Care Home: 5 Seafield Road

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What the care home does well This service provides a professional yet homely and relaxed service to people with complex and profound needs. Staff ensure that points of reference, aids and adaptations are used to help ensure that the home is accessible to people. The people living here are continually assessed, and monitored so that their needs can be met. Because people living here have such complex individual communication needs, this means that staff have to constantly use their skills of observation and interpretation, and they do this well. By doing this staff ensure that they plan each person`s care with their needs, preferences, choices and goals in mind. Each person has a detailed plan of care. This is an important working document used to enhance the quality of care given to people. Staff use it to guide their care and support and to ensure that important facts are recorded and shared, and to further develop the support given to each person. This system helps to ensure that people stay physically and emotionally well. Care planning also involves the identification of risk. This services balances the reduction of risk with a person`s right to make decisions and to take risks. Where restrictions are placed on people because of unacceptable risks, significant supporters are involved and the decision making process and recorded and reviewed. People who live here are encouraged to have experiences and staff are very creative in finding ways of achieving this. People are supported to go out as much as possible, tot he beach, the park, college and swimming. In addition the home has it`s own aqua cabin, sensory room and activities room. Each person has an individual programme designed to help them to have their individual needs for stimulus and activity met. This includes finding out what each person likes to eat and supporting them to do this as independently as possible. We observed staff treating people as their equals, being respectful, promoting privacy and dignity, watching out for behaviours which could be interpreted as `complaints` and doing something to address these complaints. We spoke with staff about safeguarding people from abuse. They have a good knowledge of what abuse is, including more subtle forms of abuse, and of deprivation of liberty and infringement of rights as forms of abuse. All staff receive on going training in this. They also receive other training which helps to ensure they can meet people`s needs. In addition, staff are recruited using robust methods helping to ensure that that people are only cared for by suitable staff. The above is achieved through good management systems and the commitment of the registered manager of this service. This is the second time this service has been assessed as `excellent` and this in itself shows the commitment, ability and hard work of the manager and her team. What has improved since the last inspection? Since the last inspection the manager has reviewed the pre admission assessment process to ensure that it is the best it can be. On going decoration and refurbishment continues. The service continues to monitor it`s own performance, challenge their practice and strive to ensure that this home is always run in the best interests of the people living here using current and best practice. What the care home could do better: There are no recommendations or requirements resulting from this inspection. Key inspection report Care homes for adults (18-65 years) Name: Address: 5 Seafield Road 5 Seafield Road Seaton Devon EX12 2QS     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Teresa Anderson     Date: 0 5 0 8 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: 5 Seafield Road 5 Seafield Road Seaton Devon EX12 2QS 0129722423 0129724641 Seaton@sense.org.uk www.sense.org.uk Sense, The National Deafblind and Rubella Association care home 6 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) : Number of places (if applicable): Under 65 learning disability physical disability sensory impairment Additional conditions: Date of last inspection Brief description of the care home This service was last inspected on 8th August 2006. 5 Seafield Road cares for people with significant sensory impairments who may also have a learning disability, complex and diverse needs, and/or a physical disability. The home is a large converted terraced property close to the centre of Seaton. Bedroom accommodation is on three levels. The third floor also has a sensory room, an activities room and an office. There are two ground floor bedrooms that are suitable for wheelchair users. However, the home does not have a lift and therefore the upper floors are unsuitable for anyone with mobility difficulties. Wheelchair users cannot access the sensory room or activities room. There is a ramp to the dining room to enable wheelchair users easy access to this room from the ground floor, but there are Care Homes for Adults (18-65 years) Page 4 of 30 6 6 6 Over 65 0 0 0 Brief description of the care home two steps down into the kitchen that cannot be ramped, and therefore wheelchair users can only access this room via an outside ramp. To the front of the property there is a small garden area and to the rear there is a paved patio area and a sensory garden with raised flowerbeds and swing bench. The home is run by the national organisation Sense, who provide registered care homes and other services for people with sensory impairments and learning disabilities. Fees charged by the home are available direct from the home and will vary according to needs. Each person living here recieves a mobility allowance, and the service charges 60 of this to pay for the use of the homes two mini buses. 