Care Home: 8 Restormel Terrace

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What the care home does well People are provided with good information to enable them to make an informed choice about where they live and the type of services they receive. The key principle in the home is that people using the service are in control of their lives. Care plans are developed with the individual and take into account the individuals personal goals and wishes. The staff and management are committed to promoting independence and to delivering a service that respects peoples rights and choices. The views of both people who use the service and staff are listened to and valued. The staff and management support people to take risks as part of an independent lifestyle. people are supported to partake in a wide range of leisure activities, and to maintain contact with family and friends. The service ensures that all staff receive relevant training that is focused on delivering improved outcomes for people who use the service. The service puts a high level of importance on training and staff say that they are supported through training to meet the individual needs of people using the service. Staff are well supported by the manager and their colleagues. What has improved since the last inspection? After listening to the views of people who use the service some recent changes have been made,these have included; Increasing the frequency of key-worker meetings, and providing some additional educational resources including a new computer in each house. A behavioral adviser has been recruited to support staff and work with individuals to ensure that support plans are relevant and focused on individual needs. 1a Restoramal Terrace has been redecorated and refurbished throughout and No8 has had a new kitchen and updated boiler system. All of the staff working in the home now have a National Vocational Qualification of level 3 or above. Team meetings now include an opportunity for staff to present training sessions and share their skills, knowledge and experiences with their colleagues. Staff spoken to said that this was a valuable addition to the homes training and support plan. What the care home could do better: The service should be commended for meeting or exceeding all the standards at the time of this key inspection. As a result there have been no requirements or recommendations made on this occasion. Key inspection report Care homes for adults (18-65 years) Name: Address: 8 Restormel Terrace 8 Restormel Terrace Mutley Plymouth Devon PL4 6BJ     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: Wendy Baines     Date: 3 0 0 9 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 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 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 32 Information about the care home Name of care home: Address: 8 Restormel Terrace 8 Restormel Terrace Mutley Plymouth Devon PL4 6BJ 01752253179 01752253179 1Aand8restormelterrace@regard.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Regard Partnership Ltd care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 10. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home This service comprises of two properties, 1a and No 8 Restormal Terrace. They are located within walking distance of the shopping precinct at Mutley Plain, Plymouth and a short bus ride from the city centre. Both houses provide care for people with a learning disability, although with very different needs. The registered manager for both units is Miss Kerry Libby. 1a Restormal Terrace is registered to accommodate 6 people who may have a mild to moderate learning disability and other associated care needs. The property is a large end of terrace house with a lounge and separate dining room and a small patio area at the rear. No 8 Restormal Terrace is registered to accommodate 4 people with a moderate learning disability, and who may have behaviours that challenge services. The property is a mid terrace house with a lounge Care Homes for Adults (18-65 years) Page 4 of 32 10 Over 65 0 Brief description of the care home and kitchen- dining room and a small patio area at the rear. The premises are not suitable for persons with significant mobility difficulties. Fee levels for the service are available from the organisations head office but are generally based on individual need and decided at the time of admission. Care Homes for Adults (18-65 years) 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 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: The Key unannounced Inspection at 1a and No8 Restormal Terrace took place on the 29th and 30th September 2009. The Registered manager for both houses was present throughout the visit. Prior to the inspection the provider sent the Commission their Annual quality assurance assessment (AQAA). The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. The information sent was detailed and clear and provided us with all the information we had asked for. The two homes are located within the same street a short distance from each other. During the visit we were able to visit both houses and had a look around all the communal parts, garden area and some of the bedrooms. A sample of records relating to the people who use the service and the running of the Care Homes for Adults (18-65 years) Page 6 of 32 home were examined and all staff and management on duty were spoken to during the visit. Six surveys were received from people in the homes, some completed with support from staff, and eleven surveys were completed and returned by the staff team. We were also able to speak to other professionals who have had involvement in the home and asked them their views on the quality of the service provided. We also looked at any information that we have received from the service or others since the last key inspection, which took place on the 25th September 2007. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Adults (18-65 years) Page 8 of 32 The service should be commended for meeting or exceeding all the standards at the time of this key inspection. As a result there have been no requirements or recommendations made on this occasion. 