Care Home: 58 Crantock Drive

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What the care home does well There is a clear process to ensure that the service is able to meet the assessed care needs of prospective people moving to the home. There is an admission procedure, which is included in the Statement of Purpose and full assessments of needs were undertaken prior to people moving into the home. The home have developed `person centred plans` and the ethos of the home is that the whole service provided is tailored around the needs and wishes of those who live at the home, this includes involvement in daily living activities, decision making process and putting the person who uses the service first. Prior to our visit we received fifteen completed surveys from people who are associated with the home, all of these contained favorable comments about the services provided at 58 Crantock Drive. We received six completed surveys from people who live at the home, these indicated high levels of satisfaction, people said that the staff and manager treat them well, that staff act upon what they say and they knew what to do if they were unhappy. Additional comments made by residents included; ` Staff listen to me, I can go out when I want, all of the staff are very kind`. Information contained within individual staff files were all of a consistent standard. The files for three staff were reviewed; including a recently recruited staff member. All of the required documentation was in place in respect of robust recruitment and selection practices. It was found that all of the checks and records required under Schedule 2 of the Regulations had been complied with, including two references being taken up, a Criminal Record Bureau check and clearance from the register of people deemed unsuitable to work with vulnerable adults had been checked before the staff started working at the home. The registered manager, Mrs Paula Ralph is experienced, appropriately qualified and committed to improving the quality of life for the people who live at the home. People living in the home spoke positively of the care provided. Practice observed was of good relationships between those who live at the home, staff and management. Staff files also contained evidence of supervision and positive comments were noted in the feedback to staff. Frequency of supervision was good and staff had received the required sessions. Areas of discussion included guidelines and policies of the home, individual`s expectations and an evaluation of their performance and how this can be developed. The manager and staff team at the home fully engaged with us during this visit and were able to locate all of the necessary information and documents easily. This shows that generally the home has good systems in place and is well run. What has improved since the last inspection? The home continue to build upon the existing good practices that are in place and work well to provide a personalised service to those who live at the home. No requirements or recommendations were made by us during our last visit to the service in January 2007. What the care home could do better: There are people who live at the home who are supported with their finances by the organisation in the form of a `power of attorney`, it is recommended that copies of these powers and what this means for the individual`s concerned should be obtained and retained, this will show what the responsibilities of this role are. Key inspection report Care homes for older people Name: Address: 58 Crantock Drive 58 Crantock Drive Florence Park Almondsbury South Glos BS32 4HG     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: Odette Coveney     Date: 0 5 1 2 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 Older People Page 2 of 32 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 Older People 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 Older People Page 3 of 32 Information about the care home Name of care home: Address: 58 Crantock Drive 58 Crantock Drive Florence Park Almondsbury South Glos BS32 4HG 01454614941 01179709301 max@aspectsandmilestones.org.uk admin@aspectsandmilestones.org.uk Aspects and Milestones Trust care home 8 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 Additional conditions: May accommodate up to 8 persons with a Learning Disabilty aged 55 years and over. Date of last inspection Brief description of the care home 58 Crantock Drive is a care home that had been initially registered with South Gloucestershire Council and then with the National Care Standards Commission. Since April 2004 the home has been registered with the Commission for Social Care Inspection, and now known as the Care Quality Commission (CQC). This is one of the homes operated by Aspects and Milestones Trust, a non-profit making organisation. It provides accommodation and personal care, but not nursing, for up to eight adults who have a diagnosis of learning disabilities, aged 65 years and over, male or female. There are currently no vacancies at the home and all living at the home are female. The home provides a variety of daytime activities. The present manager has been in post since 1996. The home is a mature detached bungalow, which has been modernised and extended. It is wheelchair accessible. There are gardens to the front and rear of the property. There is a large lounge and a kitchen dining room that leads Care Homes for Older People Page 4 of 32 Over 65 8 8 Brief description of the care home onto a conservatory. There are eight single bedrooms, none of which are ensuite. Two bedrooms are adapted to meet the needs of wheelchair users. 