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place as part of the normal programme of inspection. It was carried out by one inspector over one day. Notice of the inspection was given to the service as the people who live here have active social lives and we wanted to make sure that we met as many of them as possible. Prior to visiting the home. we requested and were sent an Annual Quality Assurance Assessment (AQAA) by the manager. This gives us details about the service including what they think they do well, what has improved since the last inspection and what the plans are for further improvement. The way this was completed gave us comprehensive and very useful information about the service. We sent surveys to staff asking for their feedback and comments and received 3 back. We also sent a survey to one person living here who was able to give their comments and we received this back. Comments and feedback are included in the report. Care Homes for Adults (18-65 years) Page 6 of 30 On the day of the visit to service we met with all the people who live here. Everyone living here has sensory and communication disabilities. For this reason we could not get their feedback in the traditional way. Instead we spent some time observing them and and their interactions with staff. We also spoke with staff and the manager. We saw all of the communal and service areas of the home and we saw 2 bedrooms. We looked at records relating to peoples care and medicines, and at records relating to the management of peoples monies and at recruitment and training records. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? Since the last inspection the manager has reviewed the pre admission assessment process to ensure that it is the best it can be. On going decoration and refurbishment continues. Care Homes for Adults (18-65 years) Page 8 of 30 The service continues to monitor its own performance, challenge their practice and strive to ensure that this home is always run in the best interests of the people living here using current and best practice. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 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 10 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. People who might consider coming to live here would have enough information about the home and services offered so that they, and their supporters, could make an informed choice. Evidence: The home produces information about the service that provides people with in depth information about the home. This is available in many formats including larger print, videotape and videotape in British Sign Language (BSL). The manager told us in the information provided prior to this inspection that since the last inspection she has reviewed the pre admission assessment processes to ensure they are completely thorough. However, she and we have been unable to test their effectiveness as there have been no new admissions since the last inspection. 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. People living here benefit from a care planning system that ensures their changing needs are identified and met and which takes into account each persons preferences and communication abilities. Evidence: Each person living here has a plan of care. These comprehensive documents contain important information about the persons history, historic and on going medical conditions and their preferences. These documents also contain detailed information about how that person communicates and communication dictionaries. This means that staff use each persons individual language when communicating with them. We saw staff using the care plans to record important information about what had happened for that person that day. We read some care plans and saw that they are important working documents used to help ensure that people get the best care and support possible. For example one person has a problem with digestion. Staff clearly record what has happened in relation to that problem so that appropriate actions can Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: be taken. We spoke with staff about this. They know what to do if the problem occurs and records show that appropriate actions are taken to help this person be comfortable. In addition, staff had recorded that one person had a new way of communicating something. This means that staff are helping each other to understand peoples language so that they can better communicate with them and understand their needs and preferences. We talked to staff about the care plans. They demonstrate an excellent understanding of their function and importance. Staff are very knowledgeable about the care that is planned for people and how to deliver this in a way that suits each person. Staff also have a high degree of understanding of the risk assessments and of how to minimise the risks identified. One example of this is how staff adjust their support for someone with epilepsy depending on how they are. Records also show that regular reviews of care and needs take place. Informal reviews take place as and when needed to help ensure the planning and delivery of care is completely up to date. More formal reviews take place with other agencies and supporters of the person and records confirm this. All decisions which are made on behalf of people who live here are carried out in discussion with for example supporters and the persons care manager. Records are kept of all decisions made and these are recorded in line with the Mental Capacity Act and are kept under review. Similarly any risks to people that are identified are recorded and kept under review. Actions taken to reduce risks to people are balanced with peoples rights. For example, one person has been identified as being unsteady on their feet and at risk of falling due to medical reasons. This person still walks around as this is what they enjoy doing. However, the degree to which they may be harmed by a fall is reduced by the presence of a support worker who is allocated to always be with this person. We saw staff ensuring this happened by asking another member of staff to cover