Care Home: 76-78 Hampstead Road

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What the care home does well The way staff engage with people at the home was observed during the inspection. In house 11 staff were seen engaging with people on a group and individuals basis, people were observed going out on outings with staff, joining staff in the kitchen, bedrooms and in the lounge. People in house 11 were alert and engaged with their surroundings and powerfull emotions expressed were acknowledged by the staff. In house 1 the staff were also seen spending 1:1 time with individuals either on trips out or in the kitchen while the staff were cooking and baking. Staff were seen using their specific knowledge of the person to acknowledge emotions expressed. What has improved since the last inspection? The staff told us that since the last inspection, the changes have been vast, they are better informed about the organisations, equipment is provided and there are no strict restrictions on the food budget. It was also stated that people at the home benefit from continuity because they have the same staff, while others felt there was more accountability. While the rating for this home has not changed, there have been great strides in improving the quality of the care provided. Aids and equipments have been provided to ensure individuals comfort and dignity is respected whenever moving and handling techniques are used. More activities are taking place and the staff recognise that the range of activities and variety need to improve. There are systems in place such as handovers when shift changes occur, individual supervision and staff meetings to maintain consistency at the home. What the care home could do better: There are three requirements made through this visit and relate to care planning, outstanding from the last inspection and two requirements arising from this inspection. The care planning process must be develop to adopt a personalised approach to meeting needs. Care plans must include the staff`s specific knowledge about the way people like their care to be delivered, the way people communicate including the use of assistive technology. Risk assessments for people with mobility needs must be formulated to ensure that safe systems of moving and handling are used. Where medical procedures are used, risk assessments must be developed to assess staff`s training needs and appropriateness of undertaking such procedures. Medication systems must be made safer, members of staff must sign medication records immediately after administration. Protocols must be devised for medications that are administered `when required,` this will ensure that safe systems of administration are in place Key inspection report Care homes for adults (18-65 years) Name: Address: 76-78 Hampstead Road 76-78 Hampstead Road 76-78 Hampstead Road Brislington Bristol BS4 3HN     The quality rating for this care home is:   one star adequate 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: Sandra Jones     Date: 2 5 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: 76-78 Hampstead Road 76-78 Hampstead Road 76-78 Hampstead Road Brislington Bristol BS4 3HN 01179728513 01179699000 judi.lorentz@brandontrust.org www.brandontrust.org The Brandon Trust Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Stuart Robbins Type of registration: Number of places registered: care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users who can be accommodated is 12. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Learning disability- Code LD Physical disability- Code PD Date of last inspection Brief description of the care home The Brandon Trust operates 76/78 Hampstead Road and their philosophy is supporting and enabling people to live the lives they choose. The care home is registered to provide accommodation and personal care to twelve younger adults with learning and/or physical disabilities. The property was purpose built to accommodate people with physical impairments. As the property is purpose built to accommodate people Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 0 12 12 2 7 1 1 2 0 0 8 Brief description of the care home with physical impairments, there is level access and wide corridors. It blends well with its local residential environment and close to shops, park and bus routes. There are three staff rostered in each house throughout the day, with ancillary staff to maintain the home clean. At night there are two staff awake and one sleeping-in. Care Homes for Adults (18-65 years) Page 5 of 31 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: one star adequate 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 key inspection was conducted unannounced in over two days in November 2009 and focused on the assessment of key standards. The main purpose of the visit was to check on the welfare of the people who use the service, ensure the premises are well maintained and to examine health and safety procedures. During the site visit, the records were examined and feedback was sought from staff. Prior to the visit some time was spent examining documentation accumulated since the previous inspection and this information was used to plan the inspection visit. The Annual Quality Assurance Assessment (AQAA) was sent to the home and the manager failed to return the AQAA within the timescale given. There are twelve individuals currently living at the home and four people were case tracked. Case tracking is the method used to assess whether people who use services receive good quality care that meets their individual needs. The inspection included Care Homes for Adults (18-65 years) Page 6 of 31 looking at records such as care plans and reviews of the care of people using the service and other related documents. The homes policies and procedures were also used to confirm the findings Care Homes for Adults (18-65 years) Page 7 of 31 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 on page 4. Care Homes for Adults (18-65 years) Page 8 of 31 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information provided through the Statement of Purpose and not fully accurate. The admission process ensures that the needs of the people wishing to live at the home can be met by the skills of the staff. Evidence: The Statement of Purpose in place was recently reviewed by the manager. However, it must be updated to include the Visitors policy and Privacy and Dignity policy. Also, the format is not suitable for the people at the home and its unlikely that it could be understood by the people at the home. Within the Statement of Purpose, the Admission policy is included and confirms that admissions to the home are based on full assessments. Introductory visits and trial periods are offered to ensure that the staff at the home are able to meet the persons needs. At present there is full occupancy. Care Homes for Adults (18-65 years) Page 11 of 31 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. A