Care Home: 5 Greenbrook Court

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What the care home does well The home is bright, clean, comfortable and homely The building and contents are well maintained.Bedrooms are all single and very well personalized. People who live in the home are well treated by the staff.Care plans are well written and people have clear goals.People are supported with risks to help them be as independent as possible. People have health action plans that give good information about their healthcare.People who live in the home share household tasks to help develop their skills. People say they are pleased with the care and support they receive. What has improved since the last inspection? There are now more staff on duty. This helps to ensure that individual goals are met.Peoples` daily diaries are now monitored to make sure that people go out into the community more often. All staff understand risk assessments. This helps to ensure that staff are aware of individual abilities and support needs. What the care home could do better: The home could provide a ramp from the dining area to the garden. This will help people who use wheelchairs to be able to go outside. The staff should make sure that people are safe during the night by checking on them fromtime to time. Key inspection report Care homes for adults (18-65 years) Name: Address: 5 Greenbrook Court St Michaels Road Newcastle Staffordshire ST5 9QB 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: Yvonne Allen Date: 1 8 0 9 2 0 0 9 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 38 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 38 Information about the care home Name of care home: Address: 5 Greenbrook Court St Michaels Road Newcastle Staffordshire ST5 9QB 01782628190 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) : Choices Housing Association Limited care home 6 Number of places (if applicable): Under 65 Over 65 6 6 0 0 learning disability physical disability Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Learning Disability (LD) 6 Physical Disability (PD) 6 Date of last inspection A bit about the care home Care Homes for Adults (18-65 years) Page 4 of 38 Greenbrook Court provides care for six older people with a learning and physical disability. The home is located on the outskirts of Newcastle-underLyme and is within easy reach of local facilities. There are 6 bedrooms a large lounge/dining room, a small kitchen, a bathroom with toilet, a shower room and an additional separate toilet. People have access to transport locally. Care Homes for Adults (18-65 years) Page 5 of 38 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 38 How we did our inspection: This is what the inspectors did when they were at the care home We did this inspection visit to look at what life is like for people who live in the home. We used other information from what people told us about the home. We spoke with people who live in the home. We spoke with the staff who work at the home and the manager. We looked at care plans and records for the home. We walked around the home and looked in all of the bedrooms. Care Homes for Adults (18-65 years) Page 7 of 38 What the care home does well The home is bright, clean, comfortable and homely The building and contents are well maintained. Bedrooms are all single and very well personalized. People who live in the home are well treated by the staff. Care plans are well written and people have clear goals. Care Homes for Adults (18-65 years) Page 8 of 38 People are supported with risks to help them be as independent as possible. People have health action plans that give good information about their healthcare. People who live in the home share household tasks to help develop their skills. People say they are pleased with the care and support they receive. What has got better from the last inspection There are now more staff on duty. This helps to ensure that individual goals are met. Care Homes for Adults (18-65 years) Page 9 of 38 Peoples daily diaries are now monitored to make sure that people go out into the community more often. All staff understand risk assessments. This helps to ensure that staff are aware of individual abilities and support needs. What the care home could do better The home could provide a ramp from the dining area to the garden. This will help people who use wheelchairs to be able to go outside. The staff should make sure that people are safe during the night by checking on them from Care Homes for Adults (18-65 years) Page 10 of 38 time to time. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Yvonne Allen Care Quality Commission Citygate Gallowgate Newcastle-Under-Lyme NE1 4PA 03000 616161 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 11 of 38 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 12 of 38 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given information about the service in a suitable format and are able to make an informed decision on whether the home can meet their needs. People undergo a full assessment of their needs prior to being offered a place at the home and can be assured that the home they are entering will be able to meet their needs. Evidence: In their AQAA the Providers tell us - that an Effective admissions procedure and admissions file is in place. They also say that there are Inclusive referral forms