Care Home: 57 Bury Road

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Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 57 Bury Road 57 Bury Road Gosport Hampshire PO12 3UE The quality rating for this care home is: three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Laurie Stride Date: 2 3 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. 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 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 34 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: 57 Bury Road 57 Bury Road Gosport Hampshire PO12 3UE 02392588756 02392587852 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) : Care Management Group Ltd care home 6 Number of places (if applicable): Under 65 Over 65 6 0 learning disability Additional conditions: The registered person may provide the following category of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Learning disability - LD The maximum number of service users who can be accommodated is: 6 Date of last inspection 2 3 0 4 2 0 0 7 Care Homes for Adults (18-65 years) Page 4 of 34 A bit about the care home Six people live at the home. The home is near to the town and they can use the bus to get there. They all have their own bedroom. The home has detailed information for people about what it can offer them. Fees range from 1,390 to 1,660 pounds per week. Care Homes for Adults (18-65 years) Page 5 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 6 of 34 How we did our inspection: This is what the inspector did when they were at the care home We (the commission) visited the home and did not tell them we were coming. We looked at how well the home was doing since the last inspection on 23/04/07. We were in the home for six hours. We met some of the people who use the service and we talked with the manager and three staff members. The home gave us information about what they were doing in their annual quality assurance assessment (AQAA). Care Homes for Adults (18-65 years) Page 7 of 34 We sent survey questionnaires to staff and other people who have contact with the service. We received responses from a care manager and eight staff members. What the care home does well The home works at providing support for each person in the home to make sure their health and personal care needs are met. Staff know how to support each person in a way that suits them. Care Homes for Adults (18-65 years) Page 8 of 34 A range of activities are available for relaxation, mental stimulation and learning life skills. Visitors are made welcome. People can keep in touch with their friends and relatives and the home helps them to do this. Meals at the home are varied and people can choose what they want to eat. The home offers a clean, wellmaintained and comfortable place to live. Care Homes for Adults (18-65 years) Page 9 of 34 There is a reliable staff team who have training to make sure that they can meet the needs of everyone who lives in the home. The service has an experienced manager who runs the service well, making sure it is safe for the people who use it. What has got better from the last inspection Care plans tell staff more about how a person wants to be supported and what they need to do for that person. Care Homes for Adults (18-65 years) Page 10 of 34 The home has had new carpets fitted. Staff have had more training to make sure that they can continue to meet the needs of everyone who lives in the home. What the care home could do better The home say they could do better at using pictures to help more people to see what is in their care plan. Care Homes for Adults (18-65 years) Page 11 of 34 The home say they could do better at supporting people who use the service to be more involved in the daily running of the home. The home say they could organise more day trips for each person who uses the service. 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 Laurie Stride Care Quality Commission The Oast Hermitage Court Hermitage Lane Maidstone Care Homes for Adults (18-65 years) Page 12 of 34 Kent ME16 9NT 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 . Prospective service users individual aspirations and needs are assessed. Evidence: There had been no new admissions since the last inspection. The AQAA stated that complete and full assessments were carried out on each individual before moving into the service. During our visit we looked at the assessment records and processes in relation to one of the people who use the service. The records contained the original assessment completed by the organisations placement officer at the individuals previous address. The manager said she had been involved in all admissions to the home and this helps to ensure the compatibility of people using the service. Following the initial assessment staff visited the individual for lunch and a transition plan was drawn up, then the person came to Bury Road. We saw that the home had also obtained the care management assessment. After admission, the service carries out 28 day, 3 and 6 month reviews to monitor the transition. The manager said that staff from the home attend reviews at Adult Service offices if care managers are unable to come to the home. Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: A care manager who took part in our questionnaire indicated that the homes assessment arrangements always ensure that accurate information is gathered and that the right service is planned and given to individuals. 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 . People who use the service know their assessed and changing needs are reflected in their individual plan. The service uses innovative approaches to support people to make decisions and to take risks as part of an independent lifestyle. Evidence: The homes approach to support planning centres on the individual. For example, we saw a day in the life of plan for one person, which was based on staff observations and descriptions of the individual from which a picture of the persons abilities and support needs was drawn. The plan had been reviewed, which the manager said enabled the service to monitor the individuals developing skills, such as household tasks and communication, and make any necessary changes to the way staff worked with the person. We saw a recent goal plan in relation to staff supporting the individual on visits to their family home. This was being closely monitored and we saw the ongoing plans for extending the visits. At the time of the inspection the person was returning from a third visit and two staff members had stayed nearby to give support to the individual and their family if needed. We spoke with one of the staff members Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: who told us that the individual uses sign language to say when he wants to visit and that he had stayed two nights this time and has been much happier and brighter after these visits. We saw that the relevant risk assessments and guidelines were in place and had been signed by staff to say they