Care Home: 6 Southbank Close

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What the care home does well The home would carefully make sure that staff know all about and could meet the needs of possible new customers before they start using the service. Each customer has a plan showing their care needs, likes and dislikes. Plans help staff to know the care that people need and want so they can give them the right support. Customers can take part in activities they like and go out in the community. Staff help customers keep in contact with their families and make them welcome in the home. Customers receive good support with their personal care. Staff also make sure that they have regular health care checks and manage their medicines safely for them. The home is in a good place near shops and other facilities in Hereford. It is an ordinary bungalow with ramps, aids and equipment to help people move around better. Staff are well trained, which helps them keep people safe and understand customers` needs. The staff team work well together so customers get good, consistent support. What has improved since the last inspection? This is the first inspection of this home since it was registered and run by Midland Heart and so this does not apply. What the care home could do better: When customers` plans are "person centred" and focus on their personal goals and support they need to achieve them they should benefit from more individual lifestyles. Customers` protection would be better ensured if more information about new staff is obtained to confirm that they would be suitable to work caring for vulnerable adults. Midland Heart must visit to check how the home is being run and make a written report about what they find every month. This would help them make sure that the home is being managed properly and that customers are getting a good quality service. Plans to develop the service should show how this will be done and be based on how customers and other people involved with the home would like it to improve. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 6 Southbank Close 6 South Bank Close Hereford Herefordshire HR1 1LZ     The quality rating for this care home is:   two star good 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: Christina Lavelle     Date: 1 1 0 3 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. 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. 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. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI 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 29 Information about the care home Name of care home: Address: 6 Southbank Close 6 South Bank Close Hereford Herefordshire HR1 1LZ 01432268258 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Midland Heart Limited Name of registered manager (if applicable) Mr Leon Davies Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 5. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disability (LD) 5 Date of last inspection Brief description of the care home This home at 6 Southbank Close was registered in respect of Midland Heart Limited in September 2008. Midland Heart is a well established national provider of services for people with learning disabilities. The home was previously part of a larger care home that comprised of three adjoined bungalows run by Herefordshire Council. The home was originally set up (and the property is still owned) by the Primary Care Trust who lease it out. It can provide accommodation with personal care for five adults with learning disabilities. People use this service for respite support and so they normally live with their family or carers in the community. Most people have regular stays Care Homes for Adults (18-65 years) Page 4 of 29 care home 5 Over 65 0 5 Brief description of the care home arranged, although places can be available to offer support in an emergency situation. Southbank Close is located in a residential area of Hereford. It is within a short walking distance of the shops and other facilities in the city. The bungalow is in a cul-de-sac and is campus style with a central parking area. There is a separate building opposite, which has offices and meeting rooms. The home has its own gardens at the front and back. All the bedrooms are single and have wash hand basins but no en-suite facilties. There is a sitting room, open dining area, kitchen, utility and bathrooms for everyone to use. Ramps, rails and other adapatations and aids are provided for people with mobility difficulties, who may be wheelchair users, for access to the bungalow and garden. Information about the service is available in a statement of purpose and a customers handbook. The weekly fee is based on the assessed needs of individuals using the service and funding is through Herefordshire Social Services. Each customer should have a terms and conditions of residence (contract) specifying their support needs, the service they receive, the cost and any additional charges. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This is the first key inspection of 6 Southbank Close since Midland Heart was registered as provider of the service in September 2008. This means all the standards that can be most important to people using care services are assessed. As part of the inspection we, the commission, visited the home for more than two hours without telling staff or people using the service beforehand. Midland Heart call people who use their services customers and it was agreed that they would be referred to as such in this report. A range of evidence is used to make judgements about the quality of the service. This includes discussing the way the home is being run and plans to develop the service with the manager. It is difficult to ask customers dierctly about their care and lifestyle because of their communication and so time was spent in their company. Support staff Care Homes for Adults (18-65 years) Page 6 of 29 on duty discussed their role and customers support and seven staff had completed surveys asking for their views. Their feedback is mentioned in our report. Some records about customers care, staff and health and safety were checked. We also visited most areas of the home. An annual quality assurance assessment (AQAA) was completed before our visit, as required. The AQAA asks managers to say what their home does well, could do better and about their plans to improve the service. It also has numerical information about customers, staff and other aspects of the service. All other information we received about the home is considered. This includes events that affected the welfare and safety of customers (these are called notifications) What the care home does well: What has improved since the last inspection? 