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 Adults (18-65 years) Page 9 of 32 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 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, 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. People who may use the service have the information they need to make an informed choice about where they live and the services they receive. Thorough and comprehensive procedures prior to admission ensure that people in the home can be confident that their needs will be met. Evidence: When people are making a decision about moving into the home they are provided with information about the service. It gives people details of the type of support, care and accommodation they should expect to receive at Restormal Terrace. The service is able to provide this information in a range of formats such as a written document or pictures dependent on the needs of the individual concerned. Each house has also developed a power point presentation so that people can use the homes computer system to see and hear information about the service. All of the people who completed surveys said that they had received copies of this information when they first moved into the home. Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: A thorough assessment is completed of peoples needs before they move in. The manager said that she would usually meet with the person within their home or placement and gather as much information as possible from the individual and people involved in their care. The purpose of this is to ensure that the service can meet the identified needs of the person before they move in. It is also an opportunity to involve the person themselves in the assessment, and provide them with information so that they can make an informed choice about where they live. The pre-admission assessment of one person was looked at during the Inspection and the experiences of the individual and their representatives was tracked to establish the quality of the homes admissions procedure and the experiences of all concerned. Records confirmed that visits are arranged, and the actual move into the home is planned in the way that best suits the needs of the individual. Feedback from a representative of Social Services was very positive about the home admissions process, comments included, The manager and staff provided excellent support for the individual and their family during the move to Restormal Terrace, I have been very impressed with the service and their person centered approach to providing care Some of the people who already live in the home were spoken to and said that they had had lots of support from the staff when they first moved in and now enjoyed living at Restormal Terrace. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are involved in decisions about their lives, and play an active role in planning the care and support they receive. A variety of different and creative methods are used to help people who use the service to contribute in the development of their care plan and on-going review of their needs. Evidence: Each person who lives in the home has a detailed plan of care stating how they need and want to be supported. This plan has been developed using the initial preadmission assessments and information the home has learned about the person since they moved in. A sample of care plans were seen and all included information about peoples daily support needs and personal goals. The home should be commended for the quality of their care planning which involves the individual at every stage and takes into account Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: the persons rights and preferences about how they are supported. Several of the people spoken to said that their personal goal is to develop their skills and hopefully one day move into their own flat or accommodation where they can be more independent. These goals had been documented within care plans and included a detailed action plan about how the individual would be supported to achieve them. People using the service had a copy of their care plan in a format that they could understand and staff were provided with sufficient detail to ensure that the care provided is consistent and meets the individuals needs at all times. Staff were observed throughout the inspection encouraging people to make choices about their daily routines and lifestyle. The staff also reminded people that others living in the home also have rights and that it is important to respect that people may make different choices about the things they do and the way they live. The home has supported people to access advocacy services when they have needed independent support to make decisions. People are fully involved in planning their care and are encouraged to voice their opinions formally and informally. Group meetings take place regularly to discuss issues relating to the running of the home. Individuals meet with their key workers and staff to review and discuss their specific needs and support arrangements. The manager said that for some people who live in the home making choices about how they live is quite new and choices need to be introduced slowly and with support. Some people may also have limitations or restrictions on the choices they make for their personal safety and where this is the case the reason for the restriction had been documented and reviewed as part of a multi-agency care plan process. A representative from Social Services said that a review they held at Restormal Terrace was one of the best they had ever attended, The home has a very Person Centered approach to care, the individual was fully involved in their review and had opportunities to write down any comments and questions they wanted to ask Detailed risk assessments are in place for all activities inside and outside the home. The risk assessments seen during the inspection were well written and specific to the individual. Discussion with staff and information within records confirmed that the home encourages people to be as independent as possible, whilst recognising possible risks and safety issues. One person had a detailed plan to support them to use the local train service safely, and another plan detailed arrangements for someone who Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: requires high staffing levels, to fulfill their wish to have times in the week without staff support. Risk assessments are reviewed regularly to ensure that the information and guidelines are up to date and appropriate. Care Homes for Adults (18-65 years) Page 15 of 32 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 who use the service are able to make choices about their lifestyle and support