had read and understood them. The manager told us that the risk assessments and guidelines are reviewed on a monthly basis by a different staff member. This is to ensure that staff do not become complacent and that all staff review all the plans. We spoke with a staff member who also told us about this procedure and we saw the review records, signed and dated by staff. If any changes need to be made to plans following review, the manager makes the amendment and the plan goes into a read and sign file for staff. The manager informed us that, at the organisations request, the local authority Adult Services had visited the home the week before the inspection to review the support plans, risk assessments and guidelines. The manager said that no issues had been raised as a result of this. The AQAA told us that systems are in place to support individuals with their communication needs, which has enabled individuals more choices and they are more able to be involved in the decision making within the home. We met another person who uses the service who greeted us. This persons support records showed that their verbal and sign communication had improved, increasing their confidence and independence. The records also showed a decrease in the level of challenging behaviours. The persons support records contained action plans and priorities for the individual, which were in a pictorial format to make them more accessible to the person. The home has put photographs on a disc, which the individual uses on a laptop and can now identify staff members by name. The manager showed us the talking photo albums that the home is now working on for each person who uses the service. Staff use communication books that contain photographs and symbols depicting current activities, which are used when providing support to individuals in the community. These are linked to larger pictorial flow of the day diagrams that each person has to support them with their communication and routines. We saw that one person who lives in the home and who has a sight impairment had a talking flow of the day system. Staff at the home continue to learn more sign language, we saw there was a sign of the week poster near the office door. A member of staff told us about using objects of reference that resemble the activities an individual takes part in. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The service is run in a way that ensures daily life and activities are flexible and focussed on the needs and wishes of the people living there. Individual diets and food preferences are well catered for. Evidence: The home supports and encourages individuals development through continuously reviewing and updating the tools used to assist communication. We also saw that individual activity schedules in picture formats were in place. These indicated activities such as shopping, swimming, cafe visits, art and craft, aromatherapy and reflexology. The schedules are flexible, for example one person had wanted to join some others to do bowling, so his art and craft session was swapped to a different day to enable him to do both. We saw that people who use the service have scrapbooks, which they fill with pictures and memorabilia of their choosing. One person had collected tickets and leaflets from trips they had been on, such as the Isle of Wight and Monkey World. Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: Another person keeps a book of their artwork. The manager informed us that since coming to the home, this person now chooses her own clothes and likes to wear jewellery and perfumes. The manager told us that this year 3 people are going to the Lake District on holiday, travelling together then taking separate breaks while there. Two others will be going to the Isle of Wight and another person will have periodic day trips in line with his needs and wishes. The home supports people who use the service to keep in touch with friends and relatives. We saw one person received cards from a relative with photographs of the sender attached, which helps staff at the home to communicate the message. In the case of another individual, as already mentioned, staff were supporting the person and their relatives to see each other more frequently including overnight stays. The service produces a newsletter for relatives and carers. The manager said that the home has good relations with neighbours and that people who use the service use the local shops and public house. People are supported to use public transport and the home also provides transport for community based activities. The AQAA indicated that the home is researching additional facilities such as clubs and has plans to organise more day trips. People who use the service are encouraged and supported to take part in daily tasks around their home. This is recorded in their support plans. A cleaning schedule/photo board is used to assist individuals in choosing which task they are going to do. We observed staff members supporting people to do tasks such as cleaning and tidying in the lounge. We saw that people who use the service have access to the kitchen and there are locked drawers where knives and cleaning materials are kept for safety. A talking device had been fitted to the cupboards that says what is in the cupboard when a button is pressed. This is to assist a person with a sight impairment to access the kitchen independently. The AQAA told us that the food menus have changed as a result of staff listening to people who use the service. Rather than a rotational 4-week menu, these are now chosen by people who use the service at monthly meetings using photographs and pictures of different foods. The home keeps a record of what food individuals have and from this we saw that people are offered a varied diet that reflected the preferences identified in their care plans. Staff understand individuals cultural wishes and expectations regarding diet and support one individual to go to a specialist food shop as well as learning how to cook this food. Alternative food is also made available to meet another individuals cultural and religious requirements. A care manager commented in our survey The service is very proactive in meeting my clients cultural needs. We spoke with three staff members who told us that all meals are home cooked using fresh ingredients and people who use the service are involved. We observed an individual cooking cakes with a staff member and saw a recipe folder for all staff to use. People who use the service are also given the opportunity to be involved in buying food items for the home. The home has a food and nutrition policy and monitors and records the temperature of cooked food. The home was in contact with a dietician in order to ensure that one individuals health and dietary needs were being fully met. Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who use the service receive personal and healthcare support in the way they prefer and require and are protected by the homes policies and procedures for dealing with medicines. Evidence: Individualised support is provided for people using the service and details of this are recorded in care plans. Staff at the home monitor individuals health and support people to access appropriate healthcare services and attend any appointments. The outcomes of these are recorded in individual health action plans. During our visit an oral hygienist visited the home to give some guidance to staff. We saw that the home also refers to the local learning disability team who provide additional support for specific matters. A care manager told us the service does well at meeting the needs of a client with complex needs. They indicated in our survey that the service always respect individuals privacy and dignity. During our visit we observed staff supporting people who use the service in a friendly and sensitive manner. An emotions board in the home is one of the tools staff use to support individuals to express how they are feeling. At the time of the our visit, the organisations Health Action Advisor also paid a visit to the home and audited a sample of the Health Action Plans. Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: We saw that the home has suitable storage facilities for medication, including storage for controlled drugs although there were no controlled drugs being held at the time of our visit. The home has policies and procedures for the receipt, storage and administration of medication and staff confirmed they receive training in the procedures. We observed the manager checking and giving medication to a person who lives in the home. The manager stayed with and encouraged the person until he had taken the medication before signing the records. The manager showed us that she also undertakes and records medication audits. Night staff also do stock checks so that any possible errors are picked up on quickly. A file is kept for as required medications that includes the reasons such medication is given and how often. These procedures had been signed by a doctor. A member of staff explained the procedures for as required medication and how individual behaviour management strategy plans and the staff training linked with these. 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 . People who use the service can be confident that their views are listened to and acted on. The homes policies and procedures, backed up by staff training, protect people from abuse, neglect and self-harm. Evidence: The service has a complaints procedure that is in written and pictorial form. The manager told us there had been no complaints in the time since the last inspection visit. People who use the service have limited verbal communication, however staff we spoke with demonstrated their knowledge and understanding of individual ways of communicating, for example through behaviour changes, and how to support someone to make a complaint if necessary. The home also has a positive feedback book and we saw that there were numerous entries in it. Staff members told us that all staff receive training in Preventing and Managing Challenging Behaviour (PMCB) and records we saw further confirmed this. We saw an individual behaviour management strategy plan that contained clear guidance on the specific physical interventions that may be used. The manager told us that there had been a dramatic decline in the number of times physical intervention was used, which was mostly touch support, linked with the development of communication tools. The home has a copy of the local authority Safeguarding procedure. We asked a member of staff about this and she demonstrated a clear understanding of how to Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: report and record any instances of suspected abuse. We saw a safeguarding flowchart in the office that had been signed by staff. The AQAA stated there had been one safeguarding referral in the last 12 months, which the manager told us had been reported to the care manager and safeguarding team. All of the people who use the service have bank accounts and the manager is a trustee along with two other managers from nearby services. The home looks after small amounts of service users money and we observed a record being completed by a staff member and checked by the manager. The manager told us that the balances are counted at each staff handover and one staff member on each shift is responsible for the safe key. This promotes staff accountability and protects the interests of people who use the service. 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 . People who use the service benefit from a clean, homely and comfortable environment. Evidence: We were shown around the premises by the manager and we saw that the home was clean and comfortably furnished. Bedrooms all had en suite facilities and were furnished and personalised to reflect the needs and interests of the individual occupants. The manager told us how the staff are supporting one individual to personalise his room. This is being done gradually at the persons own pace. We saw that staff had found pictures on the internet of places that the person recognised and had laminated these for him. The individuals relative was also involved in this. Since the last inspection the carpets had been replaced in all bedrooms. The manager also told us that the lounge carpet is to be replaced with flooring next month as this will be more suited to the needs of people who use the service. We saw there were photographs and examples of individuals artwork on boards in the lounge. One of the bedrooms has an alarm on the door, so that staff know and can provide support if the person leaves their room. The en suite bathroom in the persons room is locked. The individuals care manager had signed the relevant care plan as being in the persons best interests and a review was scheduled on Monday. Staff came very quickly when we activated the alarm going into the room. In another persons room the furniture is fixed to the floor and this is also agreed with the care manager. Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: There is an enclosed garden to the rear of the property that is equipped with a table and chairs and other seating. Each person who uses the service has an allocated fence panel, which they decorate how they please. The home has a small utility room that contains a washing machine and tumble drier. The AQAA stated that the laundry equipment is easy to use to enhance individuals independence as much as possible. The AQAA told us that a maintenance audit is completed on a monthly basis. