confidential documents. We checked four of the staff files that are kept in the home and saw copies of training records. There was evidence of regular supervision taking place and we were told staff meetings are held at least every two months or more regularly in necessary. There were six residents living at the home on the day of the inspection and the home has two vacancies. We met and spoke to all six residents as well as speaking to staff Care Homes for Adults (18-65 years) Page 6 of 30 on duty at the time of the inspection. We met the parents of one resident who were very happy with the service and said they visited their daughter at least once a week. Three residents responded to the survey we sent out as part of the inspection. Residents said and indicated they liked living at the home and had settled into the community well. One new resident said they liked it here and it was a good choice. They said they were encouraged to be independent. We found that the home continues to offer a high level of care and support to the residents and give a good service. Staff were observed to be competent and caring. Staff interaction with residents was observed to be knowledgeable, such as knowing when a resident puts their hands on their head they mean they want a head massage. They were always observed to treat residents in a respectful manner. Care Homes for Adults (18-65 years) Page 7 of 30 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 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 30 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 30 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. There are effective assessment methods, which allow essential information for each new resident to be obtained so that staff can go on to provide a service that will meet their needs. People who are new to the service are introduced gradually and carefully through a trial system and via communication with relevant professionals. There has been careful consideration to those who have had to come on an emergency placement to ensure their needs can be met, too. Evidence: The homes statement of purpose, and a residents guide, which includes the complaints procedure has been reviewed and updated since the previous inspection in March 2008. We saw copies of this in the home and in residents rooms. Three residents responded to our survey we sent out prior to the inspection. All indicated they were asked if they wanted to move into the home Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: We met the two new residents who have moved in since the previous inspection. At the time of the inspection there were still two vacancies which the home is hoping to fill once the building work on the new ground floor bedroom is complete. This will give the home two wheelchair accessible bedrooms. We were told that there had been a number of other referrals but they had not been able to take them because the home could not meet their needs. The registered manager said they follow the organisations procedure when admitting prospective residents and they would have their needs assessed by senior staff before they move to the home. If they think the home will be able to meet the residents needs, the resident will be invited to come for a tea visit then for an overnight stay. If all goes well with the overnight stay, they will come for a longer stay of twelve weeks. During this time the resident will be assessed and the resident will be able to decide if they like living in the home and it can meet all their needs. We were able to look at residents files and saw records of tea visits and over night stays as well as the initial assessment report, assessment of needs during the trial period and contact that was signed by the resident if appropriate and the registered manager. We were told the home encouraged a prospective resident to visit the home on a number of occasions, accompanied by their social worker and their family, where they meet the staff and other residents and was able to see the bedroom they was being offered. This enabled them to make an informed choice as well as giving the home a chance to assess where they could meet their needs. We noted one resident had been admitted as an emergency and assessments were done very quickly to accommodate this. We saw initial assessments for them by the assessment team on file. There was a contact on file that had been signed by them, their family and the appropriate professionals that supported them during this time. The resident told us they were very happy living in the home and would like to stay there if possible. Care Homes for Adults (18-65 years) Page 11 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are consulted and supported to make decisions about their lives by staff and appropriate independent professionals. Potential risks are identified and residents are supported to take risks within a risk management framework. Evidence: We checked four residents files including the files of the two new residents. Initial assessments on file had been used to develop the residents care plans. Each resident has an induction into the home and individual personal wishes are recorded. The home does all it can to help residents make decisions for themselves by involving them in the development of the care plans and through person centred planning. All but one resident have family who are involved with them to help them say what they want. We saw the six weekly and six monthly reviews that had been held when a resident comes to live at the home and the outcome of the reviews. We saw the home tried to get as many of the appropriate people to attend the reviews to gain a balanced fair review. Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: We were told the home would carry out reviews every six months whether the residents care manager could attend or not but the expectation was the care manager would attend at least once a year. Copies of the recent reviews were seen on the residents files and support plans had been re written to reflect any changes. Support plans continued to be well written and give a thorough description of residents individual behaviours, reactions and preferences and how the residents liked to be treated. These included an activities programme for each resident. We were told the staff uses objects of reference, facial expressions and the way a resident responds with different sounds are used by staff to find out what residents want, like or disagree with. The resident who had recently come to live at the home had been shown pictures of the home in advance of coming to visit. The home operates a key worker system and residents have a weekly key worker session with their key worker. This is recorded and even if the resident is not able to communicate verbally or wants to do something else on a one to one basis this is recorded. There were copies of the residents meals in picture format as well as a number of other notices that needed this type of format for communication. We were told all residents support plans are reviewed six monthly or earlier if the need arises. There were individual risk assessments had been carried out monitored and are reviewed by the staff with residents every six months or when the need arises. Details of any changes to the risks are recorded in the residents care plans, with details of how to manage the risk. There were copies of these on file. The registered manager said they were always trying to improve the format of the care plans and risk assessments to make them more user friendly. Each resident have their own communication book and they have just relooked at the format of this. They have taken lots of different photographs of the residents, their activities and social skills and are incorporating them into the residents communication books to make them an informative working tool for communication. The staff told us they are continually looking at other ways to make communication clear and easier. Care Homes for Adults (18-65 years) Page 13 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are encouraged to develop independent skills and interests as well as access the community with the support of staff when required. Families and friends are encouraged to keep in touch with the residents and participate in social activities. Residents engage in appropriate, enjoyable and fulfilling activities and mix with the general community. Residents rights and responsibilities are respected. A healthy diet is encouraged, which the residents enjoy. Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: On the first day of the inspection one resident was already out for the day at college, three others had plans to go to their day centre and another was going to the resource centre. Staff explained the each resident had a weekly programme that was agreed with them at individual residents key worker meetings or at general residents meetings. We saw copies of the activities plans on the lounge walls. These were in picture format that made for easy reading. Each time we have visited they have been out or going out or activities have been planned. We have always seen they were eager to go out and there has never been any reluctance to go. The activities programme is designed to meet each residents individual needs. In this way residents are supported and encouraged to take part in activities that are enjoyable, beneficial to their mental and physical health and which give them the opportunity to develop skills within their abilities. The home has its own transport and staff take them to their activities and would stay for the session depending who the resident was and if they need support during the session. One resident enjoys being driven around in the van and as they have sensory impairment they find it very soothing. This resident uses part of a car seat belt with seat belt catch attached as an object of reference and knows or asks through touching this they are going or want to go in the van. We spoke to the new resident who said the home was encouraging them to be independent and has the code to the front door so they could if they wished just come and go. All the residents have family or friends who they are encouraged to keep in touch with. On the second day we met a residents family. They said they came every week as well as coming regularly to take them to their church. One resident regularly goes to stay with their family who live locally and meets friends there. Another resident who has recently come to live in the home because their mother died has family and they visit their mothers grave when they want to. The deputy manager told us about the homes healthy eating program and said all the residents are encouraged to eat a healthy diet and take exercise. Residents are asked about what food they would like on the menu and meals have been devised from those preferences and also based upon foods they have liked in the past. The home involves residents in kitchen activities in addition to their activities program to help residents develop independent living skills. Residents are encouraged to assist in the meal preparation, washing up and general kitchen tasks. Cupboards are clearly marked with pictures of what is in them so residents can see where the plates or pots and pans are. During the inspection we noted residents were able to go into the kitchen and make their own lunch and others went at different times to make drinks when they wanted them. Residents who were not as independent were offered drinks, meals and snacks at appropriate times and regular intervals. One of the newest Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: residents said they have what they want to eat and at times cooks for