for them if they needed to leave the room. People living here have complex and profound needs. In order to help keep them safe, some restrictions of movements and infringements on privacy occur. However, this service understands that blanket restrictions and impositions are not good practice. In line with this ethos, all restrictions or infringements are discussed and agreed with each persons supporter to ensure these are in place only when less restrictive practices are not suitable. These decisions are documented and kept under review. Actions taken to keep people safe which are restrictive include locking the exit doors, not allowing people into the kitchen when staff are not around and using listening devices at night for two people living here. Their use is clearly documented with Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: explanations as to why they are used and when they should be used. Care plans and observations demonstrate that these actions are short lived and that for example people can easily leave the house and go into the kitchen with a member of staff. Care Homes for Adults (18-65 years) Page 14 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living here experience a lifestyle that enhances their quality of life and supports their rights as citizens. Evidence: People living here have support on a one to one basis the majority of the time during the day. This means that each person has an activities programme that is not always constrained by staffing levels. On some days five service users are supported by 4 support workers. However, evidence shows that people are able to live a lifestyle that is varied, active and suited to each individuals needs and preferences. On the day of this inspection all service users were engaged in activities both in and outside the home. Care plans show that each person has a programme of activities specifically designed for them. Activities outside the home include going to the pub, to college, to church, to the park, to the beach, for walks and swimming. The home has Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: two mini buses which means that more than one person can go out for a trip at one time, and that outings do not have to happen in groups. Activities inside the house include interacting with staff, using the activities room, the aqua room and the sensory room. Each is designed for people with sensory impairments to experience and enjoy the feeling of being and interacting. Staff also help to ensure that people living here have their social needs met by referring them to a multi sensory impairment specialist who can offer advice on how their needs can be met. Each persons bedroom is designed to support that person to enjoy an enhanced lifestyle. For example, some people have music and or televisions in their rooms. Each room has tactile, visual, auditory and/or olfactory (smell) stimuli. In order to assess if people with such profound sensory disabilities are benefiting from these interactions, we observed their behaviour for a period of about an hour. We saw that people living here show signs of well being, of being engaged and we observed good staff interactions. We saw people chuckling and smiling. People had relaxed body posture. One person lay with their supporter on the sofa enjoying a drink whilst manipulating an object. Another sat in the window smiling and communicating with staff. When this person shouted out, staff understood that this was this persons way of asserting their dislike of the short lived noise. Staff apologised and the person settled. This degree of assertiveness on behalf of the service user, and the degree of understanding and respect shown by the support worker demonstrates excellent practice and interactions. Staff were observed showing warmth, acknowledging peoples achievements such as when someone playfully threw a cushion, including people in conversations and having fun. Our observations also demonstrate that staff have an excellent understanding of how each person communicates and how they like to be approached. One person is touched before staff make contact. Another person is supported to put on a particular T shirt as an indicator that it is time to eat. Another person likes to play in the local park and there is a clear photographic description of what this person likes to do and how they do that. Records show that staff work hard to find out what senses each person has so that these senses can be used for communication, processing and for enjoyment. Staff also make referrals to the specialist occupational therapist who can make suggestions on how to help people to experience different stimuli. Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: We saw in records that peoples supporters are involved in reviews and in decision making. Staff are very knowledgeable about peoples families and support them to stay in touch. This includes sending cards and flowers for significant events such as anniversaries and birthdays, as well as in times of ill health. We observed part of the lunch time meal. We saw staff supporting people to eat, to make choices and to let them know what each food was. The atmosphere was relaxed and sociable. All staff focused on the service users and attended to their needs. Staff know what peoples preferences for foods are and try to meet these. However, they also try to achieve a balance between preferences for fast food and the need for a nutritionally balanced diet. We saw that fresh fruit and vegetables are available and used. Staff told us the home runs a four week menu plan but that this is flexible depending on peoples preferences and choices on the day. We saw in records that staff ensure that people with swallowing problems are assessed by the Speech and Language Therapist so that they are supported to eat safely. Care Homes for Adults (18-65 years) Page 17 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health needs are