for Choices admissions panel. Also there is a Pre admissions trial period with 6 and 12 week reviews. They also tell us that people are introduced to the home Over a period of time, suitable to the individual, includes short visits and overnight stays. The Providers also tell us that there is a Formal transparent process to clarify changes and care package. There is Social worker involvement with community care assessment prior to admission, Care Homes for Adults (18-65 years) Page 13 of 38 Evidence: liaising with multi disciplinary teams and health professionals, full family involvement during assessment. There is also a Comprehensive assessment by the Registered Care Manager during the trial period. There is Full involvement of service user/significant others throughout the whole process. Personal Care Plans and Health Action Plans developed are for individual service users. The manager of the service has developed an admissions policy. This policy ensures that people are given all the required information they need in order to help them make an informed decision on whether the home is suitable for their needs. This information is also provided in pictorial-type in order to assist people who need help to understand. People undergo a thorough assessment of their individual needs prior to being offered a place at the home. This assessment consists of A Choices guide to housing application (provided in pictorial type). A referral assessment form and assessment of needs. The OK Health Check, which is an assessment of individual health needs. A Daily Living Care and Support Assessment, which assesses peoples individual activities of daily living needs. In this assessment the service ensures that people make everyday choices. A Disability Distress Assessment Tool, which identifies the specific learning disability needs of people including triggers and support needs. In relation to all of the above assessments, referrals to the promotion of individual choices and preferences are not only evident but are the main theme running throughout. The Statement Of Purpose and Service User Guide have been updated since the last Key Inspection and copies of these are given to people wanting to come into the home and to funders of care. We found that the information about this outcome area contained in the AQAA is both accurate and current. Care Homes for Adults (18-65 years) Page 14 of 38 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples assessed and changing needs and personal goals are reflected in their individual plan. People make decisions about their lives with assistance as needed. People are supported to rake risks as part of an independent lifestyle. Evidence: In their AQAA the Providers tell us - Each service user has a person centered plan which is reviewed regularly. They also say that A personal carer is allocated to each service user to aid implementation of priorities, hopes and dreams and that Comprehensive risk assessments are in place to support risk taking. We looked at the support plans of three people who live in the home. We spoke with the people and with the staff who look after them. We looked at whether their care needs are being met as agreed in their individual support Care Homes for Adults (18-65 years) Page 15 of 38 Evidence: plans. All of the support plans we looked at are comprehensive and portray a thorough assessment of the persons specific needs. Care plans have been developed from the assessments, to meet the persons individual needs. The Personal Care Plans (PCP) are updated regularly and document what people like to do each day as routine. Comments included - likes to have his breakfast before getting dressed in the mornings and when we arrived for the visit this person was, indeed, still in his pajamas, as he preferred. Other comments include - usually prefers to have a hydro bath and, during the course of the visit, this person was supported to have this. He then told us that he had always enjoys the bath. The activities of daily living are very detailed and specific to the individual person. He likes to load the dishwasher. We saw this person doing this. He appeared to be happy and he told us I like doing this. People are encouraged to make decisions for themselves and are supported to do so. The decisions making process is in line with the Mental Capacity Act and assessment. Support plans documented - Decisions I can make for myself. Decisions I may need support to make and Decisions that may need to be made for me in my best interests. For one person we saw that he could make all his decisions for himself with support. For two other people we saw that some decisions had to be made for them in their best interests. Staff encourage people to take responsible risks, ensuring they have good information on which to base decisions, within the context of the persons individual plan. It was documented within support plans - the identified risk and objective, the resume of risk, the benefits of taking the risk, possible harms, the likelihood of harms and the actions to be taken to reduce the risk of harms. We looked at the care of a person who has a diverse need and is registered blind. This persons PCP is very detailed and geared to meeting his specific needs in relation to his blindness. The plan tells staff to how to describe clothes to him and let him feel the clothing prior