they receive. People are able to enjoy a full and stimulating lifestyle. The routines and activities are focused on the needs of individuals, regularly reviewed and can be quickly changed to meet an individuals changing needs, choices and wishes. Evidence: Throughout the visit all the people who use the service were involved in a number of activities inside and outside of the home. Some people were doing daily household tasks, such as laundry and planning menus and others were relaxing around the home or attending planned activities. Some people have 1:1 support with daily household tasks and to access opportunities Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: outside the home. These arrangements were clearly documented within individual care plans. Each person is supported by staff to put together a weekly activities plan. People are also expected to partake in tasks around the home as part of developing their skills and for some people learning the skills necessary to achieve their goal of living more independently in the future. In addition to social and leisure opportunities several people attend local college courses and one person was being supported by staff to undertake some voluntary work. Records and discussion confirmed that people enjoy a wide range of social and leisure opportunities. Both houses are located within easy reach of local shops, Plymouth City Centre and the train station. Daily records and discussion confirmed that people are supported to use these local facilities whenever possible. One person was supported by staff to make regular visits by train to their family home and another had specific guidelines in place to enable them to use the local train service independently and safely. Information is available to people about the local community and events that they may be interested in. This information is given to each person in a way that they can understand and make use of. One of the houses has individual notice boards and these were full of interesting information about events and activities inside and outside the home. People spoken to said that they could choose to spend time in their rooms or with others and all said that there was plenty of facilities in the house to occupy them such as televisions, computers, music and books. Both homes had made good use of the communal areas so that people could sit quietly or join in with others in the busier parts of the house. People spoke about the holidays they had enjoyed during the summer and parties they had started to plan for Christmas. The manager said that each person is supported to plan a holiday and although they may choose to go in a group the staffing levels would be high to allow for activities to be planned on an individual basis. Interaction between people in the home and the staff was noted to be very positive. Staff spoke to people in a respectful and friendly manner at all times and were able to use their skills and knowledge of each individual to help create a relaxed and happy environment. Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: Contact with family and friends is encouraged and any arrangements to support this is documented within peoples care plans. Several people spoke about their arrangements to visit their relatives or meet up with friends. The manager said that all staff work hard to maintain a positive relationship with families and keep them informed of important issues when it is appropriate to do so. A representative from Social Services said that the manager and staff had been very supportive to family members when their relative moved into the home, and that this support had made it easier for them to accept and manage major changes in their lives. Mealtimes and the way meals are planned is very much dependent on each persons needs and preferences. People are encouraged and supported to put together a weekly menu and are responsible for all the tasks involved including shopping and meal preparation. One person was happy to show the inspector how they plan their menu using the computer, pictures and symbols. Each person has their own storage and separate fridge and can choose to eat their meals on their own or with others. People are encouraged to make choices about what they eat, and are provided with information about healthy eating as part of a healthy lifestyle. A record is kept of the meals people have each day and any special dietary needs are documented as part of the individuals care plan. Care Homes for Adults (18-65 years) Page 18 of 32 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. The health and personal care that people receive is based on their individual needs. The home strongly promotes independence and the principles of respect, dignity and privacy are put into practice. Evidence: The people who live at Restormal Terrace are generally independent with personal care and require mainly prompting and encouragement from staff. More support is required from staff to help develop social and independent living skills. Individual care plans have clear information about the type of support people need and how this will be delivered. Each person helps to choose one member of staff/ keyworker who will support them to Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: develop their care plan, attend reviews and discuss any issues or concerns they may have. The manager said that the key worker system works well and although all staff are familiar with the needs of people living in the home this system further improves consistency of care and ensures that people have someone they know they can go to for support. Some of the people who live in the home may at times display behaviours that challenge the service and affect their own emotional health and well being. Clear guidelines are in place for staff to manage any episodes of difficult behaviour and staff receive training in this area of care. People using the service are supported to manage their behaviours and to recognise the affects their behaviour may have on their lifestyle and others living in the home. Medication was found to be accurate and completed appropriately. Whenever possible people are encouraged to take responsibility for their medication, which may include collecting the prescription from the surgery and taking it to the pharmacy. An example of this arrangement was documented as part of one persons care plan and included an assessment of any possible risks and how these would