Care Home: Acash Lodge I

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What the care home does well The needs of people using the service are assessed prior to admission into the home.This ensures that the home can meet people`s needs. People have detailed care plans. This ensures that people`s needs can be met in a consistent professional way by the home. People living in the home make clear decisions about their lives and their involvement in the home is promoted.This makes them feel empowered. People living in the home undertake a range of activities both in the local community and within their own home.This improves their social inclusion and independence. People are encouraged to have appropriate relationships and maintain contact with family and friends, which promotes their emotional wellbeing. Detailed health action plans are in place and all medical appointments are being undertaken and recorded effectively. People are offered a healthy varied diet and their cultural wishes and preferences are respected. This further empowers them as they are treated as individuals. There is a complaints procedure in place. Health and safety procedures are in place that protect people living in the home. What has improved since the last inspection? This was the first key inspection of this service. What the care home could do better: A written contract of terms and conditions needs to be obtained for one identified person living in the home. This will ensure that both the person and the home know what is expected of them and ensure that the rights of all parties are respected. Risk assessments for one identified person need to be updated further and guidelines further developed to ensure that all risks are fully minimised. A referal needs to be made for one identifed person to assist with the management of their behaviour. The service needs to develop guidance in relation to an identified item of medical equipment being used. Minor environmental improvements need to be made in relation to two shower heads being replaced and a larger shower tray needs to be fitted in a bathroom. A toilet ceiling needs re-painting, advice needs to be sought from the fire brigade in relation to a restrictor being placed on a skylight window.This will ensure that the home continues to be maintained to a good standard. Staff need to undertake some identified training to ensure that they have updated knowledge and skills to ensure people`s needs are met. The service needs to forward notifications to the Care Quality Commission they have been sending them to the placing authority with detailed information. Key inspection report Care homes for adults (18-65 years) Name: Address: Acash Lodge I 96 Mattison Road Harringey London N4 1BE     The quality rating for this care home is:   two star good 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 Heal     Date: 2 7 0 5 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 33 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 33 Information about the care home Name of care home: Address: Acash Lodge I 96 Mattison Road Harringey London N4 1BE 02088000036 02088098118 udevs@apollo-care.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Apollo Care and Supported Housing Ltd care home 6 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: 6 The Registered Person may provide the following category of service only: - Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD Date of last inspection Brief description of the care home Acash Lodge is a home registered to provide accommodation and personal care for a maximum of six people with Learning disabilities. The home is a three storey house. On the ground floor there is one bedroom, a toilet, a kitchen and a lounge dining room. There is also a staff office. On the first floor there is one bedroom a bathroom and toilet. on the second floor there are a further two bedrooms. On the third floor there are two bedrooms. All bedrooms have ensuite facilities. There is a conservatory to the side of the house and a garden at the back of the home. The garden is accessible to the people living in the Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 6 Brief description of the care home home. The home is located in a residential area a short distance away from the local shops and wood green shopping centre. There are near by bus stops and a train station. The fees for the home are available on request. Care Homes for Adults (18-65 years) Page 5 of 33 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 was anannounced inspection and took place as part of the inspection process. Compliance was checked against key standards and took approximately 9 hours. A second inspector assisted with the inspection. We undertook a tour of the home and spoke with the people that live in the home and members of the staff team. We gained further information from the Annual Quality Assurance Assessment form and an inspection of the documents kept at the home. This included care plans and health and safety documentation. The manager offered their assistance throughout the period of the inspection. We would like to thank the people that use the service and the management team for their openess and participation. Care Homes for Adults (18-65 years) Page 6 of 33 What the care home does well: What has improved since the last inspection? What they could do better: A written contract of terms and conditions needs to be obtained for one identified person living in the home. This will ensure that both the person and the home know what is expected of them and ensure that the rights of all parties are respected. Risk assessments for one identified person need to be updated further and guidelines further developed to ensure that all risks are fully minimised. A referal needs to be made for one identifed person to assist with the management of their behaviour. The service needs to develop guidance in relation to an identified item of medical equipment being used. Minor environmental improvements need to be made in relation to two shower heads being replaced and a larger shower tray needs to be fitted in a bathroom. A toilet ceiling needs re-painting, advice needs to be sought from the fire brigade in relation to a restrictor being placed on a skylight window.This will ensure that the home continues to be maintained to a good standard. Staff need to undertake some identified training to ensure that they have updated knowledge and skills to ensure peoples needs are met. The service needs to forward notifications to the Care Quality Commission they have been sending them to the placing authority with detailed information. Care Homes for Adults (18-65 years) Page 7 of 33 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 8 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 33 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. The manager has made sure that assessments that have been obtained have been used to inform care plans. This improves the quality of care provided. All of the people living in the home do not have a contract of terms and conditions on file. This means that their individual rights are not fully safeguarded. Evidence: This was the first key inspection of the service.This took place because two people have now moved into the home. The files of the two people that live in the home were inspected. There was clear evidence that assessments had been completed. However the detailed assessment information was located across a number of different assessment documents. We suggested to the manager that the most relevant information should be gathered togeather in one place and the other documentation could be archieved. This would ensure that the information is more accessible to those people that need to access this information for the benefit of the people living in the home. The manager confirmed that this suggestion would be acted upon. Annual review meetings with social services were available for inspection. This ensures Care Homes for Adults (18-65 years) Page 10 of 33 Evidence: that professional practice is being followed. One identified person did not have an individual contract or statement of terms and conditions within the home. We discussed this with the manager of the home and their line manager and it was confirmed that a written contract of terms and conditions would be obtained and placed on file so that it was available for inspection. This needs to take place to ensure that the individual person is aware of what is expected of them and the home is also aware of their responsibilities. This will ensure that the rights of all parties are respected. Care Homes for Adults (18-65 years) Page 11 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Detailed care plans are in place that reflect peoples goals and changing needs.People make decisions about their daily lives, which promotes their daily needs and empowers them. The current risk assessments need to be developed further along with guidance to ensure all potential risks are identified. Evidence: The care plans were inspected and in relation to one identified person the information was located across a number of different documents. However the information was comprehensive, detailed and individualised. We noted that the care plan had been reviewed. The identified people had had a review six weeks after moving into the home. A further social services review had taken place after this. We advised the manager of the home that the care plan can be reviewed at any point when a change takes place without waiting for Social Services to call a formal review. We noted that the last review for this identified person recommended that they be referred to a psychologist. We confirmed in a conversation with the manager that they follow up on these recommendations and do all they can to access these services for this person. Care Homes for Adults (18-65 years) Page 12 of 33 Evidence: This will assist to ensure their individual needs are met. Another persons care plan is still being further developed, as minor gaps exist. The manager and staff team are working hard to develop this care plan.The care plans also need to be signed and dated by the person the care plan refers to. This further evidences that they are fully involved in the planning process. People living in the home make decisions about their lives this is evidenced in the care plan. On the day of the inspection one identified person wanted to visit another person in hospital and their request to do this was supported by the staff working in the home. Risk assessments were evidenced and covered a number of topics including, shopping, cooking and accessing the community. However some of the risk assessments needed updating for example one identified persons medication had changed and the risk assessment needed to be updated to reflect this. This will ensure that all identified risks are minimised. We could see that the risk assessments specified strategies for reducing risk but did not give guidelines in relation to what to do if strategies failed for example if incidents relating to a persons behaviour took place when they were out in the community. Care Homes for Adults (18-65 years) Page 13 of 33 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. Peoples personal development is promoted and encouraed. People undertake appropriate activities both inside and outside of the home. People are actively encouraged to maintain their relationships. This promotes their emotional wellbeing. Peoples rights are respected within their daily lives which makes them feel valued. People are supported to choose healthy nutritious meals, which benefits their health and wellbeing. Evidence: Currently only two people live in the home. The one person at the home on the day of the inspection had their own activity plan for the week which had been discussed and agreed with the person concerned. A range of activities are undertaken and the examination of the records and feedback from the staff and the person at the home at the time of the inspection confirmed that people walk to the park, shops, go swimming, attend a day centre. One identified person enjoys bus rides to the west Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: end. In discussion with the manager of the service we were informed that one persons routine is to get up around 7 a.m in the morning and complete their personal care, have breakfast and then undertakes some food preparation for their dinner later that day. This structured start to the day appears to be ideal for this identified person.This person spoke with great enthusiasm with regard to the activities that were undertaken. We felt that his activities programme was meeting the persons needs needs well. There are a range of activities to promote and develop peoples independence. These include, changing their own bedding, cleaning their own bedrooms and making their own dinner with staff when required.This assists to promote their independence. We saw evidence that staff do assist people in the community if that is what the person needs to ensure they have the opportunity to develop and achieve their identified goals. On the day of the inspection one of the people living in the home was in hospital and was visited by the people living in the home with staff support and