58 Crantock Drive is located in a small residential area next to green belt land to the north of Bristol and is close to the M4 and M5 motorways. There are no shops within close proximity of the home, which has a minibus that has been adapted with a tail lift and a side step to meet the needs of disabled people. The minimum fee charged at this home is £989.00, this is based upon the asssesed needs of individuals at the home. Care Homes for Older People Page 5 of 32 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit as part of the key inspection process. The purpose of the visit was to review and monitor the quality of the care provided to the individuals living at 58 Crantock Drive. There have been no additional visits to the service since the last key inspection that took place in January 2007. We have completed an annual review of this service in January 2008 and January 2009, these reviews did not change our opinion about the service, this was based on information gathered and received by us since our last key visit. The Commission for Social Care Inspection, now known as The Care Quality Commission have received no complaints about the service, no issues of concern were raised in surveys received by us prior to our visit, nor were any issues or complaints raised to us during our visit to the home. Care Homes for Older People Page 6 of 32 There has been no changes within the management structure at the home since the last visit. The provider has kept the Care Quality Commission informed throughout the process.The registered manager was on duty on the day of the visit. The focus of this inspection visit was on the general care of a sample group of people who use the service and the environment, including a general tour of the premises and a review of staffing records such as recruitment, selection and training. The home has been sending information in respect of regulation 37 notices of events affecting the well being of the people who use the service. The manager completed an annual quality assurance assessment in November 2009. This was well written and sufficiently detailed. In addition views were sought through surveys to health/social care professionals who visit people living at the home (2), staff who work at the home (7), (5) surveys were received from people who use the service. The inspection was conducted over 7 hours on the weekend. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? The home continue to build upon the existing good practices that are in place and work well to provide a personalised service to those who live at the home. No requirements or recommendations were made by us during our last visit to the service in January 2007. Care Homes for Older People Page 8 of 32 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 Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a full and detailed admission process at 58 Crantock Drive to ensure that the prospective needs of residents can be met. This whole process is thoughtfully and sensitively carried out. Evidence: Crantock Drive is registered with The Care Quality Commission to provide a residential care service for eight people, male or female, over the age of 55 years and over who may have a learning disability. At the time of our visit there were eight ladies residing at the home, there are no vacancies and there have not been any for some time. There is a settled group of people living at the home. Upon arrival at the home we found that the homes certificate of registration was on prominent display, along with the visitors book we found a copy of the homes Statement of Purpose. Alongside this document the home had provided a copy of the homes last key inspection report that had been undertaken in January 2007 and a Care Homes for Older People Page 11 of 32 Evidence: copy of the last annual review of the service that had been completed by us in January 2009. Significant time and effort is spent planning to make admission to the home personal and well managed. Prospective residents and their families are treated as individuals and with dignity and respect for the life-changing decisions they need to make. There is a high value placed upon on responding to individual needs for information, reassurance and support. Before agreeing admission the service also carefully considers the needs assessment for each individual prospective person and the capacity of the home to meet their needs. Prospective residents are given the opportunity to spend time in the home. An individual member of staff, known as a key worker is allocated to give them information and special attention to help them to feel comfortable in their surroundings and enable them to ask any questions about life in the home. All of those who live at the home have in place a contract to which they have agreed, this is called a licence agreement and outlines the terms and conditions of the placement. It gives clear information about fees and extra charges, this agreement is reviewed and kept up to date. This information is meaningful and is provided in an easy read format. The licence agreements are explained to individuals when they were initially completed and at each review in order that they fully understand the information. The use of advocates to support people is encouraged, the manager was aware of who to contact should this support be needed. The licence agreements in place are reviewed and amended with the person when their life and circumstances change. Care Homes for Older People Page 12 of 32 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. The home operates with a good person centred perspective for all of the people who live there. Care plans, daily records and individuals person centred records are extremely detailed and are regularly reviewed and updated to reflect the individuals currently changing needs and choices to ensure that the correct level of support is required. Individuals health is monitored and appropriate action taken. The home seeks professional advice on health care issues and acts upon it. Evidence: All care plans reviewed by us showed a clear understanding of the individual needs of those who live at Crantock Drive, they contained clear guidelines for staff. In addition to the main care plans the monthly reviews of the plan of care covered areas of identified need such as health, social needs and emotional wellbeing, these recorded individuals progress and any actions, which have been taken. Staff at the home have spent time with individuals on a one to one basis in order to Care Homes for Older People Page 13 of 32 Evidence: develop Building the Picture profiles. These profiles are well written and extremely detailed they ask the person in the home about important things about their past, about people who are important to them, they are asked about what choices they have and what future wishes and aspirations they have. As a result of these support sessions an action plan is drawn up in order to facilities areas of further development and support for the individual. These profiles provided sound information upon which individuals are empowered to make decisions and choices which affect them and their future. Me Profiles have also be developed through one to one time with individuals asking them about their preferred routines and also about areas within their life that are essential to them. The