be managed. When people are able to manage their own medication they are provided with facilities to ensure that they are stored safely. Records confirmed that staff undertake regular training to ensure that they have the skills and knowledge to handle and administer medication in the home. All staff who completed surveys said that they receive training that gives them enough knowledge about healthcare and medication. Each person in the home is registered with a general practitioner and healthcare services such as the dentist and opticians are available locally. Examples were also given of when the home had requested support and advice from specialists such as the Learning Disability and Mental Health services. Care Homes for Adults (18-65 years) Page 20 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns and can be confident that their complaints will be taken seriously. The home has an open culture where individuals as well as staff feel safe and supported to share any concerns in relation to their protection and safety. Evidence: The home has a complaints policy and procedure in place that has been developed into an appropriate format for the people in the home to understand. This information is also available on the notice boards in the home, and each person has been given their own individual copy. Most of the people who live in the home are able to voice their views and are encouraged to do so both informally on a day to day basis, and formally in resident and keyworker meetings. All the people who completed a survey said that they know how to make a complaint and who to talk to if they have any concerns. The staff recognise that not all people may be able to express their views in this way and therefore use their knowledge of each individual to check out of they are happy and satisfied with the service and support they are recieving. Daily communication books are completed for each person, which records any changes in mood and behaviour that may need addressing. Throughout the inspection staff were observed Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: dealing sensitively and promptly to issues and concerns raised by people in the home. One complaint had been received by the Commission since the last key inspection. The complaint related to staff training and the numbers of staff working in the home. The Commission asked the Registered Provider of the service to investigate the complaint using their complaints procedure. The Provider completed a thorough investigation and reviewed all areas of the service relating to this concern. The organisation provides training to all staff in issues relating to abuse and the safeguarding of vulnerable adults. Safeguarding policies and procedures are in place to guide staff and protect people in the home. In addition a locally issued alerters guide is in place for staff to refer to. All the Staff who were spoken to and those who completed surveys said that they knew what to if someone had concerns about the home. Each person in the home has their own bank account and is encouraged to manage their money whenever possible. Any arrangements for the home to support people with their money is documented within their care plan. People are provided with lockable storage space and keys to their bedrooms. Care Homes for Adults (18-65 years) Page 22 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, 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 people at both 1a and No8 Restormal Terrace are living in pleasant, comfortable homes that are warm and clean. The physical design and layout of both houses mean that people can have a choice of places to sit quietly, meet with family or friends or spend time with others who use the service. Evidence: The service consists of two houses, 1A and No 8 Restormal Terrace. Both properties are of Victorian style and are located close to Plymouth City Centre. Since the last inspection 1A Restormal Terrace has been redecorated throughout. The home now has two new bathrooms, a new kitchen and has also had new furnishings and decor in all the communal areas and peoples bedrooms. The property has plenty of communal space and has been well organised to allow people to spend time on their own or in the company of others. As well as the main sitting room there is also a separate communal sitting room which has a house computer, notice boards and other facilities for people to pursue their interests and hobbies. Number 8A Restormal Terrace has also had a new kitchen since the last inspection. Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: Both houses have a small garden area and people who use the service said that they enjoy BBQs and sitting outside during the summer months. Neither of the properties would be suitable for anyone with limited mobility as they have steep stairs and steps leading up to the front door. The Inspector was able to see two of the bedrooms and these were found to be clean, well decorated and contained plenty of personal belongings to reflect the individuals age, personality and interests. Kitchens in both houses are well designed and provide separate cupboard and fridge facilities for people to store their own food. Both houses were found to be homely, comfortable and clean. The manager said that there is a daily list of household tasks that have to be completed and people are encouraged to partake in these tasks and keep their personal space tidy as a way of developing their independent living skills. People who completed surveys said that the home is always kept fresh and clean. Care Homes for Adults (18-65 years) Page 24 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, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are well trained, skilled and sufficient in numbers to meet the needs of people currently living in the home. The team of staff demonstrate a thorough understanding of the individual needs of people who use the service and are therefore able to deliver highly effective person centered care. Evidence: There is a separate staff team for each of the houses and in addition to the Registered Manager who is usually based in No8 there is a deputy manager who is responsible for overseeing the management of number 1A. At night in each house there is one waking night staff member. In house 1a there is also an additional member of staff at night due to the particular needs of the people who live there. Several of the people who live in the home have 1:1 