taken items of their choice. The home does not own there own means of transport people living in the home use public transport and when necessary taxis to access the community. A number of activities are provided within the home. People can watch the television. People also have music centres, televisions and books in their bedrooms. This ensures their are opportunities for them to be stimulated at home. This prevents the people living in the home from becoming bored and allows the people living in the home to socialise together. People living in the home have regular contact with their family and friends. On the day of the inspection one person discussed with the inspectors the fact that their relatives visit and produced pictures of their family members. Another person that was not at home at the time of the inspection visits their family and stays with them at weekends. This promotes peoples emotional wellbeing and it makes them feel secure. During the conversation it was also confirmed by one identified person that they go to church on a Sunday. This assists to ensure that their religious rights are promoted and respected. All of the people living in the home have a key to their bedroom and use it if they wish to which means their rights are respected. One person spoken to on the day of the inspection confirmed they do use their key to lock their room. Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: The homes menu was seen and offered a range of varied meals. There was clear evidence that the two people living in the home store the the identified food that they have chosen in identified areas of the fridge. Food was appropriately stored.The kitchen was clean and tidy. The fridge and fridge -freezer were inspected and were hygienic. Clear records were being kept with regard to fridge and fridge-freezer temperatures. There were colour coded chopping boards to prevent cross contamination during the preparation of food. This protects the health and wellbeing of the people living in the home and the staff that work there. One person spoken to on the day of the inspection confirmed that they choose their own food, go shopping for their food with staff on a daily basis and assist with the preparation of their meals. Care Homes for Adults (18-65 years) Page 16 of 33 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. People receive support in a way they prefer. This means their personal wishes are respected. Peoples emotional and health care needs are met, which safeguards their health and wellbeing. Staff need to undertake identified training to ensure that the administration of medication continues to be effective. Guidelines need to be completed to ensure the good health of people in the home is promoted and protected. Evidence: The record of peoples health care appointments for the two people living in the home were inspected. We found documented evidence to indicate that people are being supported to receive all of their individual health checks. This means that peoples health care needs are being monitored.The appointments had been conscientiously completed. People living in the home have health action plans and the manager informed us that care planning information was integrated into it. We advised that the health action plan be restricted as far as possible to actions to be taken regarding health matters and the recording of actions which have been taken. The health action plan was comprehensive and personalised and had many elements.The manager was in the process of updating these further at the time of the inspection. Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: The medication and administration records were inspected and all medication had been signed for on the administration record. This means that professional procedures are being followed. One identified person chooses to use an identified gel.We advised that advice should be sought from the General practioner to ensure that this does not have an adverse effect on the persons health by acting with other medication being taken. The manager agreed to do this. The medication cupboard was inspected and found to be in order. This safeguards peoples health and wellbeing. The manager has completed an up to date document to indicate staff signatures and those that can administer medication.This is good practice. The manager is in the process of completing guidelines in relation to the use of the identified medical equipment being used. The manager has agreed to organise further training in relation to the use of this equipment for staff. At the time of completing this report the manager confirmed that training was being organised with the support of the community nurse and hospital. The manager has agreed to ensure that all staff are trained to administer medication. No staff were being allowed to administer medication without training at the time of the inspection. This will ensure that up to date information is available in the home in relation to who can administer medication.This will ensure that professional practice is promoted. The people living in the home were appropriately dressed at the time of the inspection.This promotes peoples self-esteem. Care Homes for Adults (18-65 years) Page 18 of 33 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 living in the home are able to express their views and concerns and these are appropriately responded to by the home. This makes people feel that complaints are taken seriously by the home. People are protected by adult protection policies and procedures. Evidence: We examined the complaints procedure and no complaints had been made at the time of the inspection. The manager is in the process of completing a pictorial complaints procedure. A discussion took place with the manager in relation to the format of the complaints book. When entries are made they must be dated and signed by the person entering the information. There must be documented evidence of the action taken and this needs to be taken within the timescale identified within the homes policy document. The manager has a copy of the homes complaint procedure on the homes notice board.This ensures that the document is accessible to all of the people that wish to view it. The whistle blowing policy was seen and found to be in order. This ensures that people have the necessary information to report any concerns in relation to professional practice within the home. This will benefit the wellbeing of people living and working in the home.The adult protection guidelines for the organisation were available. The adult protection procedures in relation to the relevant placing authority was also