information provided within these profiles provide staff with detailed information in order to support and enable people living at the home, in the manner they prefer. Daily records, individuals Me profiles and Building the picture profiles, as well as person centred, essential lifestyle planning information were in place for the three peoples records who we reviewed. Documentation examined were found to be recorded with a high level of information and it was clear that the information had been gathered over a long period of time with the individual involved being central to the whole process. The information in place recorded the individuals preferred routines and the monthly overview provides information about individuals health and well being; these are reviewed and updated, where needed, on regular daily basis and we saw that these are completed sooner should an individuals circumstances change. Staff ensure that care is person led, personal support is flexible, consistent, and is able to meet the changing needs of those who live at Crantock Drive. Staff respect peoples preferences and have expert knowledge about individual personal needs when providing support, including intimate care. We saw that each person has an intimate care agreement in place, these recorded individuals wishes and preferences. Our observations of staff during our visit were that staff respond appropriately and sensitively in all situations involving personal care noted by us, ensuring at all times that support given was conducted in private and at a time and pace needed by the person receiving the care. Aids and equipment are provided to encourage maximum independence for people using services; these are regularly reviewed and replaced to accommodate changing needs. Specialist advice is sought by the home to ensure effective use of equipment. Care Homes for Older People Page 14 of 32 Evidence: The home fully respects the rights of people in the area of health care and medication. They recognise and work with the decisions made by the individual regarding any refusal to take medication, or any specific requests about how their healthcare is managed. Information we saw in care records and monthly care planning review notes evidenced to us that staff members are very alert to changes in mood, behaviour and general wellbeing of the people in their care and fully understand how they should respond and take action, these responses and actions are tailored to the individual needs and choices of those living at Crantock Drive. Staff are trained and competent in health care matters particularly in the care of individuals who have diagnosed health problem or require complex mental health support. We found that the home arranges training on health care topics that relate to the health care needs of the people who are supported at the home, most recently this has included bereavement awareness and self harming. The registered manager showed us the medication administration systems in place at the home. The manager was fully conversant with their role and responsibility in this area and the importance of adhering to policies and procedures that are in place for the safe administration of medication. A review during the inspection revealed no errors. The medication was appropriately stored and was well organised. All medication records were up to date and in order. All staff handling medication have attended training. We saw that the pharmacist who dispenses medication to the home completed an audit in July 2009. The audit reviewed individual patients medication, controlled drugs, homely remedies, medication storage, administration and training of staff. No concerns were identified during this audit and good systems in place were found. All of the people living at the home are registered with a local general practitioner (GP), people are supported by staff to visit the surgery if they are able, if they are not well enough the GP would visit people at the home. Care records showed evidence that people who live at the home are assisted in attending health care services such as the optician or dentist, the home has a visiting chiropodist. People are supported to access specialist healthcare services as required, such as hospital outpatients appointments, people have been recently assisted to attend appointments at the Bristol Royal Infirmary and the eye hospital. People are also supported well with their emotional and mental health. Care Homes for Older People Page 15 of 32 Evidence: In individuals medical records we saw that those who wanted them had recently had an influenza vaccination. When we reviewed individuals records we found that the home are prompt to respond to identified needs. We saw that services recently accessed by people living in the home has included; psychology, art therapy, speech and language therapy, physio and occupational therapy. Prior to our visit we received two surveys from social/health professionals who visit people at the home, within these they had written; The home provides support to service users in a person centred way that gives service users choice. The staff base remains stable and consistent, which gives service users continuity of care. Whenever I visit service users appear to be happy and participate in various activities outside and within the home environment, information is always available and staff strive to increase the quality of life for the people in their care. Another visiting professional told us; All of the service users are very well looked after, guidelines implemented had been well adhered to, management is good at liaising with professionals, there is a very caring staff group. Risk assessments were seen by us, these related to activities that those who live at the home participate in and areas of their life which may affect them. The assessments recorded the activity, the identified/avoidable/potential hazard and outlined the safe system of working to effectively manage the risk. Assessments seen by us included use of transport, use of equipment and support with aspects of personal care. Assessments had been written in accordance with the specific needs of people living at the home. Assessments are kept under review and updated when needed. Care Homes for Older People Page 16 of 32 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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. Staff plan routines and activities of the home in a way, which meets the choice, and wishes of the the individuals who