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 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 8 of 29 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 9 of 29 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 customers can be confident the home could meet their needs. This is because a full assessment would be made of their needs and wishes with them, their family and representatives involved before they are offered a service. Evidence: No one new has taken up the service offered by 6 Southbank Close since Midland Heart was registered and for a while before. The services business plan and statement of purpose describe how referrals will come through Herefordshire local authoritys community learning disabilities team. A community care assessment would be completed by a social worker and the homes manager then visits potential customers at their current residence to carry out their own need and risks assessments. This assessment visit would be followed by introductory visits arranged to the home and their family and or other people involved with their care. This could include for a meal, overnight and weekend stays to see how they like it and to check their compatibility with existing customers. Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: A trial stay would be arranged next, with an initial care plan set up that shows the support people need, to make sure that staff could meet their needs. The trial stay to be followed by a review with all parties involved to make a decision about the suitability of the placement and agree a contract. The manager understands the assessment and admission procedures and confirms that the home will follow them. Care Homes for Adults (18-65 years) Page 11 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each customer has a care plan outlining their needs and the level of support staff should give them. Whilst plans include peoples likes and dislikes they could better reflect their personal goals and promote their choices and life skills more. Possible risks to customers safety are assessed so that they can be minimised. Evidence: Customers of this service use the home for respite support but plans sampled were those of people who normally live at 10 Southbank Close. However both managers confirm that a more person centred way of care planning needs to be implemented. The home recognises that people should be involved in planning their own care and make choices about their daily lives and routines. Whilst staff have a person centred approach to care it is good therefore that a more person centred care planning format is to be introduced. The new plans should help to identify customers personal goals and how they can be supported to achieve them and develop their life skills. Plans also Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: need to be user friendly so that customers can understand them more easily. Their families and advocates should also be involved in setting up and reviewing plans. Plans seen are based on needs assessments that were completed some time ago. The manager acknowledges that they need to be reviewed and updated and that customers should be supported to express their preferences, make choices and increase their life skills more. Staff have received training on equality and diversity and also need to promote this and reflect it in individuals plans and care planning. Currently the daily shift records completed by staff about customers moods, behaviours and activities and events in their life are used as their working tool, which care plans should also be. Support workers are allocated to particular customers as their keyworker. Staff are clear about their keyworker role to personalise support and advocate for these people. The home tries to provide some one to one time for keyworkers and they will become more involved in care planning. Currently keyworkers are expected to complete monthly care summaries, which should include progress to meet goals and achievements. Risk assessments have been completed for every customer. They primarily identify hazards and how people can be kept safe when doing such as bathing and going out. There are also individual behaviour management plans showing behaviours that can be challenging with warning signs and describing how staff should respond and use methods such as diversion to manage them consistently. A psycholgist was involved in setting up one persons management plan. Any incidents are appropriately recorded. Care Homes for Adults (18-65 years) Page 13 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Customers take part in activities they enjoy and go out in the wider community. They will benefit from having more individual support and being enabled to follow their personal interests and develop their life and social skills. Customers are supported to maintain links with their families and the home provides healthy meals that they like. Evidence: The staff team understand that customers should be supported to participate in a variety of activities in the home and out in the community and develop their life and social skills. Whilst it is difficult for some people to take up work placements and educational opportunities it is good that one more able customer has been supported with a work placement and is actively involved in household tasks and cooking. Some customers attend a local day service and their other activities include swimming, Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: using sensory facilities, horse riding and music therapy. The manager says staff aim to give customers an opportunity to go out every day and the AQAA that they plan to seek more social, community based activities and enable more flexible daily routines. Each customers plan includes brief information about their leisure interests. A weekly chart is completed by staff showing what activities they have been doing and if they enjoyed them. Whilst acknowledging that it can be difficult for people with complex needs to follow regular activity schedules their plans could better reflect how their personal interests are being met. Plans should show how the home enables individuals to take part in meaningful activities they like, which help them achieve their identified goals and develop life skills, as part of person centre planning. The home supports customers to maintain links with their relatives. Keyworkers send cards and make calls on their behalf and families are kept updated about important things that happen such as health problems. Social events are arranged when families, friends and peers are invited to the home and efforts are being made to involve families and other involved people more in care planning and reviews. Regarding food provided by the home the AQAA states that customers have a balanced, varied and healthy diet. They are planning to offer a more diverse menu and be more flexible in respect of meal time routines. The menus we looked at show a good range of nutritious meals with meat, fish, rice and pasta dishes. There is always a choice of two main meals, which include fresh vegetables. Breakfast and snack meals are chosen flexibly. Food stocks included fresh vegetables and fruit, a range of cereals and wholemeal bread. Customers plans detail any special dietary needs and the assistance, oversight and any aids that individuals use at meal times. Care Homes for Adults (18-65 years) Page 15 of 29 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. Customers