Care Home: 55 Lincoln Avenue

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What the care home does well Lincoln Avenue provides an excellent respite and short break service for people with learning disabilities as it meets and sometimes exceeds the minimum standards of care and support.Staff support customers to be independent and make choices about their time there.There is good access to activities, which have been checked for safety, and which they really enjoy.We had many comments about the staff`s cheerfulness and willingness to listen.Care plans are regularly reviewed to make sure they reflect customers` needs and wishes.Staff were well trained to be competent to support customers. What has improved since the last inspection? All staff have an NVQ to show their competence to support customers.The qualification of an in house manual handling assessor has enabled every customer to have a detailed assessment and review.Staff have taken on the roles of champions in control of infection, manual handling, dignity, diet and nutrition, health action planning, and dementia.Medication policy has been updated and standard medication record sheets introduced to ensure that customers receive the correct medication. What the care home could do better: The Manager has identified in their assessment the areas which they wish to develop. Examples include:the continuation of staff trainingtrying to access funding for more one to one staffingreplacing some furniture. Key inspection report Care homes for adults (18-65 years) Name: Address: 55 Lincoln Avenue 55 Lincoln Avenue Ash Rise Saxmundham Suffolk IP17 1BY 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: John Goodship Date: 2 2 0 3 2 0 1 0 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 34 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 © (2010) 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 34 Information about the care home Name of care home: Address: 55 Lincoln Avenue 55 Lincoln Avenue Ash Rise Saxmundham Suffolk IP17 1BY 01728603148 01728603148 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) : Suffolk County Council care home 3 Number of places (if applicable): Under 65 Over 65 3 3 0 0 learning disability physical disability Additional conditions: Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 34 A bit about the care home Lincoln Avenue is a Local Authority respite home, where short-term respite care is provided for up to three adults who have learning disabilities, and some may also have physical disabilities. The home can accommodate a maximum of 3 customers at any given time. Respite visits usually vary between a few days and a 2 weeks stay. Lincoln Avenue rent the property from Heritage Housing Association. The house is situated on a housing estate and is near to the local amenities on offer, in the Saxmundham town centre. Care Homes for Adults (18-65 years) Respite Page 5 of 34 care fees are charged at a nightly rate of £10.48 at the date of this inspection. Care Homes for Adults (18-65 years) Page 6 of 34 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 Care Homes for Adults (18-65 years) Page 7 of 34 How we did our inspection: This is what the inspector did when they were at the care home We visited the home and spent time looking at some care plans. We spoke to the staff on duty, and to the customers as they came in from their day service. We checked that the service had safe policies in place. Before we went, we asked parents and staff to fill in a questionnaire about the service and how well it met the needs of the relatives and the carers. Care Homes for Adults (18-65 years) Page 8 of 34 The manager had to fill in an assessment to tell us how the home had improved over the last year and what plans there were for further improvements. What the care home does well Lincoln Avenue provides an excellent respite and short break service for people with learning disabilities as it meets and sometimes exceeds the minimum standards of care and support. Staff support customers to be independent and make choices about their time there. There is good access to activities, which have been checked for safety, and which they really enjoy. Care Homes for Adults (18-65 years) Page 9 of 34 We had many comments about the staffs cheerfulness and willingness to listen. Care plans are regularly reviewed to make sure they reflect customers needs and wishes. Staff were well trained to be competent to support customers. What has got better from the last inspection Care Homes for Adults (18-65 years) Page 10 of 34 All staff have an NVQ to show their competence to support customers. The qualification of an in house manual handling assessor has enabled every customer to have a detailed assessment and review. Staff have taken on the roles of champions in control of infection, manual handling, dignity, diet and nutrition, health action planning, and dementia. Medication policy has been updated and standard medication record sheets introduced to ensure that customers receive the correct medication. Care Homes for Adults (18-65 years) Page 11 of 34 What the care home could do better The Manager has identified in their assessment the areas which they wish to develop. Examples include: the continuation of staff training trying to access funding for more one to one staffing replacing some furniture. Care Homes for Adults (18-65 years) Page 12 of 34 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 John Goodship CQC Eastern Citygate Gallowgate Newcastle upon Tyne NE1 4PA Tel: 0300 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 13 of 34 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 14 of 34 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. Customers can expect that their individual aspirations and needs will be thoroughly assessed and met and that they will be able to test that the service is