themselves and sometimes cook for everyone, if that is what they all want. They have with the help of staff developed a menu book with copies of their favourite dishes in it. The home keeps a record of what has been offered to the residents to eat and what they have actually eaten in a menu book. Other tasks the residents are encouraged to do is keeping their bedrooms clean and tidy and each resident has a particular day when they do their laundry. This helps them develop their daily living skills that will be important for when some residents want to move on. Care Homes for Adults (18-65 years) Page 16 of 30 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. Staff help residents to go to the doctors, hospitals and dentists when they need to so that residents do not get sick and are looked after properly. Residents receive personal support, in the way they prefer and their physical and emotional needs are met. Medication is handled safely but need to ensure residents have seperate dosset boxes when taking out medication out of the home. Evidence: The home has continued to develop the residents support plan with the resident, their family and key worker. We were shown copies of these and they had lots of photos of the resident, family life, then and now setting out in pictorial format how they their support needs, self care needs and how they like it to be done. The deputy manager said they were taking photos of different events and aspects of the residents lives to change or add to the support plans and communication books. This means the support plans are more person centred and residents can identify the activity more readily. The care files that were seen contained all the information staff needs to support the Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: residents in their preferred personal care routines and there are details of how much help an individual requires with different personal care tasks. As stated above where appropriate objects of reference will be used too. From looking at the residents files we could see each resident has a copy of their medical history, a health assessment done by the home and health action plan on file. This is in the form of a Health Action Plan booklet that has a section for each area of health covered. The record of health appointments attended indicated that staff supports each resident if this is what the resident requires, to attend an appropriate range of health care appointments in line with their individual health care needs. This included the outcome of the appointment. We saw some of the health action plans had been signed by the resident where they were able to have some understanding of what and why they were signing. We noted that family members were also signing where it was more appropriate for them to do this. We saw how one residents family, their GP and staff as well as the resident were involved in their health action plan. They were being supported to loose weight and this also involved their day centre where they attended a healthy eating group which involved taking part in an excise group. One resident was going to go to the Mens Group but said he did not want to go. Anything that might need an informed decision, such as dental treatment that was being refused, about the residents health would be discussed at a best interest meeting. Although at the present time none of the residents are able to self medicate and this was recorded in their medical risk assessment, one resident will be encouraged in the future to do this. Residents medication is stored securely in a locked medication cabinet in the staff office. The home has changed to the Boots dispensing system and a Boots pharmacist came in to train the staff to use the system. Staff are able to go on and take the Boots Accredited training course. The registered manager told us all staff must to go through the homes medication training programme before being allowed to dispense medication. This involved the pharmacist coming in to do medication training with the staff. Staff then has a one to one training session with the registered manager. They are observed for three times dispensing medication by the registered manager before they are allowed to dispense medication on their own to the residents. There was a copy of all staff signatures that dispense medication and information about the medications in use. The registered manager said the medication is checked and recorded when it comes into the home and they do an audit every two weeks, which we saw. We were told they could contact Boots pharmacist to speak to them if they had any concerns around the medication. Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: We checked three residents medication and all medication stocks checked where in order. We had a general discussion with the registered manager around the ordering, storage and retuning of un used medication and how this was carried out. Homely remedies are signed as being able to be given by the GP. The home has put in place risk assessments for residents when they go out or home for the weekend. They are going to discuss with the pharmacy having dosset boxes made up so residents can safely take medication to their day centre with out staff having to decant medication. Care Homes for Adults (18-65 years) Page 19 of 30 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. There are safeguards in place to protect the resident from abuse, neglect and selfharm. Evidence: The home has a complaints policy, a copy of which is in the service users guide. We were shown the complaints book and saw there have been no complaints. The registered manager said they would follow the organisations complaints procedure had record their actions and the outcomes and all complaints are taken seriously. Appropriate action would be taken to ensure residents complaint was addressed