receive the personal support they need and their health care needs are met. Their medicines are also managed safely in the home by staff on their behalf. Evidence: Plans include customers personal and health care needs and their prescribed medications. The AQAA states that the home ensures that the dietary and physical support of service users promotes their well being and that they aim to promote positive, healthy lifestyle choices. Each person has a health action plan, which should provide a comprehensive overview of their medical condition, emotional and health related issues and ensure that any changes are monitored and dealt with. Plans show that most customers need full support from staff in respect of their personal care. Daily checklists are completed by staff indicating the aspects of care they have given each person. We observed customers to be appropriately clothed and well presented and that staff offered personal assistance in a caring, respectful way. Customers particular needs in respect of such as maintaining continence and their Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: mobility are specified in their plans. The home is a bungalow that was purpose built and so has wide doors, ramps and adaptations. Customers also have any aids and equipment they need to enable them to move around easier. Staff have had training on moving and handling and how to use hoists so they can support them to mobilise safely. Records are kept of routine and specialist health input each customer receives. Staff arrange and suppoprt them to attend appointments. Daily records are also used to monitor health care issues as they arise and to ensure that medical advice and input is sought. Whenever necessary staff carry out physical checks and keep records about such as customers weight and food intake. Special needs are highlighted including behaviours that can be challenging and staff have received training on how to identify signs and use techniques to manage aggressive or challenging behaviours. Regarding customers prescribed medication the home has appropriate policies and procedures in place that staff understand and follow. There is suitably secure storage space available. Medication records required to be kept are maintained appropriately by staff and a community pharmacist regularly checks that the homes system is run properly. Staff are only designated to administer customers medication when they have completed formal training on safe handling of medicines. Regular checks are carried out by the home, with records kept, which ensure there is an audit trail so that all medicines that have been administered and are in stock can be accounted for. Care Homes for Adults (18-65 years) Page 17 of 29 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. If people have concerns about the service they know how to complain and can be confident they would be listened to and action taken to deal with them. There are systems in place to safeguard customers and follow up any allegations made. Evidence: Midland Heart provides a comprehensive complaints procedure, which is given out and will be included in the customers guide. It is planned to also make this procedure available in a more user friendly format. If concerns are raised about the service there is a log to record them with details of any action taken and outcomes. No complaints have been made to us or the home since Midland Heart took over the service. The AQAA states that the home supports whistle blowers and has an open door policy. Staff confirm that they would know what to do if anyone raises concerns with them. All staff receive instruction about how to recognise signs of abuse or neglect and their responsibility to ensure and promote the safety and welfare of customers. Keyworkers understand they should also help them to express their views and advocate on their behalf. The manager and staff have received training on safeguarding vulnerable adults. They also know about local multi-agency safeguarding procedures and how to report incidence or suspicion of abuse or neglect to external agencies if necessary. Care Homes for Adults (18-65 years) Page 18 of 29 Care Homes for Adults (18-65 years) Page 19 of 29 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 stay at 6 Southbank Close have accommodation that suitably meets their needs and is comfortable, safe and kept clean. The planned improvements will make the environment more homely, better furnished and equipped for customers benefit. Evidence: 6 Southbank Close is owned by the Primary Care Trust, which leases out the property. The home is in a convenient location within walking distance of Hereford city. The bungalow is in a quiet cul-de-sac and fits in with the local community. There are ramps and rails around the building and garden and other aids and adaptations are provided to meet the needs of people with mobility difficulties who may be wheelchair users. The sitting room is comfortable and efforts have been made to make it more homely. Bedrooms are not personalised to any extent because customers are usually having respite care and currently they are people who live in another care home in Southbank Close. The dining room is less homely being an open plan thoroughfare and bathrooms look rather bare and clinical. It is good therefore that the bungalow is soon to be upgraded. This will include new flooring, furnishings and fittings, bathrooms improved and dining area enclosed. This work will be done when people have moved back to bungalow 10 and before the respite service recommences and the AQAA says that the Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: opinions of customers and their families will be sought. All areas we visited were well maintained, clean, tidy and fresh. It is apparent, and the AQAA confirms, that staff follow required health and safety procedures and maintain good hygiene so promoting infection control. Disposable gloves and aprons are also provided for staff and paper towels, liquid soap and alcohol gel are available. Laundry facilities are suitable and soiled waste is disposed of appropriately. Staff receive necessary instruction on infection control and food hygiene. Care Homes for Adults (18-65 years) Page 21 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Customers personal and health care needs are met by sufficient, qualified staff who receive appropriate training and support. Although necessary checks are carried out to help to make sure that new staff are suitable to care for vulnerable people customers would be better protected if aspects of staff recruitment are improved. Evidence: This home now has its own core staff team and although the AQAA states there had been staffing issues this has stabilised. New staff are being recruited and all staff have received an induction to Midland Heart and are receiving better training and support. There are still several vacancies (including the senior support worker post) but the home no longer needs to deploy agency staff, which is good for care consistency. Rotas are being planned more flexibly around customers needs and activities and the manager plans to arrange more time for keyworkers to spend with individuals. Regarding recruitment staff surveys confirm they all had checks taken up, including a police check (CRB) and two written references, before starting work at the home. Most aspects of Midland Hearts recruitment and selection processes appear satisfactory, other than their application form does not request a full employment history with any gaps explained and one reference can be personal, which may not be creditable. Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: The whole staff team completed a full day induction when Midland Heart took over the service and were also expected to read and sign up to all their policies and procedures. For new staff there is a six week induction programme that includes training in all mandatory health and safety training topics, adult protection, equality and diversity. All new staff also complete an accredited learning disabilities qualification (LDQ). Staff then move onto do a National Vocational Qualification (NVQ) and most staff have achieved an NVQ. It is also good that the manager plans to provide more in house training and seek opportunities for training specific to learning disabilities. The home now has its own training co-ordinator as well as trainers in techniques for management of behaviours that may be challenging. Staff confirm that they have received training relevant to their role and there is an ongoing training programme. The AQAA and staff say there is good communication within the team, regular team meetings are held and they have individual supervision. Midland Heart provide a written format for supervision, which should make sure that staff work performance is monitored. Each staff member has a learning and development plan showing their training needs and how they will be met. The home also has a staff team training profile and plans to arrange staff forums to improve team work. Staff comments in their surveys include that we have good handovers and my manager will always be available on request. He will listen and give his view of a situation but will inevitably give me autonomy to use my own judgement. Care Homes for Adults (18-65 years) Page 23 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident customers receive good quality care because the home is run appropriately. Practice is developing to individualise support, however the conduct of the home must be monitored formally by the provider and plans made showing how the service will improve based on what customers and their representatives want. The home environment is kept safe because staff follow health and safety procedures. Evidence: The manager Leon Davies was previously senior support worker in this bungalow for many years when it was part of the larger care home. Mr Davies is currently working on achieving the Registered Managers Award and NVQ level 4, which are the qualifications care managers are expected to have. He has completed other relevant health and safety, care practice and staff related training such as recruitment and absence management and has identified other training that would be of benefit. Since taking up the managers post Mr Davies has not received formal, individual supervision as expected. This was included in Midland Hearts business plan that was agreed when the service was registered and we have written to them about this. Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: Mr Davies is clear about the managers role and responsibilities and the management ethos and approach appears to be open and transparent. It is evident that there is commitment to the key aims of the service and one main objective is the development of a more personalised service and individualised support. Midland Heart provide the full range of policies and procedures for staff to follow to promote good practices. The AQAA contains clear and relevant information with some evidence about how what the service does well results in good outcomes for customers. The manager has identified areas that are in need of improvement including person centred planning; reviewing care plans and risk assessments; reviewing activities and promoting life skills, choices and social opportunities; reviewing menus; refurbishment of the home; more staff training and arranging staff forums to promore team work. It is also good that another plan is to involve customers and their representatives in service development and obtain their feedback through questionnaires and meetings. These plans and peoples views should be included in an annual development plan for the home showing how they are going to do them. This also needs to be part of a formal quality monitoring and assurance system that includes regular audits of aspects of the service to make sure they are working properly. Service providers are required to make monthly visits to their care services to check them out and also to interview people and then to write a report on their conduct. Whilst there has been some management input these visits and reports have not been made and the commission has written to Midland Heart about this. Regarding health and safety staff receive training in all the manadatory topics. There are also relevant policies and procedures in place that staff follow. The AQAA confirms that necessary checks on the fire safety and watre systmes are carried out and the electrical, gas and heating are serviced and or maintained regularly. Risk assessments have been completed and there were no safety hazards identified during our visit. Care Homes for Adults (18-65 years) Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 29 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 1 34 19 Recruitment procedures 31/05/2009 must include new staff only being confirmed in post when the home has obtained their full employment history, with any gaps explained in writing. This is to help to ensure that the homes customers are protected from unsuitable staff providing their support. 2 39 26 The provider must arrange for this care home to be visited by their representative at least monthly to inspect the service, interview people and write a report on the conduct of the home. This is to ensure that the home is being run properly; it is achieving its aims and provides a good quality service for customers. 31/05/2009 Care Homes for Adults (18-65 years) Page 27 of 29 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 6 The home should progress with their plan to implement more person centred care planning. This means there would be more focus on identifying customers individual needs and personal goals and the support needed to meet and or achieve them. There should be an annual development plan for the home that shows how the service needs to improve and how this will be done. This plan to be based on the views of customers and other stakeholders to ensure the service improves as they want and or for customers benefit. 2 39 Care Homes for Adults (18-65 years) Page 28 of 29 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). 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