Care Home: 8 Southbank Close

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What the care home does well The home would carefully make sure that staff know all about and could meet the needs of possible new customers before they move in. People living at 8 Southbank Close have a safe, clean, comfortable and caring home. One person`s relative comments "they have excellent staff and care is second to none". Each customer has a plan showing their care needs, likes and dislikes. Plans help staff to know the care that people need and want so they can give them the right support. Customers can take part in activities they like and go out in the community. It is good that staff now have more time to give people one to one support. Staff also help customers keep in contact with their families, who they make welcome in the home. Customers receive good support with their personal care. Staff also make sure that they have regular health care checks and manage their medicines safely for them. The home is in a good place near shops and other facilities in Hereford. It is an ordinary bungalow with ramps, aids and equipment to help people move around better. Staff have good training that helps them keep people safe and understand customers` needs. They have good support from home management and the staff team work well together. This helps to ensure that customers get good and consistent support. What has improved since the last inspection? This is the first inspection of this home since it was registered and run by Midland Heart and so this does not apply. What the care home could do better: When customers` plans are "person centred" and focus on their personal goals and support they need to achieve them they should benefit from more individual lifestyles. Ways of communication such as pictures, objects and signs could be used by staff to help customers make more choices about their lifestyle such as what they do and eat. Customers` protection would be better ensured if more information about new staff is obtained to confirm that they would be suitable to work caring for vulnerable adults. Midland Heart must visit to check how the home is being run and make a written report about what they find every month. This would help them make sure the home is being managed properly and that customers are getting a good quality service. Plans to develop the service should show how this will be done and be based on how customers and other people involved with the home would like it to improve. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 8 Southbank Close 8 South Bank Close 8 Southbank Close Hereford Herefordshire HR1 2QT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Christina Lavelle     Date: 1 1 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: 8 Southbank Close 8 Southbank Close 8 South Bank Close Hereford Herefordshire HR1 2QT 01432268258 01432354552 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Midland Heart Limited Name of registered manager (if applicable) Mrs Elaine Doris Booton Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The Registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: LD - people with a learning disability. The maximum number of service users users to be accommodated is 4. Date of last inspection Brief description of the care home This care home at 8, Southbank Close was part of a larger care home set up by the Primary Care Trust in 1989. It later transferred and was run by Herefordshire Council. The operation of the service was taken over by Midland Heart Limited in September 2008. Midland Heart is a well established national provider of services for people with learning disabilities. The home is a self contained bungalow adjoined to two other bungalows that are now registered as three separate care homes. It can provide accommodation with personal care for four adults with learning disabilities. People Care Homes for Adults (18-65 years) Page 4 of 30 care home 4 Over 65 0 4 Brief description of the care home living there may also have associated physical disabilities and low level challenging behaviours. Southbank Close is in a residential area of Hereford, a short walking distance from the citys shops and other facilities. The bungalow is in a quiet cul-de-sac and is campus style with a central parking area. There is a separate building opposite that is part of the site and has offices and meeting rooms. The premises were set up for people with mobility difficulties who may be wheelchair users. It has ramps, wide doors and other aids and adaptations. The home has four single bedrooms that all have a wash hand basin but no ensuite facilities. There is a sitting room, kitchen, dining area, utility room and bathrooms for everyone to share. Information about the service is available in a statement of purpose and customers handbook. The weekly fee is based on the assessed needs of people using the service and they are funded through Herefordshire local authority. Each customer should have a terms and conditions of residence (contract) specifying their support needs, the service they will receive, the cost and any additional charges. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This is the first key inspection of 8 Southbank Close since Midland Heart was registered as provider of the service. This means all the standards that can be most important to people using care services are assessed. As part of the inspection we, the commission, visited the home for about four hours without telling staff or the people living there beforehand. Midland Heart call people who use their services customers and it was agreed that people living at the home would be referred to as such in this report. A range of evidence is used to make judgements about the quality of the service. This includes discussing the way they home is run and plans to develop the service with the manager Elaine Booton. It is difficult to ask customers directly about their care and lifestyle because their learning disabilities effect their communication. Time was Care Homes for Adults (18-65 years) Page 6 of 30 therefore spent in their company and their activities, presentation and interactions with staff observed. Two staff were also spoken with about their role, training and support. Feedback from our discussions, and from surveys asking for views of the service and completed by four staff and one customers relative, is mentioned in our report. Relevant records relating to customers care, staff and health and safety were looked at. An annual quality assurance assessment (AQAA) was completed before our visit, as required. The AQAA asks managers to say what their service does well, could do better and about their plans to improve it. There is also numerical information about customers, staff and other aspects of the service. All other information received about the home since it was registered is considered. This includes events that affected the welfare and safety of customers (these are called notifications). What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Adults (18-65 years) Page 8 of 30 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 30 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 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective customers can feel confident the home could support them. This is because a full assessment would be made of their needs that they, their family and representatives have been involved in. This is to ensure that staff know their wishes and how to meet their needs before they live there. Evidence: No one has moved into 8 Southbank Close since Midland Heart was registered and for a while beforehand. The services business plan and statement of purpose describe how all new referrals will come through Herefordshire local authoritys community learning disabilities team. A community care assessment would be completed by a social worker and the homes manager is then expected to visit potential customers at their current residence to carry out their own need and risks assessments. This assessment visit would be followed by introductory visits arranged to the home with the persons family or other people close to them. This could include for a meal, overnight and weekend stays to see how they like it and to check their compatibility Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: with people already living there. A trial stay would be arranged next with an initial care plan set up showing the support they need, to ensure that staff could meet their needs. The manager confirms she knows and would follow the assessment and admission procedures. In addition she says that a formal review meeting would be held at the end of prospective customers trial stay with all parties involved so a decision can be made about the suitability of the placement before their contract is agreed. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each customer has a care plan outlining their needs and level of support staff should give them. Whilst their plans include some likes and dislikes they could better reflect their personal goals and staff could enable people to make more daily life choices. Possible risks to customers safety are assessed so they can be minimised. Evidence: The home recognises that people should be involved in planning their own care and make decisions about their lives. Customers daily routines are flexible, as staff take into account their mood and behaviour. However because of their limited communication other ways could be used to help them make choices including such as objects of reference, signs and pictures. Plans also need to be user friendly so that customers can understand and be involved in them more easily. Staff have a person centred approach to care but it is good that a more person centred plan format is to be introduced. The new plans should help to identify Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: customers personal goals and focus more on how they can be supported to achieve their goals and develop their life and social skills. Their families and advocates should be involved in the process of setting up and reviewing care plans. Plans seen were set up based on needs assessments that were first carried out in 2005. Although they have been reviewed regularly they are not very detailed and do not refer to individuals diverse needs in respect of such as their gender and disability. Staff have recently received training on equality and diversity and so should be able to put their knowledge into practice. Currently it appears that daily shift records completed by staff on customers moods, behaviours, activities and events are being used as a working tool, rather than their plans. Support workers are allocated to particular customers as their keyworker. It is good that keyworkers now have more time to give people one to one support and will be more involved in care planning. Staff understand their role as a keyworker is to help to personalise care and advocate for their allocated people. They are also expected to complete monthly care summaries, which should include progress to meet goals (or not) and any achievements. Risk assessments have been completed, which primarily identify hazards and aim to keep people safe. There are also individual behaviour management plans showing behaviours, that can be challenging with warning signs indicated and action staff should take to divert, intervene and manage them. Any incidents are appropriately recorded also showing the people involved and outcomes. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Customers take part in activities they enjoy and go out in the community. They will benefit from having more individual support to enable them to follow their personal interests and develop their life and social skills. Customers are supported to maintain links with their families and the home provides healthy meals they like. Evidence: Staff are clear that customers should be supported to take part in a variety of activities (both in the community and at home) and to develop their life and social skills. It is acknowledged that due to the level of peoples disabilities that the possibility of them taking up work placements, educational opportunities and of active involvement in household tasks is limited. Some customers go to day services, riding for the disabled and use sensory facilities. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: It is good the AQAA says that peoples range of activities has improved and the home is now arranging holidays or short breaks. Staff also have more time for one support for shopping and other outings and they plan to seek further activities. Some staff comment however they would still like to support people more in the community. Plans include a brief social and life skills assessment and a list of regular activities each customer takes part in. This should be more detailed and focus on their personal interests and what they would enjoy and benefit from. Plans should also show how staff can enable individuals to take part in meaningful activities they like and help them achieve their goals and develop life skills, as part of person centred planning. The home supports customers to maintain links with their relatives or advocates and keyworkers sends cards etc. on their behalf and keep them updated. Social events are arranged when families, friends and peers are invited to the home and efforts are being made to involve families and advocates more in care planning and reviews. Regarding food provided by the home menus show varied and nutritious meals such as roasts, fish and pasta dishes. Food stocks on our visit included fresh vegetables, fruit juice, a range of cereals, porridge and wholemeal bread. Staff confirm most meals are home made and they use fresh vegatables. For people not able to eat fresh fruit easily juice or pureed fruit is offered. There are always two options available for the main meal and breakfast and snack meals are chosen flexibly. Whilst staff know what each customer likes and dislikes pictures could be used to help them make choices. Plans show special requirements, assistance or oversight that each customer needs at mealtimes and special aids and cutlery they use. Individual food and weight records are kept as part of monitoring their health and lifestyle. The manager recognises that some people have issues and plans to involve a dietician to review diet provision. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Customers receive the personal support they need and their health care needs are met. Their medicines are also managed safely by staff in the home on their behalf. Evidence: Customers personal, health care needs and prescribed medications are outlined in their care plans. The AQAA says the home intends to set up separate health action plans (HAP) for everyone, which will be a positive development. HAPs should provide a comprehensive overview of individuals medical condition, emotional and health related issues and ensure that any changes are monitored better. They should also specify customers preferences in respect of their personal support and involve them as much as possible in promoting their own good health. Plans show that customers need full support from staff in respect of their personal care. Staff complete daily checklists showing the aspects of care they have given each person. We observed that customers were well presented and suitably clothed and staff offered them assistance in a respectful and caring way. Peoples particular needs relating to such as their mobility and continence are detailed. The home is specially Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: adapted and customers have aids and equipment they need to move around, which staff are trained to use as well as how to support them safely. Records are kept of routine and specialist health input each customer receives and staff arrange and support them to attend appointments. Daily records are used to monitor any health care problems as they arise and to ensure that medical advice and treatment is sought. When necessary staff carry out and keep records of physical checks such as food intake, weight and blood pressure. Body maps are completed when marks or bruises are noticed. Special needs, such as epilepsy, are highlighted with guidelines for staff and records kept of seizures. Staff have received training on epilepsy and on how to manage behaviours that may be aggressive and challenging. Regarding customers prescribed medicines there are appropriate policies, procedures and guidelines in place that staff understand and follow. Lockable storage is available, which we saw is kept tidy and well ordered. Records of medication kept in the home and administered are maintained appropriately. A community pharmacist checked the homes medicines recently and reports that all systems are being used correctly. Staff are only designated to manage and administer customers medicines when they have completed formal training on the safe handling of medicines and instruction in respect of one particular type of medication. Appropriate checks are carried out with records kept, which ensure there is an audit trail so that all medicines in stock and that have been administered can be accounted for. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If people have concerns about the service they know how to complain and can feel confident they will be listened to and action taken to deal with them. There are systems in place to safeguard customers and follow up any allegations made. Evidence: Midland Heart provides a comprehensive complaints procedure, which has been given to people who are involved with customers. The home plans to work with a local advocacy group to make this procedure available in a more user friendly format. The AQAA states that complaints would be dealt with confidentiality and any whistle blowers protected. No complaints have been made to the home or commission since Midland Heart took over the service. If concerns are raised there is a log available to record them with any actions taken and outcomes. Staff surveys confirm that they would know what to do if anyone raises concerns with them. All staff receive instruction on how to recognise abuse and about their responsibility for promoting the safety and welfare of customers. The home plans to arrange regular meetings so that keyworkers can help customers express their views and advocate for them about the day to day running of the home, their activities etc. Staff spoken with are also aware of local multi-agency safeguarding procedures and know how to report any incidence or suspicion of abuse or neglect to external agencies if necessary. Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: Although none of the homes customers need physical interventions due to aggression staff have updated their training on how to manage challenging behaviours. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at 8 Southbank Close benefit from accommodation that suitably meets their needs and is comfortable, safe and kept clean. Improvements are planned soon, which will also make their environment more homely, better furnished and equipped. Evidence: 8 Southbank Close is owned by the Primary Care Trust, which leases out the property. The home is in a convenient place in a quiet cul-de-sac within walking distance of Hereford city. The bungalow is in keeping with the local community. There are ramps in the building and garden and other adaptations, aids and equipment are provided for people with mobility difficulties who may be wheelchair users. Customers bedrooms and their sitting area are comfortable and efforts have been made to make them more homely with pictures etc. Some people chose their own decor and the furniture in their bedrooms. The dining area is less homely being an open plan thoroughfare and the bathrooms look rather bare and clinical. It is good therefore that the house is soon to be upgraded. This will include new furnishings, carpers and flooring, the kitchen completely refitted, a new bath, the bathrooms personalised and the dining area enclosed. Suitable arrangements are being made so that there will minimal disruption to staff and customers when this work is being done. Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: All areas we visited were clean, tidy and fresh. It is evident that staff follow required health and safety procedures, maintain good hygiene and so promote infection control. There was a supply of disposable gloves and aprons and paper towels, liquid soap and alcohol gel available. Laundry facilities are suitable and soiled waste disposed of appropriately. Staff receive necessary instruction on infection control. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Customers personal and health care needs are met by sufficient, qualified staff who receive appropriate training and support. Whilst necessary checks are carried out to ensure that new staff are suitable to care for vulnerable people customers would be better protected if aspects of staff recruitment are improved. Evidence: This home now has its own core support staff team, including the manager and a senior. The team is more stable and they no longer need to deploy agency staff, which is good for consistency of care. Rotas are planned around customers needs and activities. This means that some one to one support can be given, although several staff still feel they need more time to enable customers to go out in the community. Regarding recruitment staff confirm they had necessary checks taken up, including a police check (CRB) and two written references, before starting work at the home. Most aspects of Midland Hearts recruitment and selection processes appear satisfactory. However their application form does not request a full employment history, with any gaps explained, and one reference can be personal, which may not be creditable. All staff completed a full day induction when Midland Heart took over the service when Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: they were also expected to read and sign up to all their policies and procedures. For new staff their induction takes six weeks, including all mandatory trainingtopics as well as adult protection, equality and diversity. They move onto complete an accredited learning disabilities qualification (LDQ). The manager confirms the senior support worker mentors new staff who also work shadow shifts before being confirmed in post. Most staff have achieved or are working towards a National Vocational Qualification (NVQ) in social care. It is good that the manager plans to develop in house training and seek more opportunities for training specific to learning disabilities. Staff all confirm they have had training relevant to their role and they seem committed to ensuring that customers have a nice home and good care. One customers relative comments the home has excellent staff, always very polite and courteous. Midland Heart provide a written format for supervision. This should help to ensure that each staff members work performance is monitored and they have a learning and development plan showing their training needs and how this will be fulfilled. The manager recognises that more regular individual sessions should be arranged. Staff confirm that they are usually supported well and there is good team work. Meetings are held regularly and information is communicated through daily reports and shift handovers. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident customers receive good quality care because the home is run appropriately. Practice is developing so support given will be individualised but the conduct of the home must be monitored formally by the provider with a plan showing how it will improve plan based on what customers and their representatives want. The environment is kept safe because staff promote good health and safety. Evidence: The manager Elaine Booton was previously the senior support worker in this bungalow when it was part of a larger home. Ms Booton is currently working to achieve a management and care qualification and to become an NVQ assessor. She has previously completed relevant safety and practice related training and has identified other training that would benefit her and the service. However she has not received formal individual supervision as would be expected, especially for a new manager. This is included in the business plan that was agreed when the service was registered and the commission has written to Midland Heart about this. Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: Ms Booton is clear about the managers role and responsibilties and the management ethos and approach in the home seems to be open and approachable. It is evident she understands and is committed to the key aims of the service and is focusing on developing more person centred, individualised support. Midland Heart provide comprehensive policies and procedures, which the staff team follow. The AQAA contains clear and relevant information, although it needs to include more evidence about how what the service does well results in good outcomes for customers. The manager has identified areas needing improvement, which should be in an annual development plan showing how they are going to do this. This also needs to be part of a formal quality monitoring and assurance sytem that includes regular audits of aspects of the service. Service providers are required to make monthly visits to their services when they also interview people and write a report on their conduct. Whilst there has been some management input these visits and reports have not been made and the commission has also written to Midland Heart about this. Regarding health and safety staff have received necessary training in all core topics. There are also relevant policies and procedures in place. The AQAA confirms that required checks on fire safety and water systems are carried out and the electrical, gas and heating are serviced and/or maintained regularly. Risk assessments have been completed and there were no safety hazards observed during our visit. Care Homes for Adults (18-65 years) Page 26 of 30 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 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 34 19 The homes recruitment procedures must include new staff only being confirmed in post when the home has obtained their full employment history, with any gaps explained in writing. This is to help to ensure that the homes customers are protected from unsuitable staff providing their support. 31/05/2009 2 39 26 The provider must arrange for the care home to be visited by their representative at least monthly to inspect the service, interview people and write a report on the conduct of the home. This is to ensure that the home is being run properly, is achieving its aims and providing a good quality service for its customers. 31/05/2009 Care Homes for Adults (18-65 years) Page 28 of 30 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 The home should progress with their plans to implement more person centred care. This means they would more focus on identifying customers individual needs and personal goals and the support needed to meet them, which they and people close to them are involved in planning and reviewing. The home should consider providing more ways to support customers to communicate better, such as signs, photos and objects of reference. In this way they could be enabled to make more choices and decisions about their daily routines and lifestyle. Efforts to provide more flexible staff support and opportunities for customers to take part in activities and go out in the community should continue. This would help to ensure they follow their interests and lead fulfilling lifestyles. There should be an annual development plan for the home that shows clearly how the service is to improve and how this will be done. This should be based on the views of customers and other stakeholders to ensure that the service improves as they wish and or for their benefit. 2 7 3 13 4 39 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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