immediately. The organisations quality assurance inspector monitors any complaints when the homes monthly quality assurance inspection takes place. We noted the complaints procedure was displayed in the entrance hall of the home and it is user friendly. There has been one concern sent anonymously to CQC in the past year that did not concern any resident and this had been fully addressed by the registration team. All the appropriate people were kept informed of the actions taken and the out comes. Each resident has a separate account in the home and a record of his or her money is kept. These are checked by two members of staff and handed over at the beginning of each shift. Petty cash for the home is kept separately and this is checked at the same Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: time as the residents money. We checked the residents accounts and records with the registered manager and they were found to be in order. We were able to observe how staff and residents recorded financial transactions and noted the financial records and money are locked away. Residents are able to access their money at any time should they wish to do so. We were told one resident has his or her own back account. All the accounts and money in the home is checked once a week by the registered manager and these are audited every month by the organisations head office. The registered manager spoke about the procedures that are in place to protect the residents from abuse. The registered manager is a Train the Trainer for Safe Guarding Adults. We were told the registered manager and staff has completed the training raising awareness in the protection of vulnerable adults and this is included in the induction training that all staff has to undertake when joining the organisation. Staff told us of the training they had around safe guarding adults and what it meant. They said they would contact the manager or deputy manager if they suspected abuse. There is also external training for residents and staff about keeping safe. We were told and saw evidence of best interest meetings that were held for residents who were not able to make an informed decision for themselves. Care Homes for Adults (18-65 years) Page 21 of 30 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. The home is safe and comfortable with adequate private and shared space, toilets and bathrooms. The home is well maintained and furnished. Residents bedrooms are comfortable and are decorated to reflect their personalities. Evidence: We were given a tour of the home by one resident and the deputy manager. The house was completely refurbished when it opened three years ago and meets all environmental standards. It is very well decorated and furnished. The home recently applied to divide the large sitting room to make a smaller sitting room and join the other part of it with what was the sensory room to make a second downstairs en suite bedroom. This has not altered the number of residents the home can accommodate but it will enable them to have greater flexibility about their choice of residents. A bedroom at the top of the house has been made into the staff office and what was the staff office has become the sensory room. This means there are now two accessible bedrooms on the ground floor. These are bright comfortable rooms. There is a sitting area and a dining room that opens onto a large patio area that is safe and secure. The garden is a good-size that is mainly laid to lawn that faces south. There is a domestic style kitchen, which is starting to look shabby and the door closure needed to be adjusted. We spoke to the registered manager about this and staff were going to Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: contact the organisations handy man to adjust the door closure. This over looks the garden. There is a small toilet and a separate shower room on the ground floor. The small laundry room has the appropriate equipment and residents are encouraged to do their laundry with the support of the staff. Each of the eight bedrooms contains the required fixtures and fittings and has an en suite facility of bath, shower attachment and toilet. There was a leak in an upstairs bedroom that caused the ceiling to collapse into a downstairs bedroom and this is still being refurbished. This was recorded in the occurrence book and no one was hurt. The home told us about this incident. Three residents showed us their rooms. Each room is of an individual style and residents have brought items of furniture and personal possessions to the home that makes each room individual and homely. The home has its own car and parking space is available at the side of the house. Care Homes for Adults (18-65 years) Page 23 of 30 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. Appropriately trained staff meets the residents individual needs. The recruitment procedures followed are safe, thorough and comply with legal requirements. Supervision is held at regular intervals. Evidence: We met eight staff during the course of the inspection and six responded to the survey we sent out as part of the inspection process. The rota records there are always at least three staff on duty at the home in the daytime. The registered manager said they tried to have extra staff on duty if there was a special event taking place. Training dates are recorded on the rota to make sure they are not forgotten. This is recorded as study leave and other staff cover the shifts making sure the home has the correct number of staff on duty. We observed staff interacting with residents and the qualities seen included good listening skills, a calm and confident manner, and a good grasp of the basic areas of need they needed to meet, including communication. We found the home has a warm and friendly atmosphere and staff were helpful during the visit and willing to answer questions