to dressing. The plan also states - ensure that he is guided to the dining table and we saw staff doing this. The plan also tells staff to give verbal prompts and encouragement and we saw that staff were doing this. All of the people who live in the home have allocated personal carers to aid implementation of personal goals and priorities. Care Homes for Adults (18-65 years) Page 16 of 38 Evidence: We spoke with the two care staff who were on duty on the morning of the visit and they told us that the training they receive helps them to be able to support people to meet their goals. We found that the information about this outcome area contained in the AQAA is both accurate and current. Care Homes for Adults (18-65 years) Page 17 of 38 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home feel part of the community and are able to take part in activities which meet their individual needs. People have appropriate relationships with family and friends and peoples rights are respected. People have a healthy diet and meals and mealtimes are enjoyable and flexible. Evidence: In their AQAA the Providers tell us that - there is Active support in house to support service users to maintain independence, participating in domestic tasks, meal preparation etc. They also say that Service users are supported to attend church if they choose. They tell us that Opportunities for employment and occupation are offered as appropriate. (1 gentleman has a job and regularly attends college). They say that All service users are supported to access the community regularly, individually or with Care Homes for Adults (18-65 years) Page 18 of 38 Evidence: friends/family. They say that Service users are supported to maintain social contacts with family and friends via telephone calls, visits, community activities and writing (there is an open door policy within the home). The Providers tell us that A variety of leisure activities are offered in /out of the home to suit individuals interests/hobbies. They say that Privacy is upheld at all times with staff always knocking before entering room and ringing the door bell to be invited into the home and that Service users are always supported to open their own mail and interpret the content. They tell us that Service users are given the opportunity to keep bedrooms locked,having their own key to gain access (1 gentleman chooses to do this). Mealtimes are very flexible, service users can choose to eat together or separately in dining room/lounge/bedroom. Risk assessments are in place highlighting the level of support required. Service users are supported to plan menus prior to shopping and dietary requirements are assessed by the dietitian, speech and language therapist as necessary. People who live in this home have quite diverse needs in their chosen lifestyles. The age range is from 59 years to 86 years. Routines, services and facilities have to be flexible to cater for those needs. At the time of the inspection visit there was one person attending college. This person had also completed a college course the previous year. He showed us his certificate for the Art course and various pieces of art work which he had created. This person has now started another college course in Drama at the same college. All of the people who live in the home are actively encouraged to pursue their hobbies and interests and are supported to do this by the staff who work at the home. All the people living in the home had been on holiday to the company caravan in north wales. The people we spoke with about this told us they had enjoyed it. Personal care plans include a learning log to show whether the person has enjoyed that particular activity or not, such as he liked the caravan holiday as he could walk to the club and dance all night. When we spoke to this person about this he told us that he loved going to the caravan and couldnt wait to go on holiday there again. He said I loved dancing and danced with everybody. Another person, who is interested in transport had been on a visit to the Transport museum in Matlock and really enjoyed it. Care Homes for Adults (18-65 years) Page 19 of 38 Evidence: People have daily diaries and these include their individual activities and visits such as visits to the Handy care scheme and the Rainbow club. The service actively encourages people to keep in touch and meet with their family and friends. One of the people who live at the home told us that his friend had been picked up in the homes minibus and brought round to have lunch with him. This person showed us his room and told us that he is interested in music and dancing. His room is very personalized with DVDs and Cds and pictures of Pop Stars. Another person has more complex needs and has sensory lights up in his room. Another person, who has restricted vision, uses the library and staff help him to choose audio books and Cds. This person also enjoys someone reading out load to me and someone reading the newspaper to me. The service runs Active support - where people are encouraged to join in with household chores. This is displayed on the kitchen wall. We observed one person loading the dishwasher and the vaccuming. This is documented on this persons care plan as what I like to do. Plans also include a learning log to show whether the person has enjoyed that particular activity or not, such as he liked the