right for them. Evidence: We were told that Lincoln Avenue provided short-term respite care or short breaks for carers and the service users, which they often viewed as a break or a holiday. Service users were always referred to as customers. We saw the information provided by the service including the Statement of Purpose and Service User Guide (called the Customer Guide) which clearly outlined for customers what services were available to them. Carers agreed in their surveys that they had received enough information about Lincoln Avenue before their family member took up their allocation. The Annual Quality Assurance Assessment (AQAA) told us that the service was planning to improve these documents by including pictorial symbols and photos. We were told that the service only accepted referrals through the Community Social Work team who provided their own assessment information. The manager made an initial judgement from this information on the ability of the service to meet that persons needs. Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: After discussion with the referrer, the service completed a full needs assessment in conjunction with the customer and their family. This covered all areas of personal, social and healthcare need together with their goals and aspirations. We looked at two examples of these assessments which were fully completed and signed by the customer. Provider reviews continued to thoroughly assess each customers support and care needs, and the records we checked confirmed that comprehensive support plans were in place that showed each clients support needs. The Customer Guide explained that all prospective customers were offered a flexible introductory period made up of tea visits, day visits, overnight and weekend stays. A full allocation of time was then determined via a carers self assessment. We saw the way allocations were offered according to a three level rating system. The majority of customers were rated in the Medium category. This category in 2010/2011 would be offered two weeks and four weekends secured, that is guaranteed. And one week and one weekend unsecured, that is may be subject to change or cancellation if emergency referrals came in. When all were satisfied that this was the correct service, the customer was given a Service Agreement which outlined the expectations of both customer and service. We saw these in the files signed by both parties. Care Homes for Adults (18-65 years) Page 16 of 34 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. Clients can expect to have their support needs comprehensively planned within a sound risk assessment framework. Evidence: We examined two customers files, one of a customer who had only recently been referred. These files held assessments of needs in areas such as communication, mobility, activities, personal care, health, and goals and aspirations. One plan was fuller as it had been developed using information gathered by the service over time, and after regular reviews with the customer. This included the details of that customers support needs including morning and bedtime routines, personal care needs including bathing, dressing and toileting, meal time routines, medication needs, communication needs, seizures information, fears and phobias, comprehension, money, hazard awareness and leisure pursuits. We noted that support plans were continually reviewed and updated therefore ensuring they reflected the current needs of these individuals. The support plans checked reflected the individual preferences and choices of each client, Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: and gave staff guidance on how the customer liked to be supported, for example in the shower or when outside. Support plans were discussed with customers and their family, and were assessed against a risk assessment framework. Full consideration was seen to be given to the rights and aspirations of each individual, and planned activities were only limited should a risk assessment demonstrate the customer might be placed at risk of personal harm or injury. Risk assessments were found in place for both customers and were very detailed and included assessments around personal, environmental and general risks identified, as well as moving and handling. This was completed by a member of staff trained as a moving and handling assessor. The service was aware of customer preferences about who they liked to be staying in the house at the same time. They were also aware of customers who did not get on with others. The service carried out in-house reviews every six months with the customers and sends out quality questionnaires annually to parents and carer groups. Staff also attended service reviews with other professionals. These were carried out by the customer’s allocated social worker or community care practitioner. The AQAA told us that the service had scheduled some training for staff in the development of a more person centred approach to how they completed some documents within the personal files. This would make the forms more user friendly for customers. An internal trainer from the provider was due to provide the training. The manager told us that customers were encouraged to discuss and agree amongst themselves which community activities they would like to carry out during weekend visits. We noted that all records and personal files were kept locked in the office in lockable cabinets, apart from the personal files of those currently staying which were kept in a locked cupboard in the kitchen. Care Homes for Adults (18-65 years) Page 18 of 34 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. Customers can expect to be provided with suitable activities of their choosing, and to receive nutritious meals. Evidence: We noted from the AQAA that the service could not usually accept customers for stays during the