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who use the service are supported by a trained, competent and committed staff team and are protected by the homes recruitment policy and practices. Evidence: During our visit we spoke with three staff members including the deputy manager. We also observed other staff members interacting with people who use the service. The staff demonstrated a commitment to providing service user-focused care and support. The manager told us that all 16 staff have either achieved or are in the process of completing National Vocational Qualifications (NVQ) in care at levels 2 and 3. The sample of records we saw further confirmed this. The AQAA stated that all staff had completed the Skills for Care induction programme. A care manager who took part in our questionnaire wrote There is always a feeling of a competent and knowledgeable staff group when visiting. We looked at the recruitment records for two members of staff employed since the last inspection and these showed that all the required checks had been carried out. The information included two written references and evidence of CRB (Criminal Records Bureau) and PoVA First (Protection of Vulnerable Adults) checks. There were also records of completion of the Skills for Care induction, probationary reports and training log with certificates. The manager told us that potential new staff members are invited to the home for pre-interview visits, during which the manager and deputy observes Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: their interactions with people who use the service. This enables both the home and the prospective staff member to check their suitability for the role. Training records showed that staff receive training in moving and handling, fire safety, emergency aid, food hygiene, infection control, medication, preventing and managing challenging behaviour, epilepsy, autism awareness, care practices and other relevant subjects. The service also uses its own health and safety questionnaire that refers specifically to 57 Bury Road. A staff member told us about the day in the life of a service user training that all staff take part in, which involves staff experiencing how it might feel to be on the receiving end of care and support services. The staff member said this training was an eye opener and very effective. They told us that the manager is fantastic at informing and training staff to benefit people who live in the home. Each staff member has a continuing professional development file and receives monthly supervision. Eight members of staff completed our survey questionnaire. All confirmed that their employer carried out checks and references before they started work in the home. All indicated that they are being given training which is relevant to their role, helps them understand and meet the needs of people who use the service and keeps them up to date with new ways of working. Staff members responses also informed us that new staff started work on a supernumerary basis to enable them to learn about people who use the service. Comments from staff we spoke with and those who completed questionnaires indicated that staff are encouraged to research and access additional training. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who use the service benefit from a well run home and can be confident that their views underpin its development. The health, safety and welfare of people who use the service and staff are promoted and protected. The management and staff are able to demonstrate a proven track record of providing good services. Evidence: The manager is experienced and qualified and has been in post since August 2005. Throughout our visit we observed how the manager and staff created an open, positive and inclusive atmosphere in the home. The manager communicates a clear sense of direction and enables staff and people who use the service to affect the way in which the service is delivered. The management approach in the home encourages innovation and creativity. Records in the home showed that the manager and staff continuously refresh their knowledge through training. The organisation carries out regulation 26 visits on a monthly basis, which highlight any areas that may require attention and give timescales for remedial action. People who use the service are supported by their key workers to complete a yearly user-satisfaction questionnaire, which is in addition to monthly, six monthly and annual reviews of care plans. Through Care Homes for Adults (18-65 years) Page 30 of 34 Evidence: these and other systems the home monitors how it is meeting its aims and objectives. A recent entry in the homes positive feedback book, from a relative of someone who uses the service, commented how thorough and sensitive staff were to the individuals needs and said thank you for a job really well done. There were no requirements identified during this or the previous inspection visits. The manager told us a monthly working party takes place when a group of staff discuss sections of the Key Lines of Regulatory Assessment (KLORA). This supports staff in their professional development and to know where to locate relevant information if on duty during an inspection or other audit. We saw the agenda for a forthcoming staff meeting, which included fixed items such as the KLORA working party, health and safety matters and reviews of intervention strategy plans. Additional items included safeguarding procedures. The home has also developed reference files on the Mental Capacity Act and Deprivation of Liberty legislation. We saw the most recent regulation 26 visit report, which indicated the ongoing development of care plans, activity files and health action plans for people who use the service. As already mentioned, the organisations Health Action Advisor paid a visit to talk with staff and audit health action plans. There is a newsletter that is sent to the family and carers of people who live in the home. The home carried out the last family and carers survey questionnaire in April 2008. Four out of six people responded and all were positive in their rating of the service. The home also carries out care manager surveys and seeks their views on the service at care reviews. A care manager who took part in our questionnaire told us I am not aware of any need for improvement and Always a pleasure to meet with the people living and working at 57 Bury Road. We saw there is a business plan for 200809, which includes further developing person centred planning and communication tools for people who use the service. There are policies and procedures in place to ensure safe working practices in the home and all staff undertake statutory training in health and safety matters. The home keeps a record of the dates when fire safety equipment is checked and evacuation procedures are tested. A staff member noted our arrival on the fire safety board. There is a buddy system between the home and another local CMG service, which puts emergency procedures in place, for example if people who live in the homes had to evacuate the building. The manager said that a full analysis of the accident book is sent to the Health and Safety Officer at the local town hall, to promote discussion and best practice. 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 Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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