caravan holiday as he could walk to the club and dance all night. When we spoke to this person about this he told us that he loved going to the caravan and couldnt wait to go on holiday there again. He said I loved dancing and danced with everybody. One persons activity log included - 27/7/09 - Day trip to Blackpool, 12/8/09 - Blackbrook zoo, 16/7/09 - Caravan for three days. 15/9/09 - lunch and beer. The service has its own minibus and driver. The driver came in to introduce himself during the inspection visit. The service has a Tenants Charter which outlines the rights of people who live in the home. People have their nutritional needs assessed and special diets are catered for. Meals are planned by the people who live in the home and the staff. Staff also encourage people to help with preparation of the meals and can carry out certain tasks, according to their restricted mobility, peeling vegetables and buttering bread to name a couple. We were invited to join people for lunch and they were having hot dogs followed by a delicious fancy cake. A couple of people were having soft diet and another was having thickener added to her drinks due to swallowing difficulties. Staff also joined in with lunch and assisted and encouraged people to enjoy their meal. Everybody sat around the table and Care Homes for Adults (18-65 years) Page 20 of 38 Evidence: chatted and it was an enjoyable experience. We found that the information about this outcome area contained in the AQAA is both accurate and current. Care Homes for Adults (18-65 years) Page 21 of 38 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. People who live in this home receive personal support in the way they prefer and require. People can be assured that their physical and emotional health needs will be met. The system in place at the home ensures that people receive their medication safely. Evidence: In their AQAA the Providers tell us that Health is regularly monitoredand Health assessments are in place including waterlow and nutritional screening. They say that A variety of health professionals are involved with providing services and support to the service users: GP, dentist, chiropodist, optician, audiologist, speech and language therapist, dietician, continence nurse, district nurse, neuro psychiatrist. They tell us that Comprehensive medication policies/procedures in place and new staff are fully trained and supervised until competent. Also Service users are appropriately supported to self medicate if able. They say that Wishes regarding arrangements following death are included in Person Care Homes for Adults (18-65 years) Page 22 of 38 Evidence: Centered Plan. Individual communication methods are recognized and followed, communication plans are in place. An active support model is followed in care delivery to support independence. Full privacy and dignity is promoted at all times when supporting service users with personal care. Service users are supported to maintain social contacts with family and friends via telephone calls, visits, community activities ,writing. They say that there are Flexible routines within the home and Regular handover of health. Comprehensive staff inductions promoting privacy, dignity, choice and independence. All necessary aids and adaptations are in place for service users as needed. We looked at three care plans in detail. These contain very detailed information about the support and personal care needs of people. Health care needs are assessed, along with the individual support required and plans of care are developed to help meet personal goals. The 24 hour plan of care outlines the steps to be taken by staff to support the person throughout the 24 hour period. More details are contained in the Person Centered Plans. Staff spoken with had a clear understanding of the inputs required to ensure preferred routines and lifestyles are promoted. They told us that they feel supported with training needs and are able to understand and meet the needs of the people they look after. Individual health care needs are well documented in Health Action & Assessment Profiles and Health Care Records. All of the people we saw had annual health reviews with the GP practice. All staff have confirmed that they have received training in medication administration in-house since the last inspection. There are assessments for competency. All managers and deputy managers are booked to do an Advanced Medication course in October 09. The medication system is audited regularly by the manager. One person part-self-medicates at this time as a means of maximizing independence. For this person staff are instructed he administers his own medication but requires full supervision and direction from staff. Examination of the medication system, supplied by Boots Chemists in MDS form (blister packs) was inspected. Medication Administration Record (MAR) charts demonstrated that medication had been administered as prescribed and signed by staff. There is a policy in place for as required PRN medication. This relates to each individual person and is unique to them. Care Homes for Adults (18-65 years) Page 23 of 38 Evidence: We found that the information about this outcome area contained in the AQAA is both accurate and current. Care Homes for Adults (18-65 years) Page 24 of 38 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home and their