personalisation approach to meeting needs must be introduced and support plans must be essential to meeting needs. Risk assessments must be undertaken for activities that involve an element of risks so that people can take risks safely. There are opportunities for people to make choices. Evidence: Support plans in place describe the need and the way the identified need is to be met. Four people at the home were case tracked to establish the care planning process followed at the home. However, support plans viewed were found to be generic in that the same information was found repeated for other people. It is evident from the documentation held that review meetings conveyed by the social worker took place for three of the four people case tracked. There is clear evidence that support plans are developed where changing needs are identified. The specific knowledge of the person known by the staff was not evident through the action plans. The knowledge of the person must be used to develop action plans in order to deliver Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: care in a way that preferred by the person. Comments about the care planning process was sought from the manager and staff at the home. The manager said that a more personalised approach that is accessible will be introduced. Senior support worker explained that the Trust are launching new support plan format and these will be used to develop a more personalised approach to meeting needs. A recently updated support plan for people with dementia was examined and confirms the managers comments that a more person centred approach to meeting needs will be introduced. Restrictions are in place to prevent people from going upstairs, accessing all parts of the kitchen and not having keys to the home. Bed sides are used for the people at the home and monitors for people with epilepsy. The first floor of the is used solely for staff sleeping accommodation and staff meetings and access to these areas are not necessary for people at the home. A risk assessment to restrict people from accessing the first floor is in place and shows that the restriction enables people to move around the home independently of the staff. For people at risk of Sudden Unexplained Death in Epilepsy (SUDEP), best interest decision are made to use monitors at night to ensure that staff can assist people that may have epileptic seizures. Risk assessments are completed for activities that may involve an element of risk and listed is the nature of the Rik, contributory factors along with an action plan to reduce the level of risk. Risk assessments in place include falling out of bed, using bathing facilities eating and drinking. However, risk assessments are not in place for restricting access into all parts of the kitchen and form medical procedures. Risk assessments must be completed for any activity that may involve an element of risk to show consideration has been given to reducing the levels of risk presented to the person. Staff training records show that eleven staff attended Mental Capacity Act training and we were told that Best Interest meetings are convened where people are unable to make decisions about their future. The people at the home have communication needs and profiles that describe the behaviour exhibitied with the meaning and the response necessary are in place. However, the information is not used to develop person centred support plans including assistive technology used. Senior support workers explained that people at the home are given opportunities to make choices. This is done from specific Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: knowledge of the person, by giving the person an opportunity to lead and physical choices. Daily reports are used by the staff to record observations of the person, personal care undertaken, meals and refreshments and activities undertaken by the staff. Care Homes for Adults (18-65 years) Page 14 of 31 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. People at the home are better connected with the community and participate in leisure activities. There are adequate stocks of food at the home and people have a varied diet served. Evidence: The rota of activities shows that 1:1 time with a member of staff is scheduled at least weekly, shopping trips, walks, hydrotherapy and aromatherapy is arranged, with snoozelum time, films and DVDs taking in-house. External day care is organised for four people and one person attends a day care centre daily. Where needs assessments were reviewed by the social worker, activities form part of the social workers review care plan. Support plans examined are generic as each person has the same opportunities, for example, snoozelum, aromatherapy, group activity and holidays. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: Feedback from staff was sought about opportunities for leisure activities. Senior support staff said that in future the variety, frequency and quality of activities will be monitored. This will ensure that the people experience varied and meaningful activities. Support workers were consulted about changes that have taken place since the last inspection. We were told that everything has changed, people have more contact with the community, in-house activities are improving and holidays were arranged for the people at the home. Support workers were also asked about the way they engage with people at the home and they said that in the afternoons there are more opportunities for them to sit in the lounge with people. Two people prefer to stay in their bedrooms and staff said that they use meal times and when putting clothes away to engage with these individuals. People at the home visit local shops, restaurants, places of special interest and more recently individuals went to the carnival and will accepting invitations to Christmas parties. A musician known as the music man visits every two weeks to play music to individuals that like listening to music. At present these individuals pay £5.00 per session which raises concern about those individuals that havent got funds for the activity or lack capacity to make decisions about the cost. The manager must consider the appropriateness of making people pay for entertainment, particularly when social workers care plan specify that the home must provide in-house activities. The arrangements for visiting the home are not currently included in the Statement of Purpose. The manager said that visiting is open and flexible and will be including these arrangements in the Statement of Purpose. The way the people are respected as individuals was discussed with the manager. It was stated that the home and bedrooms have the appearance of someone home and its a given that staff knock on doors before entering bedrooms and provide personal care in a discreet manner. Personal items reflect the individuals taste which the staff have worked hard to establish and associated personal care tasks are conducted in the presence of the person, for example tidying bedrooms. Equipment and aids were purchased to ensure care is provided in a dignified way. It is a concern that Privacy and Dignity policies that is based on the way people can expect to have their care provided are not available. These policies would set the approach and would confirm to people wishing to live at the home that their rights will be respected. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: The staff on duty were consulted about the improvments in the quality and quantity of food since the last inspection. We were told that there are no limited to a strict food budget and there is a smarter way of shopping. It was further stated that the budget has allowed staff to purchase kitchen equipment such as mixers and blenders. In House 1 menus are prepared four weeks in advance and in House 11 they are prepared weekly. Both menus were varied and show that a continental style breakfast, a light lunch and a cooked evening meal is served at the home. The range of fresh, frozen and tinned foods confirm that there is sufficient food and support that people at the home have a varied diet. Care Homes for Adults (18-65 years) Page 17 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The records must confirm that health and personal care that people receive is based on their individual needs. Medications systems must be made safer. Evidence: People at the home have personal care need and support plans list the individuals needs and the way the need is to be met by the staff. As previously mentioned support plans must be more personalised about the individuals likes, dislikes and the way choices are made by the person. Personal health folders are separate from the support plans which are sectioned into personal health information, checks and appointments, medical reports and correspondences. Each person has a health profile that includes the history of illnesses and diagnosis, health needs and daily routines. It is evident from the records that people have access to NHS facilities, visits to the dentist, optician and chiropodists are regularly arranged. Through the Community Learning Disabilities Team (CLDT, people at the home have specialist support from health care professionals such as Speech and Language, Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: physiotherapist and psychiatrists. Documentation in place also supports that people attend hospital appointments. When a health care professional is contacted, the staff record the reasons for the contact, the diagnosis and advise given by the professional is also recorded. The people at the home have a diverse range of mobility needs and risk assessments for two of the four people that were case tracked were in place. The manual handling risk assessments in place do not follow a set format and are in a wide range of completion. For example, one risk assessment instructed staff to use a hoist on all transfers, while another was had clear explanations on the way to support the person when a handling belt is used. Manual Handling risk assessments must be developed for individuals that have mobility needs. Where medical procedures are undertaken risk assessments must be developed to ensure that the procedure is appropriate for the staff, assess the training that must be provided to the staff, so that the procedure is conducted in a safe way. Medications are administered through a monitored dosage system and the gaps in the recording indicate that staff do not sign the records after administering the medication. When required medications are administered by the staff and fro some individuals protocols are in place. However, protocols are not in place for people that have when required medications administered. Protocols for When required must be formulated to ensure that medications are administered safely and consistently by the staff. Care Homes for Adults (18-65 years) Page 19 of 31 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. Systems in place ensure that complaints can be raised on behalf of the people at the home. Individuals at the home are protected from abuse Evidence: The Complaints procedure in place is symbolised with pictures and words and is appended onto the Statement of Purpose. It is likely that the people at the home are unable to understand the procedure in the current format, complaints received are therefore on behalf of the people living at the home. Two complaints were received at the home from relatives since the last inspection. The records show that an investigation was conducted and the complaint was resolved to the complainants satisfaction. Corporate procedures that safeguard people from abuse include Whistle Blowing, Safeguarding Adults and Dignity, Respect and Diversity procedures. It is confirmed through the Whistle Blowing procedure that staff concerns will be taken seriously, they will not be put under pressure or suffer from adverse consequences. Also made clear through the procedure is that staff have a duty to report poor practice. Where there are allegations of abuse, the Safeguarding Adults procedure is used to ensure that the actions taken by the staff safeguard people at the home from abuse. The factors of abuse are detailed within the procedure, with the actions to be taken by staff and line managers to ensure the safety of the people at the home. The Trust commitment Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: towards developing an open and transparent culture is specified within the Dignity, Respect & Diversity. Care Homes for Adults (18-65 years) Page 21 of 31 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. The property is fit for purpose and people have a comfortable environment Evidence: Hampstead Road is located close to shops, places of worship, amenities and bus routes. It was purpose built to accommodate people with physical and sensory impairments that have learning disabilities, arranged into two separate dwellings, which is linked by shared space. In each house there are six single rooms,lounge, conservatory and kitchen/dinner. Other shared space consists of a laundry and Snoozelem. A tour of the premises was conducted during the site visit and it is evident that refurbishment of some areas had taken place to maintain a comfortable and homely environment for the people that live at the home. A number of bedrooms in both houses were redecorated and are more age appropriate and adult in appearance. Shared space was decorated and in a less institutional way and is more homely, while toilets and bathrooms remain functional. The people at the home require aids and equipment to meet their physical impairments and for moving and handling. The manager told us that tracking in bathrooms and three bedrooms is being considered. This is seen as good practices Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: because it ensures that safer lifting techniques that respect the person. Other areas that require attention include the kitchen in house 11 and the lounge carpet in house 1. We were told that the kitchen in house 11 is to be refurbished in the near future and the carpet in house 1 is to be replaced. The laundry is away from the kitchens and shared by both houses. The walls are painted and there is vinyl flooring for easy cleaning. There are two small washing machines with specific programmes for sluicing and tumble dryers. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive a consistent service from staff that are skilled and suitable to work with vulnerable adults. Evidence: Staffs personnel records are held at the Brandon Trust office, and employment record sheets are kept at the home. Employment record sheets are held at the home and used to evidence that the manager saw Criminal Records Bureau (CRB) checks and references. The manager said that at present there are 20 full time (ft.)posts equivalent with a further ft. vacancy. Both houses have their own staffing structure of senior support workers and support workers, with the manager in overall control of both houses. Three staff are rostered in each house throughout the day, with two staff awake and one asleep in the premises at night and ancillary staff to keep the house clean. The manager said that statutory training includes Fire, Manual Handling, Food Hygiene, Safeguarding Adults and First Aid. Epilepsy and Midazolam training is compulsory for the staff working at the home and dementia training for house 11 is also compulsory. The manager recognizes that more staff need to attend Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DOLS) training as well as Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: vocational qualification. At present supervision is provided by the manager to the staff, in future staff will receive line management individuals supervision. The manager will continue to provide individual supervision to senior support workers, new employees and any support worker that may require additional support. The manager then went on to explain supervision format which follows a set format that includes the minutes of previous sessions and performance that is incorporated into house issues, the people at the home and training needs. Members of staff were consulted about training and supervision and the changes that have taken place in the staffing. We were told that statutory and additional specific training that ensures they are able to meet the needs of the people at the home was attended. In terms of supervision, staff said it occurs 6-8 weekly and that problems between staff is addressed through supervision and bullying no longer happens. Care Homes for Adults (18-65 years) Page 25 of 31 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 live in a home in a safe environment, where standards are subject to ongoing monitoring and are supported in maintaining their lifestyle. Evidence: Comments about the way the standards of care are to be improved were sought from the manager. We were told that there was incredible pride in what has already been achieved and as a result,the views that people have about the home are changing. It was further stated that the home is fit for purpose because the accommodation is on one level and homes vehicles allow people to maintain contact with the community. The intention is to develop standards so that the home can be recognised as a centre of excellence for people with profound and multiple needs. This is to be achieved by providing a personalised approach to meeting needs, with support plans that are not generic and agreements that run alongside. Having staff that are happy to come to work, which creates loyalty benefiting the people at the home. Staff at the home were consulted about leadership styles and consistency. One bank member of staff said that the atmosphere is more vibrant because staff feel that they Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: are part of a team. Staff are more accountable because information is passed on and work is allocated and must be signed by the member of staff. Support workers told us A big cloud has lifted, the manager is approachable and cares about the people living here. Staff want to work here even bank staff and we are no longer frightened to go into the office, we are well informed. Other staff said that staff meeting are calmer, staff sit and talk about things in a calm way. We were also told that staff feel well informed, the manager passes information about meetings attended and people have continuity because the have the same staff working in the houses. The Trust operates a Quality Assurance System based on five core standards, following the assessment; the Quality Manager will then produce an action for the manager to implement in order to fully meet the standards. The manager also said that quality is monitored through support plans, in-house reviews and meetings. The manager ensures that there is compliance with associated legislation to ensure that there is a safe environment for people that live and work in the home. Portable Appliance Testing (PAT) is conducted by a contractor for all electrical appliances to ensure equipment is safe to used. The boiler is serviced and certified by a competent contractor to show that the heating system is functioning effectively. Fire risk assessments are generic where the sources of ignition are established to then formulate an action plan to reduce the level of risks which the manager reviewed in September 2009. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 6 13 The registered person shall, for the purpose of providing care to service users, and making proper provision for their health and welfare, so far as practicable ascertain and take into account their wishes and feelings. Support plans must include the individuals likes, dislikes and preferred routines 30/03/2009 Care Homes for Adults (18-65 years) Page 28 of 31 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 19 13 The manager must make suitable arrangements for safe systems of moving and handling. a)The manager must develop risk assessments for individuals that have mobility needs. b) where medical procedures are undertaken, risk assessments must be completed to ensure staff are properly trainined and the procedure is appropriate for the staff to undertake. 01/01/2010 2 20 13 The manager must make arrangements fr the recording, handling, safekeeping safe administration of medications. a) Members of staff must sign the records to show medications were administered. b) Protocols 31/12/2009 Care Homes for Adults (18-65 years) Page 29 of 31 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 must be formulated for individuals that have when required medications. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 30 of 31 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!