live at the home with meaningful activities and trips being arranged for those who wish to participate. People who live at Crantock Drive are given the opportunity to exercise some choice and control over their daily lives. Evidence: The management and staff support those who live at the home to become part of, and participate in, the local community in accordance with assessed needs and individual plans. Staff enable integration into community life through knowledge and support to enable individuals to make use of services, facilities and activities in the local community, such as shops, pubs, bingo, garden centres, and the cinema. Information seen by us, and confirmed by staff and seen on individuals records showed that those living at the home are offered a variety of social, leisure activities. Individuals are able to participate or not, this is dependent on the individuals choice. Information seen in daily diary records evidenced that individuals regularly are supported to visits to places of local interest and local community groups. People living at the home told Care Homes for Older People Page 17 of 32 Evidence: about their recent holiday, they told us that they had enjoyed a trip to Weymouth and also told us about day trip to Weston Super Mare and that they are looking forward to visiting the Bristol Hippodrome later this month to see Snow White. The home has open visiting arrangements and those living at the home can entertain their family and friends in their own room. Staff support individuals to maintain family links and friendships inside and outside of the home and staff assisting individuals with correspondence, telephone calls and sending gifts to relatives facilitates this. One person told us about how much they enjoy visits from their relative and showed us cards they had received from them. This relationship is an important aspect of this persons life and the home works well with this person, and others at the home to remain in contact with people. We also saw tat the home have planned a mince pie and coffee morning, family and friends are all invited. Within the Annual Quality Assurance (AQAA) completed by the manager prior to our visit we asked the service what do they do to ensure that equality and diversity of people in promoted at the home and incorporated in what they do. The homes response was; We ensure that all activities are age appropriate. They also told us that any venues we plan to use are vetted for accessibility, so that Service Users are not set up to fail. Age is not seen as a barrier so our Service Users still go away on holiday, visit the cinema, the theatre during the day or evening. The home also told us that A wide range of activities are offered in group or individual arrangements and also that 1-1 rota quality time enables people to take part in activities they particularly enjoy, ie visits to the church, church drop in sessions, sing-a-longs in the community. The home has a comprehensive Care Management assessment which identifies whether the diversity of skills mix of the staff team meets the individual needs of the service users. The home told us within their completed AQAA that If service users comments or any dissatisfaction were highlighted we would endeavor to address these. The manager confirmed to us that all of those who live at the home are involved with menu planning and individuals choices and preferences are incorporated within the menu. We saw that the community dietitian has provided advice in order to provide support for people in this area. We observed those who live at the home during our visit and also saw in peoples daily diary notes that people are supported to be part of general day to day life and participate in activities of daily living, (where they able and want to) in areas such as preparing meals, drinks and snacks, baking, ironing and general light tidying around Care Homes for Older People Page 18 of 32 Evidence: the home. We saw that meetings are generally held every month with the people who live at the home, the most recent meeting took place in October. The home produces a pictorial agenda in order to support those who may have difficulty in reading. Areas of discussion have included: key working role of staff, staff support, how to make a complaint, discussion about the homes decor, people are asked what they would like to do and how they can be supported to do this. We saw that individuals responses and involvement at the meetings, be these verbal or in the form of body language were recorded with action plans agreed. Prior to our visit we received six completed surveys from people who live at the home, these indicated high levels of satisfaction, people said that the staff and manager treat them well, that staff act upon what they say and they knew what to do if they were unhappy. Additional comments made by residents included; I like the staff, they give me nice food, they help me choose nice holidays. Another person said; The home provides me with everything I want. Care Homes for Older People Page 19 of 32 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints procedure that meets national minimum standards and regulations, the procedure is available with in the home. Evidence: The complaints policy and procedure shows a clear timeline and action to be taken in event of a complaint. It also directs the complainant to senior management within the organisation and South Gloucestershire Social Services. A copy is on display in the entrance hall of the home, along with copies of previous inspection reports. The Commission has received no complaints since the last inspection. All of the comment cards received from people who live at the home prior to the site visit recorded that they all knew who to speak with if they wanted to make a complaint; Individuals said they would speak with the manager, staff or a family member. No concerns were raised to us during this site visit. The homes policy and procedures for safeguarding adults from abuse is readily available to staff. The manager of the home has undertaken training which qualifies her as a vulnerable adults alerter trainer. The manager was able to tell us about the responsibilities of this role. All staff at the home have received training in the safeguarding of vulnerable adults, this was refresher training and this was provided by the Trust in October 2009. Staff are able to describe the types of abuse and what Care Homes for Older People Page 20 of 32 Evidence: steps they should take if they had concerns. Recruitment practices carried out in the home protect people who live at the home from abuse, criminal records bureau and protection of vulnerable adults checks are carried out, and two written references are obtained before staff commence employment. Inventories are in place for all individuals who live at the home, these record items of value to the residents and provides a clear audit of their valued possessions. Care Homes for Older People Page 21 of 32 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, 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. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The quality of furnishings and fittings in the home is good and overall a warm comfortable environment has been created ensuring individuals needs are met. Evidence: 58 Crantock Drive is is a warm and welcoming home, the house is a mature detached bungalow, which has been modernised and extended. Since our last visit to the service the home has benefited from an extension, this has provided a sleep in area for staff on night duty, which in turn has created an office space. The home is located within the pleasant, semi rural area of Almondsbury. It is wheelchair accessible. There are gardens to the front and rear of the house; these were seen to be well tended. The home is able to accommodate eight people, all of the people who live at the home are female; there are currently no vacancies at the home. The kitchen was seen to be clean and tidy and well organised, the home is to be commended for obtaining five stars in a food hygiene award issued by south Gloucestershire Council in 2008. Good laundry facilities are provided and peoples clothes were seen to well laundered and in good condition. Care Homes for Older People Page 22 of 32 Evidence: All rooms at the home are single occupancy, we viewed some individuals rooms, and all were seen to contain appropriate furniture, carpets and lighting. People had personalised their own room with family photographs, pictures and nick knacks. The home is well maintained and has a homely feel, there is a pleasant dining room and a comfortable lounge residents use, there is also a conservatory adjoining the dining room. People living at the home were seen to be relaxing in these areas and referred to Crantock Drive as my home. The home shows a good standard of housekeeping and no offensive odours are apparent. Care Homes for Older People Page 23 of 32 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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. The home had sufficient staff on duty and staff are qualified to provide good level of care. People who live in the home appear to have confidence in the staff that care for them. All staff are clear regarding their role in what is expected of them. Recruitment practices safeguard the people who live in the home. Evidence: Staff induction is in line with the requirements of the learning disabilities qualification and is also tailored to the needs of those who live at the home, as well as the support needed for the newly appointed member of staff. The manager of the service, Paula Ralph and Aspects and Milestones Trust ensures that all staff within its organisation receives relevant training that is targeted and focused on improving outcomes for those who live at the home. External providers, such as the community learning difficulties team have delivered specialist training, this training was individualised in order to focus on the specific support needs for one of the individuals living at the home who exhibits some complex behaviours. This is to promote the delivery of a person centred service and to also ensure that staff are equip to meet the specialised needs of the people in their care. Care Homes for Older People Page 24 of 32 Evidence: One of the staff told us about the training they had undertaken recently, this was all refresher training in areas such as first aid, basic food hygiene and manual handling. This staff member enjoyed the training and told us that they found it informative and interesting and would be able to transfer the information given within their day to day practice. The manager informed us that future training planned includes sensory deprivation and dementia awareness, these these training course would provide staff with additional skills and knowledge in order to support those living at the home. There are eight staff members at the home who have obtained a National Vocational Qualification (NVQ) at level 2 or above in health and social care, the achievement of this award is well promoted at the home. Staff feedback that we received from surveys returned to us prior to our visit indicated high levels of satisfaction about the manager and about the service that is provided at the home. Seven surveys were received by us. Comments made by staff included:Crantock Drive is a very organised and efficient home.The staff take into account the different needs of the ladies and cater for these on a daily basis. All staff are always kept up to date, we hold monthly house meetings for staff and residents, any issues which arise from these are discussed further to find a suitable outcome. Another member of staff told us; We meet the individual needs of the ladies well, there are lots of holidays, nights out, social events. We give the ladies choices about how to live their life. Staff are well trained and supported by our manager. The recruitment and selection documents for some staff were reviewed at this inspection; staff files evidenced that full and robust practices are adhered to at the home to ensure that those appointed have the qualities and skills to work within this care environment. Appropriate adult protection checks are taken to ensure the protection and safety for those who live at the home. Staff house meetings are held regularly at the home, the most recently held staff meeting was held in November. At this meeting we saw that all individuals living at the home were discussed in depth, their health, welfare, and wellbeing were reviewed and evaluation and action plans for support were reviewed and agreed. Staff also discuss current good practice guidance and evaluate the effectiveness of training undertaken and how this has influence their practice, evidencing a forward thinking proactive, rather than reactive approach. Care Homes for Older People Page 25 of 32 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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 