anticipated and met and their health is promoted. People benefit from a staff group who promote peoples dignity and privacy. Evidence: We saw in care plans that details about how each person prefers to receive personal care is recorded. We spoke with staff about this and learned that staff have an in depth understanding of how people prefer their care to be given. We observed that people are taken to their bedroom to receive personal support and that there is sensitivity to gender preferences We looked at care records and saw that people have their health needs identified. Staff do this by understanding each persons medical condition, knowing what health problems are associated with this and by ensuring that people receive the assessments and treatment they need. We also saw, and heard from staff, that people have other healthcare needs which are not attributable to their medical conditions. Staff notice changes in people and in their behaviours. They work hard to find out what these changes mean and to be able to articulate symptoms on behalf of people so that the appropriate treatment can be given. If the people living here allow, staff Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: also support them to have preventative health checks such as seeing the dentist and attending well women clinics. We looked at how medicines are managed. We found all records to be up to date and accurate. We checked some medicine stock against records and found that they match. The manager described the ordering and returns system to us. The systems in use means that all medicines can be accounted for and that they are managed safely. All staff receive training in administering medicines. We saw a member of staff helping someone to be more comfortable by giving a medicine to them. They did this safely and hygienically. In addition, they explained exactly what they were going to do so that they gained the persons understanding and co-operation. The home keeps some homely remedies such as those for coughs and colds. The use of these medicines is agreed by the persons GP and when they are used this is recorded. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living here are supported by a staff team who work hard to interpret any behaviours that might be a communication of dissatisfaction or complaint. These are taken seriously and actions are taken to help ensure that each person is happy and fully protected from harm. Evidence: The home has a complaints policy which is available in many formats and is explained to those people who might understand it. The complaints procedure is also shared with families and with other supporters so that they might use it on behalf of a person living here if needed. We saw in records that all staff receive training, and regular updates, in safeguarding adults. We spoke with staff and they show an excellent understanding of what abuse is, including subtle forms of abuse and the deprivation of rights. They also show a good understanding of the procedures to follow if abuse were seen or suspected. It is standard practice during managers supervision of staff to highlight and discuss protection and abuse issues. We looked at how peoples monies are managed. We found that the system in place is robust and easily auditable. Each person living here has their own bank account. The balance of peoples income, after Sense fees have been taken, are paid into this account. Monies are drawn so that people have cash to spend. We looked at how some Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: people spend their money. We found this matched the lifestyle they live and their recorded preferences. All receipts for monies spent were available and are kept for audit. The manager carries out regular audits to ensure that procedures are followed and that monies are safe. We noted that people contribute a part of their mobility allowance to the running and upkeep of the minibus. This is recorded and agreed with families and care managers. 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. People benefit from living in a homely, clean and safe environment that is suited to their complex needs. Evidence: Each person living here has their own bedroom which is personalised to their needs, preferences and tastes. In addition the home has communal areas made up of the lounge and dining room. These areas are well decorated and furnished. The lounge has recently had new furniture and a new carpet. People living here can also use the garden which is accessible for all, including those with mobility problems. Recent additions to the garden include new planting and a barbecue area. Although this area is not large, flexible seating and planting mean that other items such as a paddling pool can be added and taken away as appropriate. The home also has many specialist areas for people to use on a one to one basis. These facilities include a sensory room, with the recent addition of a vibrating water bed, a music room and an aqua-cabin. Throughout the home there are objects of reference to help people with sensory impairments to understand their environment. For example, the bathroom have a sponge outside it so that people can differentiate it from other rooms. All bedrooms and the front door are linked to the lighting system so Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: that people with hearing impairments know when someone wants to come in. The home has a fragrance linked to the day of the week to help people understand time and each member of staff is recognisable by an object they carry with them at all times. The manager has systems in place for safely storing substances that might be dangerous, for managing laundry, for managing service and maintenance contracts and for regular fire checks. There is an ongoing redecoration/refurbishment programme and the manager reports that one bathroom is due for refurbishment, that a shower room is to be converted into a wet room and that the next areas for redecoration are those which are looking tired. We saw all the communal and service areas of the home as well as one bedroom. All rooms are clean, tidy and safe. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living here are supported by well trained, robustly recruited, caring and creative staff who enhance the quality of life they experience. Evidence: People living here have complex needs. In order to meet those needs, both physical, emotional and social, this service promotes one to one support. For the 5 people living here there are either 4 or 5 support staff on duty during the day. Each person is generally supported by one member of staff who meets all that persons needs during that time. This includes helping them to go out, to eat, to take their medication, to move around the home and to remain healthy. At night there are two support workers on duty, one waking and one sleeping. The home runs a system which identifies each persons circle of support. This includes the support staff who care for that person as well as family, friends and representatives from other agencies. This system helps for example to ensure that people are well supported by appropriate people, that staff are aware who is in each persons circle of support and what these relationships might mean for that person. We observed staff supporting people living here. We saw staff being mindful of peoples behaviour and interpreting what that behaviour meant or might mean so that Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: they could meet that persons need or preference. We saw staff taking action to meet needs, such as administering medicine or just sitting with someone. We saw staff taking their cues from the person they were supporting. For example we saw staff having fun, showing warmth, interacting with people, helping people to engage with activities and just sitting quietly with people. All this was done with genuine regard, respect and warmth. Staff report they receive frequent and appropriate training. Training includes health and safety, safeguarding people and administering medications. In addition staff receive training to help meet peoples specialist needs including total communication, British sign language and supporting someone with epilepsy. The manager and team leader work together to identify staffs training needs. For example an update in administering rescue medications is being arranged as these are not used very often. Of the 16 staff working here 5 have achieved a National Vocational Qualification (NVQ) to level 3 and another person is studying for this. The team leader is undertaking a diploma in deafblind studies, and is introducing her learning into the home. We looked at the recruitment files of two members of staff. We saw that staff are recruited using robust procedures. This includes a full employment history, getting written references and carrying out an enhanced police check before the person starts to work at the home. We saw that each person undergoes thorough induction training provided by Sense. In addition, staff report that they receive an induction relating to the home and the people living here and are fully supported during their first months working at the home. 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. People live in a home that is run in their best interests and which is managed in a way that promotes and encourages further development and learning. Evidence: This service is managed by Ms Dorothy Sharp. Ms Sharp has a nursing background but has worked in this specialist social care field for some years. She has been the Registered Manager of this service for nearly 5 years and holds the Registered Managers Award and an NVQ in care at level 4. She has consistently shown that her management of this home is excellent. Staff working here say that the manager provides exceptional leadership and support. They say that people living here are central to all the decisions made in relation to the home and its running. Staff say they receive all the information and training they need and that they feel exceptionally well supported. They say the manager encourages them to undertaken further training and learning as a way of meeting peoples needs and as a way of developing themselves. Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: There are excellent systems in place to monitor and review the quality of care and support. For example staff receive regular supervision and the home is slowly introducing video recording of interactions between people living here and the staff to enhance learning. Regular surveys are sent to relatives, staff and other stakeholders and their feedback is viewed positively and helps to inform further developments. Sense carry out regular inspections of the home so that they can internally monitor the quality of support provided. The management team review and audit care plans to ensure they are useful and that they act as important documents that enhance the care and support offered to people. Sense have regular management meetings for service managers so that good practice can be shared. Prior to this inspection the manager provided information for the commission in the Annual Quality Assurance Assessment. This was comprehensively completed and provided in a timely manner. This document tells us that there are systems in place to manage the home, that policies and procedures are up to date and that regular fire checks take place. This document also asks each service to tell us what they do well and what needs improving. The manager completed this in an open and honest way. Examples of how the home does things well were given and it was clear that this service is always seeking ways to further enhance staff skills and to improve the quality of life experienced by people living here. 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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