and assist in communicating with the residents. We saw copies of the minutes of the staff meetings. We were told there is a team Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: meeting every six weeks. Safe Guarding and Equality and Diversity are a standing item on every team meeting agenda. Staff said they attended these when they were on duty. October is Black History month and the home plans to mark this event in some way. Residents have weekly key worker sessions where they can voice any concerns and their key worker can keep them informed of anything that is personal to them. There are regular residents meetings where residents are able to discuss the menu, their activities and any complaints they may have. Six staff files were examined including one new member of staff. These included copies of the application forms, two written references, a signed copy of their contract stating terms and conditions and identification. All files had CRBs and POVA 1st in place. There was a copy of their induction that was completed within the first week of starting and a copy of all their mandatory training that must be completed in the first three months after they are employed by the organisation. The files contained copies of individual training records and the induction pack Skills for Care that they had completed. The registered manager said they meet and check how staff are progressing after they have been working at the home for two weeks and again after three months. Training records we saw included food hygiene, first aid, infection control and medication training. The organisation has a training and development plan in place. Staff have undertaken Skills for Care training which was seen in their files. We were shown the next three monthly training schedule that the organisation sends to the home for managers and staff to see what training is available. We were shown the homes training matrix that highlight staff training needs and the mandatory training that staff have to complete annually. This is agreed in supervision with the registered manager. Copies of certificates and confirmation of training, such as NVQ level 2 and 3 that has been undertaken and this was held on individual staff files. All staff has completed the Protection of Vulnerable Adults, Food Hygiene and Infection Control training. A number of staff have been on a course of basic skill training to help them complete documentation such as incident sheets, the daily diary, medication records and other records relating to the residents of the home. Staff said they felt this would help them produce clear concise documents. Staff had signed a supervision contract for every six weeks. We saw supervision records that were signed by the registered manager and the member of staff. Staff told us they had regular supervision. Care Homes for Adults (18-65 years) Page 25 of 30 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. Residents benefit from a home that is well run and managed. The registered manager is qualified and experienced and runs the home well. Working practices and associated records need to be more robust to ensure that the residents and staffs health and safety and well being is maintained. Evidence: There has been a change of management since the previous inspection in March 2008 and the new registered manager was the deputy manager and knows the residents and home well. He has completed NVQ level 3 and the RMA. The first day of the inspection was facilitated by the deputy manager, because the registered manager was on annual leave, was appointed in the last six months. The registered manager contacted us during the inspection and we arranged to go back for a second day to view records that were locked up and unavailable because of confidentiality. We met registered manager and the regional director came for part of the inspection. We were able to discuss the management strategy of the home and how they were developing Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: the service. The registered manage said he felt supported by the organisations management structure. We found the registered manager was professional, conscientious and open in his approach to his work. Residents family we spoke to thought the home was well run and felt comfortable with the managers and staff. The home has policies and procedures in place around health and safety. The records we saw indicated the homes health and safety services and equipment have been checked, serviced and maintained at the appropriate intervals. There was an Fire Safety Audit / Inspection by local fire brigade in July 2009 a requirement the home had to up date their fire risk assessment. There is a fire procedure in place. The break alarms are being tested weekly and fire-fighting equipment has been checked regularly. Fire drills have been carried out with service users at various times of day on different days, ensuring all staff have taken part in fire drills over the course of six months and there is a record of the date and time drills have been carried out. Copies of the reports and records of the checks are kept at the home. All other health and safety checks were in place were up to date. We were told and saw that the home have a monthly health and safety checklist and risk assessments were in place. Hot water temperatures are checked weekly. PAT testing was in place. Quality audits are held every o There are written policies and arrangements for maintaining safe working practices in place, including appropriate risk assessments. The company updates these on a regular basis. Care Homes for Adults (18-65 years) Page 27 of 30 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 28 of 30 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 29 of 30 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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