representatives can be assured that their views will be listened to and acted upon. The systems adopted by the service help to ensure that people are protected from harm and abuse. Evidence: In their AQAA the Providers tell us that there is a Grumbles/whinge box used to gather small annoyances on behalf of service users. Also All staff receive training in safeguarding vulnerable adults and All staff recieve training in values and attitudes. We, the commission, have not recived any complaints about the service since the last Key Inspection was held. The manager keeps a record of any complaints she receives in the form of a complaints log. We saw this log of complaints . The manager had only received one complaint since the last inspection and this had been from the neighbours and was in relation to storage of the waste bins. This had been responded to as per complaints procedure and resolved. The manager told us that concerns are dealt with as they arise and do not usually develop into complaints. We saw the grumbles box as outlined in the AQAA. Care Homes for Adults (18-65 years) Page 25 of 38 Evidence: The complaints procedure is displayed on the wall and in the Statement Of Purpose and is also available in pictorial form. We asked a person who lives at the home if he knows who to go to if he has any concerns and he told us yes Tracy or any of the other girls will do. Regular meetings are held with people who live in the home and their representatives and this gives an opportunity to discuss any issues of concern. The manager had sent out a Family survey in February 2009 in oder to obtain their views about the service. We saw that the results of these were positive. We spoke to staff about their understanding of Protection of Vulnerable Adults (POVA) and they confirmed that they have training on this during induction. A staff member explained how she would report poor practice or abuse. The manager is fully aware of the local procedures for the reporting under Safeguarding and there is a copy of this kept in the home for staff to refer to. We found that the information about this outcome area contained in the AQAA is both accurrate and current. Care Homes for Adults (18-65 years) Page 26 of 38 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. People live in a homely, comfortable and safe environment which is adapted to suit their individual and collective needs. Evidence: In their AQAA the Providers tell us that All rooms meet or exceed standards. The home is completely accessible whilst remaining homely. All bedrooms are single and individually decorated to a high standard, appropriate fixtures and fittings are provided to meet requirements and to suit individuals needs. All shared spaces are again decorated to a high standard with appropriate fixtures and fittings provided to meet service users needs. The Providers also tell us that Regular review of service users needs take place and any aids, adaptations required are provided. They also say that Staff are trained in food hygiene and cross infection and that personal protective equipment is used appropriately. Clinical waste is collected regularly and Cleaning standards are in place. Care Homes for Adults (18-65 years) Page 27 of 38 Evidence: The Nurse call and care call systems are used. There are Handrails in hallways. Emergency lighting is in place and regularly serviced. A Hoist is available and assisted bath both used for service users following assessment. They also tell us that there is a Rolling programme of internal and external decoration. Gardeners attend to lawned areas regularly. A Cross infection audit is completed and highlighted improvements have been actioned. Service users are supported to help maintain hygiene standards within the home via regular cleaning. The Kitchen and laundry is accessed by service users. Relatives are encouraged to use both private and communal areas when visiting service users. Service users have the choice to lock bedroom doors if they wish.. The home is a single story building on a small housing complex for older people and is not identifiable as a home. The building is well maintained. All bedrooms are for single use. There is registration to provide care for up to six people, and at the time of this inspection the home was running at full occupancy. There is an ongoing redecoration programme and people who live in the home assist with choosing the color Schemes and fabrics used, especially in their bedrooms. Bedrooms are well presented and personalized reflecting the personality and individuality of the person and the environment is bright, pleasant, comfortable and replicates a domestic setting. There are aids and adaptations throughout the home to assist with the physical disabilities of the people living there. The walk-in shower area provides an excellent facility and an alternative to the use of the assisted bath. There is a small rear grassed garden area which is part private. At the last Key inspection it was highlighted that Access to the garden is reasonable but there are plans to improve the this access for wheelchairs etc However this has not been addressed and Care Homes for Adults (18-65 years) Page 28 of 38 Evidence: there is a recommendation to provide a ramp from the dining area to the outdoor area in order to ensure that the garden is more easily accessible to all of the people who live