week unless they had an existing day service.The service was not funded for staffing to be available during the weekdays between 10:00 and 15:30. Occasionally funding had been made available for one to one support for a customer, and the service would like more of this funding to allow further flexibility for customers in their daily routines. As our visit was on a Monday, a new set of customers was due. They had been to their day service and were brought to the house by their parents. We spoke to one parent whose family member had used the service for several years. They do a good job. It is a pity there are not more services like this. One of the customers had not been to their Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: day service as they had attended the hospital for an appointment. One of the customers did not arrive at the expected time. A member of staff phoned the family who told them the person was staying at home for tea and would get to the service later. The service had close links with the Friends of Saxmundham, a fundraising organisation linked to the nearby day centre. This organization had donated a minibus to the service, and paid for its maintenance. The service paid a small amount each time they used it, and parents were asked for a donation. The Friends had also offered to buy a new digital TV. The AQAA told us that staff rotas were arranged flexibly to suit the activities planned by the customers. These included bowling, the cinema and attending clubs. There were once a month clubs run locally by Optua and one called Mingles. Our survey told us that people felt that they always or usually were able to make decisions about what they did each day. Two members of staff were identified as dignity champions, to ensure the right to privacy and dignity was upheld for all customers and incorporated in an action plan. We saw the services Friendships and Relationships policy in the Statement of Purpose, setting out for staff the rights of customers to form relationships. It clearly set out the services obligations under the Mental Capacity Act, and emphasised that no decision about the development of a relationship could be taken by a staff member without consultation. Meals were served in the dining area, which was open plan with the lounge and kitchen. The dining area was light, and overlooked the conservatory and garden. The meal that evening was quiche, mash, carrots and broccoli, with mushy peas for one customer as it was their favourite. It smelt and looked appetising. Dessert was banana instant whip. The menu record showed that customers had a good range of balanced and wholesome meals that were suitable for younger adults. Other recent main menu choices were baked sausages, fish in breadcrumbs, roast chicken, shepherds pie, chicken pie, and beans on toast. All were served with vegetables. The freezer was well stocked and the fridge held vegetables and other items properly covered. Packed lunches were supplied for customers during the week. The AQAA told us that one of the staff had been appointed as the diet and nutrition champion. They were undertaking training for this role, and were already preparing healthy eating visual material to educate and encourage the customers. Customers records checked showed that their daily routines promoted independence. Staff spoken with confirmed that customers were actively encouraged to participate in the daily routines at the home, or participate in leisure activities in the evenings or weekends. A relative told us They appear to really know their clients. They tell me what X has been doing, for example they like playing darts. One of the customers said Weekend activities are organised with outings in the minibus. We have shopping trips. Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: The staff discuss with us what meals we would like. I am on a diet and they help me to keep to it. Care Homes for Adults (18-65 years) Page 21 of 34 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. Customers can expect that their physical and emotional health needs would be fully met, and that medication would be appropriately provided. Evidence: The customers records checked showed that the service was aware of peoples personal care needs and preferences, and this had also been clearly demonstrated under support planning. Healthcare needs had also been identified and their records showed that these were regularly monitored. For example, one customer suffered from early onset dementia. One of the staff was designated as dementia champion, but all staff had attended training in dementia awareness. The manager described how the staff used visual prompts to support this customer. Personal files included care and support plans, moving and handling assessments and a communication profile. The moving and handling assessment was updated each time the customer stayed. Assessments showed when two staff were needed, sometimes because of the customers challenging behaviour during a move. We saw that the in-house assessor attended a refresher course annually. Health action plans had started to be compiled for each customer. These were completed Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: by two specialists from the provider. It was made clear to us that these plans belonged to the customer. The service did not keep them unless requested by the customer. Access to the local Doctor was available for more urgent situations, and if required, residents would be taken to the local surgery. However, as respite stays at the home were usually for short periods only, most customers would consult with their own General Practitioner. The service was able to make referrals to specialist teams such as community nurses and intensive support teams. The homes medication policies were provided for staff guidance by the Local Authority provider, and