registered manager has the required qualification and experience, is highly competent to run the home and meets its stated aims and objectives Evidence: Mrs Paula Ralph is the registered manager of this service, she has worked at 58 Crantock Drive since 1996 and prior to this position she has worked in the care field for most of her professional career. Mrs Ralph is an asset to the Trust and is a qualified trainer in areas such as medication competency, epilepsy awareness and training in safeguarding vulnerable people she delivers these training sessions to other members of staff employed with the organisation. Mrs Ralph is NVQ level 4 qualified and achieved her registered managers award some time ago and is an assessor and verifier for these processes. Mrs Ralph has maintained her professional practice and since the last inspection has completed Care Homes for Older People Page 26 of 32 Evidence: additional training understanding bereavement, self harming , fire safety, and has undertaken update training in manual handling and NVQ practices. Mrs Ralph has sound knowledge of the Trusts strategic and financial planning systems and how the operational or business plan for the home fits with these, without compromising the services delivered to those who live at the home. Working within the business systems in place within the organisation Mrs Ralph demonstrates effective financial planning and budgetary control skill and the home provides value for money. Mrs Ralph was able to describe a clear vision of the home based on the Trusts values and corporate priorities. Mrs Ralph communicates a clear sense of direction, is able to evidence a sound understanding and application of best practice operational systems, particularly in relation to continuous improvement, satisfaction for those who live at 58 Crantock Drive, and quality assurance. In a survey completed by a member of staff prior to our visiting the home they had written about the manager; Our manager is very hands on, and is very involved with all aspects involving the ladies. She is very aware of the needs of the residents and the staff and this is reflected within the positive atmosphere within the home. The home has a number of effective quality assurance and quality monitoring systems based on seeking the views of residents that are in place. These measure success in achieving the aims, objectives and statement of purpose of the home. On an annual basis a formal evaluation of the service is undertaken at the home, this is in the form of surveys. Those living at the home are asked about the service that they receive, they are also asked if they are happy with the support they receive from the manager and staff, they are asked if they know who to speak with if they were not happy. The most recent audit was undertaken at the home in April 2009, high levels of satisfaction were recorded from people who live at the home. Within the AQAA completed by the registered manager prior to our visit, within the section of the report where the service is able to tell us what they do well they had reported; From the audit we feel that we provide a committed and quality drive service which is led by a resourceful and motivated manager. The needs and wishes of the service users are paramount in all aspects of their lives and staff are enabled to develop and maintain fulfilling relationships with the service users which promote their independence, dignity and respect. Care Homes for Older People Page 27 of 32 Evidence: Within the section of the AQAA of what we could do better, and how we are going to do this, the service had reported to us; We will continue to build upon the team / service user relationships which currently exist and seek to further the overall quality and value for money of the service we provide. Staff are well supported by the management of the home with sound systems in place to support and guide staff practice in order to ensure that all staff are providing a good quality service to those who live at Crantock Drive, these include staff team meetings, supervision sessions and overall review of staff performances. The atmosphere at the home at the time of our visit was calm and relaxed with individuals looking clearly at ease and at home. There was evidence that the home ensures so far as is reasonably practicable. the health and safety of those who live and work at Crantock Drive. The home has robust policies and procedures in relation to aspects of health and safety. The fire logbook was viewed and was well maintained. The home was completing the appropriate checks on the fire equipments and recording of training and testing of equipments were satisfactory. Staff have attended fire drills and training in order to ensure that they have clear knowledge of action to be taken in the event of fire emergency. The home displays a current certificate of Employers Liability Insurance. The home has in place clear policies and procedures in areas of staff employment, residents finances and health and safety, all of which are reviewed and updated. This guidance provides clear information to staff to inform and guide their practice. Staff supervision was reviewed. Evidence from the records viewed showed that staff have received supervision and that this occurs at the required intervals. This provides the opportunity to express their opinion about the services provided at the home and to discuss areas of concern in relation to the service provided for those who live at the home. This support was valuable to staff in order to ensure clarity of their role and the expectations upon them, furthermore it ensures effective communication and Care Homes for Older People Page 28 of 32 Evidence: continuity and consistency of service provided to residents. All records seen at this inspection were appropriately and safely stored. Access was appropriately restricted. Care Homes for Older People Page 29 of 32 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 Older People Page 30 of 32 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 1 35 Copies of the Power of Attorney documents should be obtained, this will provide information of what this means for the individuals concerned. These documents should be obtained and retained, this will show what the responsibilities of this role are. Care Homes for Older People Page 31 of 32 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). 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. 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