in the home. Standards of hygiene throughout the home are high. Staff told us that they receive training in infection control and the training records we saw confirmed this. We found that the information about this outcome area contained in the AQAA is both accurate and current. Care Homes for Adults (18-65 years) Page 29 of 38 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. People who live in the home are supported by competent and qualified staff and their individual and collective needs are met by appropriately trained staff. People are supported and protected by the homes recruitment policy and practices. Evidence: In their AQAA the Providers tell us that Staff performance is reviewed via the appraisal system. They also say that All staff have 12 weekly reviews and a personal development plan. Emotional needs surveys are used to measure emotional satisfaction of all staff at work and that Staff turnover is quite low and Sickness is minimal. They tell us that Regular team meetings are held. High standards of mandatory training are in place for all staff including emergency aid, food hygiene, fire safety, personal safety, moving and handling. Also that Good practice training is available: values and attitudes ,sexuality,what is a learning disability, safeguarding adults and dementia care. Care Homes for Adults (18-65 years) Page 30 of 38 Evidence: NVQ mandatory training is encouraged for all support workers. Personnel records are held for all staff including a copy of application form, two references, identification, Criminal Record Bureau (CRB) checks and an employee record sheet. They say that there is a Full recruitment programme in line with equal opportunities and employment legislation. Full six month induction programme with ongoing reviews and end of period assessment. Learning Disability Qualification is given to all new employees and any existing employees. They told us that the Care manager and deputy have completed a Registered Managers Award and the deputy has done an NVQ level 4. Student nurses are regularly on placement at the home. Consistency is maintained by using regular bank staff when shift cover is needed. Scheme profile and staff specifications used to match staff when recruiting. At the time of the inspection visit there were three staff on duty, the manager and two care staff. One of the care staff had gone out to do the weekly shop which takes place every Friday but she was back within an hour of our arrival. The manager confirmed that the numbers of staff on duty have increased since the last Key Inspection and that th whole time equivalent is now 11.4. There is still only one member of staff on duty throughout the night, however and night time documentation in relation to checking people could be improved. Records show that there are large time lapses between people being checked at night, and, although we do not advocate disturbing peoples sleep, it is essential to ensure that people are safe and secure. Staff were seen to be friendly, caring and attentive to the needs of the people living in the home. Staff were treating people as individuals with their own special needs. They spoke to people with dignity and respect but maintained good humor and there was a good rapport between staff and the people who live in the home. Staff were acutely aware of the needs of each person and of what their reactions would be to situations. Page 31 of 38 Care Homes for Adults (18-65 years) Evidence: They told us about each persons needs and what each person enjoys. The staff told us that they feel supported at the home and that there is a very good staff team. They were somewhat unsettled by the fact that the manager was moving to another home. This is a planned move which the company who own the service have arranged, with managers moving around to other homes within the service. There is a robust staff recruitment programme in place. Staff are recruited by the company and then the manager will carry out a second interview to ensure that staff have the necessary skills to work at the home. The manager told us - I know what qualities I am looking for in a person. They have to have special qualities to be able to work here. We looked at three staff recruitment files and identified that all the required checks had been carried out prior to offering the person employment. These checks include taking up references, Criminal Records Bureau and Protection Of Vulnerable Adult checks. Employment history is also scrutinized to ensure that the right people are recruited to work with the very vulnerable people who live in the home. Once employed staff undergo a comprehensive induction training programme which ensures that they have the basic skills to be able to meet the needs of the people living in the home. The staff training and development plan ensures that staff continue to have the support and training they need in order to meet the on going and changing needs of the people in their care. We found that the information about this outcome area contained in the AQAA is both accurate and current. Care Homes for Adults (18-65 years) Page 32 of 38 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is very well managed and is run in the best interests of the people who live there. Evidence: In the AQAA the providers tell us that the Registered manager is recognized as a fit person with