staffing arrangements to assist them to participate in activities inside and outside the home. These staffing levels have been agreed when they have first moved into the home as part of their care plan and are reviewed on a regular basis. The care plans that were seen clearly documented the reasons for these staffing levels and how the support would be provided. The manager said that they are regularly reviewed to make sure that people Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: are being supported in a way that best meets their identified care needs. Of the twelve surveys completed by staff six said that there is always enough staff to meet the individual needs of people they care for and six said that there is sometimes enough staff. Twelve surveys were completed by staff and all contained very positive comments about the standard of care they are delivering, comments included; I feel we support people to live as independently as possible and to make choices in their lives, Everyone is treated as an individual, and peoples rights and dignity is respected at all times. Records relating to the recruitment of new staff are kept in the organisations head office and a checklist is kept in the care home to confirm that all necessary checks and recruitment documents have been completed prior to the person starting work. The manager said that she is kept fully involved in the recruitment of new staff and also gathers the views and opinions of the people who use the service. All of the staff who completed surveys said that the organisation carried out Criminal records checks and requested references before they started work. The organisation provides a programme of in house training and each staff member has an individual training plan. New staff must complete a comprehensive Induction programme before they can work unsupervised with people in the home. One staff member said The induction programme covered everything I needed to know to do the job when I first started. All staff complete training in Health and Safety, First Aid, Medication, Fire Safety and Safeguarding and also have opportunities to attend more specialised training relating to the needs of people they support. The management and staff keep themselves regularly updated with new legislation and best practice issues. The organisation has recently appointed a Behavior Adviser who is available to support staff when working with people who may display episodes of challenging and difficult behaviour. As a result of feedback from staff each of the homes now has an allocated time within staff meetings for staff to discuss particular issues relating to their work and needs of people they care for. On the day of the inspection one staff member was giving a presentation on the care needs of people with Autism. The manager and staff spoken to said that this has been a really valuable addition to the staff meetings and has given staff the opportunity to share their skills, knowledge and experiences with their colleagues. Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: All the staff who completed surveys gave very positive feedback about the quality of training provided. All said that they are given training which is relevant to their role and that helps them understand and meet the individual needs of people, and keeps them up to date with new ways of working. Records confirmed that all staff receive regular formal supervision. The manager said that as well as formal supervision sessions staff are supported on a day to day basis through informal discussion, staff meetings, handover and daily communication books. All of the staff who were spoken to or completed surveys were very positive about the support they receive to do their job, comments included: There is a very supportive management team, The managers are always available to chat informally or formally during supervision and are supportive of new ideas and changes that could be made to benefit the service. Care Homes for Adults (18-65 years) Page 27 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service benefit from living in a well managed home where their rights and and choices are respected. Evidence: The Registered Manager has responsibility for both houses in Restormal Terrace, they are situated very close to each other so she is able to spend time in each house throughout the week. There is a separate staff team for each home and two deputy managers. The Registered Manager was available throughout the inspection and the Inspector was also able to meet both deputy managers and staff on duty. All of the staff spoken to had a good understanding of the service and needs of the people they support. The Registered Manager and deputy managers have achieved the Registered managers award qualification and also keep themselves up to date with new legislation and best practice issues. The Registered Manager said she was very keen for all the staff to have role in planning and developing the service and felt this was important to ensure that people feel a valued member of the team. Staff spoken to said that the manager is always Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: supportive of new ideas and changes that can be made to benefit the service. The service has clear lines of accountability and a detailed set of organisational policies that are accessible to staff and regularly reviewed and updated. The organisation has a Quality Assurance system in place with feedback sought from people who use the service and their relatives. A representative from the organisation carries out a monthly visit to the home and completes a report that can be made available to the Commission if requested. This process has enabled the organisation to identify any shortfalls in the provision of the service and address these issues so that the quality of care to people who use the service will continue to improve. Routine health and safety checks take place and risk assessments are in place for individual activities and the environment. Both homes had a detailed fire risk assessment and checks on fire safety equipment and Fire safety training were found to be up to date. Care Homes for Adults (18-65 years) 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 Adults (18-65 years) 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 Care Homes for Adults (18-65 years) 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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