had been recently updated for all services. As each customer provided their medication on admission, and stayed for different periods of time, the service had adapted a check in/out system to account for each customers own medication, requiring the signatures of two staff. This allowed the service to be responsible for all medication received, and for its safe administration during the customers stay. The medication and the records for one resident were checked. These had been securely locked in the medication cabinet, and had been appropriately maintained as per the services policy. The AQAA told us that a standard medication record sheet was now in use in all the authoritys respite/short break services. We looked at the record for one customer. Staff had signed to record that they had assisted and witnessed the customer take these. Records showed that all staff had attended medication training with a local college. Care Homes for Adults (18-65 years) Page 23 of 34 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. Customers can expect that every effort would be made to keep people safe, and to promote and ensure their protection. Evidence: We looked at the services complaints policy and procedure, which was provided to customers in an accessible format, having picture symbols as well as written text. The complaints policy was also found within the homes Statement of Purpose and Customer Guide. There had not been a complaint within the last year. The complaint procedure was clearly explained in the complaints book. A relative confirmed that feedback was provided by the home and by the customer at the end of a stay, so any concerns could also be addressed at that time. The service had policies and procedures in place in relation to the Protection of Vulnerable Adults, which was available at the home. Further the service followed the Suffolk Vulnerable Adults at Risk guidance policy, which was very robust and detailed guidance. Staff understood their responsibilities in relation to the reporting of any abuse to Social Services. One safeguarding referral had been made last year. The service had been asked to investigate this by the safeguarding team, and the outcome was accepted by the team, and by the parents. The agencys recruitment procedures included Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) disclosures for all new staff. Staff members records showed they had received POVA training(now called Safeguarding training). Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: Care Homes for Adults (18-65 years) Page 25 of 34 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. Customers can expect that the environment of the building would be well maintained, safe and hygienic, with the provision of good facilities that meet customers needs. Evidence: Lincoln Avenue provided a spacious, comfortable, and clean environment for customers, which was decorated to good standards and was well maintained throughout. The lounge was decorated in modern colours, with the kitchen and conservatory in more natural colours. The lounge was provided with a lounge suite, and furnishings appropriate to the needs of younger adults. Staff told us that they would like to replace this suite with more modern furniture when budgets allowed. A new sofa bed had been bought which was sometimes used by the night staff. The manager told us that the TV was due to be replaced by the Friends of Saxmundham. The bathrooms and toilets were spacious, clean and very accessible, and safe for customers, including the provision of hand rails. Secure handrails remained in place down the stairwell. A relative told us that when I mentioned about the room being cold, the staff immediately sorted it. The building had an advanced fire system, which included automatic bedroom fire safety closures. The laundry area was very clean and well maintained, and the COSHH cupboard was properly secured. Liquid hand wash and paper hand towels were in evidence throughout the home, and there were sanitary bins in the downstairs toilet and the Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: upstairs bathroom. The AQAA told us that the service had designated a staff member as Infection Control champion, and a suitable training course was being sought. One relative told us that the laundry is always done beautifully. All the surveys told us that the house was always fresh and clean. Bedrooms were personalised to some extent bearing in mind the short stays, and were provided with suitable furnishings and pictures to create a more homely environment. The kitchen area provided a dishwasher and refrigerator and was also well maintained. Radiator protectors were in place on all radiators. There was a staff office on the first floor that was used for the administration tasks of the home, and as a sleepover room at night. The building was situated in a quiet residential area of Saxmundham that had access to the local village and shops. The grounds overlooked a field, and were quite well maintained for the time of year, but dominated by the oil tank. We were told that it had to be sited so prominently for safety reasons. However the garden provided a suitable area from the customers, particularly in the summer months. Care Homes for Adults (18-65 years) Page 27 of 34 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. Customers are protected by the services recruitment and employment procedures and can expect to be supported by well-trained and competent staff. Evidence: We were told that the three rooms were normally always filled although gaps could occur. On the day of the inspection, three customers were expected to be at the home. The staff rotas were checked and this showed a 1:1 ratio. One staff member was allocated to undertake a sleepover during the night, and was able to assist customers if required. During the day, customers