CQC. They also tell us that the manager has completed the following training - Registered managers qualifications:RNMH, Emergency aid trainer, Moving and Handling trainer, NVQ assessor, ENB998,ENB941, Registered managers award, IOSHH certificate. Registered manager, 21years experience in caring for people with learning disabilities, 12 years as registered care manager, 4 years within this home. The Manager ensures that all staff are trained to minimum standards and good practice training is encouraged. Leadership and managers meetings are held to share good practice and promote quality Care Homes for Adults (18-65 years) Page 33 of 38 Evidence: outcomes. The team are pro active and regular meetings are held and high motivation demonstrated. Effective relationships are maintained with service users, families and staff. We maintain effective communications with other professionals. All mandatory training is completed. We maintain accurate and up to date records. The Care manager remains updated with current legislation and research via her own reading, leadership meetings/CQC website. There is an Annual quality summary and service improvement plan completed in order to provide a clear vision. Person centered team approaches are followed. Budgets/finances are planned and monitored regularly(best value delivered). Comprehensive documentation regarding accidents/incidents are reviewed by the care manager. Trends or preventative measures are discussed at team meetings. The Registered Manager is a qualified nurse, has been a Registered Manager for 10 years and has completed the required Registered Managers Award. She is recognized as a competent and fit person to run the home by the Care Quality Commission. The Manager continues to update her knowledge and skills by attendance at courses and involvement in project groups within the Choices Organization. The manager has an open style of management with observed good dialog with people who live in the home and staff who work there. The Manager is supported by a Principal Officer from Choices who carries out regular monthly unannounced visits to the home which are available for inspection. Regular meetings take place with the other home managers in the organization and attendance at Senior Management meetings are cascaded to all staff positively communicating the changes and practice of the organization. Regular staff meetings are held with pro-active involvement of staff. We saw the minutes of a recent staff meeting. Care Homes for Adults (18-65 years) Page 34 of 38 Evidence: At the time of the inspection visit it was the last working day for the manager as she was moving in order to take up a managers position at one of the other homes owned by the Company. There has been a Company decision to move managers around within the area. Both the people who live in the home and the staff who work there were upset at this move. Some of the relatives were also unsettled by this and told us, on surveys, - I have always found Tracy extremely helpful and in touch with my relatives needs. So I will miss her as she is leaving. I am not impressed with the fact that Tracy is being moved. The residents are settled and know the staff and I think it is ridiculous and will be monitoring the situation very carefully. The service has a very good Quality Assurance programme in place. The manager has developed an excellent system which identifies exactly how the service meets each of the 43 standards. It also tells us how the service checks whether it is still meeting the standards and what action is being taken to address shortfalls. This Quality Assurance system also involves obtaining the views of the people who live in the home and their representatives. The most recent survey was carried out in February 2009 and these are some of the comments received Staff seem to really understand my relative. They give her choices. Tracys nursing qualification is very very valuable. The level of care and expertise is very reassuring. The staff are lovely and attentive and most importantly my relative is happy and content. There is a Health and Safety Policy statement in place and the service regularly monitors all aspects relating to Health and Safety within the home. This includes staff mandatory training updates, regular servicing and maintenance of equipment used in the home, and attention to fire safety requirements. The service also complies with relevant legislation. We found that the information about this outcome area contained in the AQAA is both accurate and current. Care Homes for Adults (18-65 years) Page 35 of 38 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 36 of 38 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 29 The service should provide a ramp from the dining area to the outdoor area in order to ensure that the garden is more easily accessible to all of the people who live in the home including people who use wheelchairs. It is recommended that more regular checks are carried out on people throughout the night and that these checks are recorded. This is so that the service can be sure that people are safe and secure. 2 33 Care Homes for Adults (18-65 years) Page 37 of 38 Helpline: Telephone: 03000 616161 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) 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. 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