would attend a day service, so support staff were not usually retained during this period. On call, and call back procedures were in place to ensure that staff could be contacted, should they be required during the day, after hours, or at the weekend. The rotas showed acceptable levels of staff for the periods required. The AQAA told us that rotas would continue to be customer needs focussed and staff would work flexibly to ensure that happened. Staff told us that there always sufficient staff on duty to meet the needs of the customers. Staff we spoke to and records checked showed that staff were thoroughly trained in their job roles, and therefore had the necessary skills to meet the needs of customers with learning disabilities. Training records checked evidenced that the home continued to ensure that staff had received appropriate and specific training. Some examples of this Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: included dementia awareness, safe administration of medication, food hygiene training, first aid, Unisafe training, adult protection training, moving and handling training, risk assessment, and MIDAS training to drive and load the minibus. The training plan showed that in the next month, staff would be receiving training in person centred plans, and challenging behaviour. All the staff had achieved a NVQ at Level 2 and above. The manager and a senior carer had achieved Level 4 in Care and Management. The AQAA told us that there had been no staff changes in the last twelve months. However we checked the recruitment and employment records for one person recruited before then and these confirmed that the home had undertaken sound and thorough recruitment checks for staff. This included obtaining a Criminal Record Bureau check and Protection of Vulnerable Adults checks, identity checks, 2 references, a job description, an application form, and a photo for each employee. The manager told us that she had attended the employers Licence to recruit course, and had already been asked to sit on interview panels at other services. We were told that there were monthly staff meetings and these were well attended, including by those who worked limited hours. We checked the supervision records and feedback received from staff confirmed that the home ensured thorough support was provided for staff members. Staff signed a supervision agreement which indicated six sessions a year. However the manager said that this was not always possible with those who worked limited hours. She also made the point that in such a small service, staff were talking to her and seniors frequently. She said that they should record these occasions. Feedback received from customers and their relatives included the following views about the staff group. Everything is done in a homely, professional manner. The staff are always cheerful and pleasant. My relative is very happy about going to the home. Staff always listen and sometimes work miracles. Care Homes for Adults (18-65 years) Page 29 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Customers can expect the home would be well managed including seeking customers views about the quality of the service, and ensuring that the home operates high quality health and safety practices to keep customers safe. Evidence: The manager had been in post for four years and was registered with the Care Quality Commission. She worked part time and was supported by a full time senior support worker.This management team was very strong on the promotion of independent living opportunities for their customers. Staff feedback confirmed that management were very supportive of them, and any problems would be quickly resolved. The home sent out annual questionnaires to customers and their parents before the beginning of the allocation year, to ascertain their preferences, and to give them the opportunity to comment on the service. The staff emphasised to us that in such a small service, there was always a personal link with all families. Care Homes for Adults (18-65 years) Page 30 of 34 Evidence: Two Regulation 26 provider visit reports were shown to us for January and February 2010. There were none prior to this until March 2009. The manager explained that there had been some gaps due to management changes but that the policy now was for peer visits by fellow home managers. We checked the incident reports. There were two in 2010, both occurring outside the home. One concerned the customers behaviour, and the other was a finger that was hurt when the wheelchair was pushed through doors. Records confirmed that staff had received appropriate health and safety training including moving and handling training, food hygiene, fire safety, and first aid training. There were always two support workers on duty, when residents were at the home. Hot water taps had restrictor valves in place to prevent scalding, and hot water outlets were checked weekly as shown by the records. Radiators were covered to prevent scalding. The home had a fire and smoke detection system, and automatic bedroom door closures. The fire risk assessment was reviewed annually, the latest review being on 4th February 2010. The laundry was found clean and well maintained, and the washing machine could operate hot water cycles at 63 degrees Celsius. The COSHH cupboards were found locked, with substances hazardous to health kept there. We have reported above that records were held securely either in the office or in the medication cupboard in the kitchen. Care Homes for Adults (18-65 years) Page 31 of 34 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 32 of 34 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 Care Homes for Adults (18-65 years) Page 33 of 34 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 © (2010) Care Quality Commission (CQC). 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