available. This means that staff are provided with the information they need to protect Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: the people living in the home from potential abuse. Staff had undertaken adult protection training. This ensures that staff knowledge and skills are being kept up to date and assists staff to protect the people living in the home from potential abuse. Care Homes for Adults (18-65 years) Page 20 of 33 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 live in a clean comfortable environment. However minor improvements that need to be made have been identified.This will then ensure that the good standards are maintained. Evidence: Acash Lodge is located in a residential area near to local shops and public transport. This assists the people living in the home to have an active role in the local community. We completed a tour of the home with the assistance of one of one person that lives there and the manager. The care home has been kept in very good condition. The six single bedrooms all have en-suite facilities which assists to promote the dignity and privacy of the people that live there. However it was noticed on the day of the inspection that two of the shower heads and hoses in the ensuite shower rooms needed to be replaced. This will ensure they were fully effective and available for people to use. The manager agreed to ensure these issues were rectified. One identified person needs to have the shower tray replaced to ensure that it is large enough for them to enjoy a shower in comfort. The ground floor toilet needs to have the ceiling painted as it is marked with a water stain and painting the ceiling will ensure people continue to live in a pleasent environment. Peoples bedrooms are personalised with their own belongings that reflect their own Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: interests. This assists people to feel valued within their own home. One identified bedroom on the top floor has no restrictor on the skylight window in the roof. The manager has agreed to seek advice from the fire authority in relation to placing a restrictor on this window given this window may be used in the event of an emergency evacuation. Currently the manager has agreed to keep this bedroom locked and this room is vacant and will not be used until the issued has been discussed and resolved. The lounge and dining area are furnished to a good standard. There is also adequate space to enable people to sit down and enjoy a meal togeather which improves their social integration. The kitchen was clean and tidy and all equipment was working effectively. This means that the home has the necessary equipment for people to lead an ordinary life. The Laundry area is situated in the basement area of the home and the manager was in the process of obtaining a new tumble dryer and ironing board.This will ensure that people have all the equipment they need to improve their independence skills. There is also a well kept garden which people can sit and relax in during the summer months. There is a small conservatory to the side of the property which provides additional communal space for people to use if they wish to use this area to relax. Care Homes for Adults (18-65 years) Page 22 of 33 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. The recruitment procedures in place contribute towards people being protected from potential abuse. Staff need to undertake identified training to meet the needs of the people living in the home. Staff are well supervised, which benefits the people living in the home as a consistent approach by staff can be maintained to assist to meet peoples needs. Evidence: The staff rota was inspected and there were adequate numbers of staff on shift to meet the needs of the people living in the home on the day of the inspection. The staff had undertaken training in relation to food hygiene, first aid,manual handling and protection of vulnerable adults training. Staff needed to undertake medication training and an email was received at the time of completing the report confirming a date for the training had been organised. A discussion took place with the manager on the day of the inspection to confirm that all staff must undertake training in relation to manual handling, infection control, health and safety ,CosHH, first aid, fire safety and protection of vulnerable adults. Evidence of this training in the form of certificates must be available on the staff file for inspection for all training undertaken. This will then ensure that the development of staff skills and knowledge is taken seriously. This will then improve the quality of care for people living in the home. Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: Staff recruitment policies and procedures and all relevant documentation were inspected and found to be in order. This ensures that people are protected from potential abuse. The supervision records of staff indicated that staff are receiving regular supervision.This means that staff are being supported to work with people living in the home in a consistent way and improves the quality of care provided to the people living in the home. Care Homes for Adults (18-65 years) Page 24 of 33 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. An effective quality assurance system is being developed to take into accout the views of the people living in the home. This assists with the self-monioring and development of the home. The notification of incidents and the portable appliance testing certificate need to be forwarded to the Care Quality Commission. However all other documentation was clearly evidenced to indicate that peoples health safety and welfare is fully promoted and protected. Evidence: The current manager is in the process of making an application to be the registered manager of the home. The manager appears to be knowledgeable with regard to the two people living in the home and their specific needs, which will assist to ensure that peoples individual needs are met. The manager of the home informed the inspectors that the views of people living in the home are obtained. The information is in the process of being compiled into a report and action is taken depending on the information received. This process is currently being developed as there are only two people living in the home currently. Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: We saw a completed survey which stated this was the best service the person had ever lived in. The manager advised us that the responsible individual calls at the home regularly and takes a view on the quality of the service being provided. We explained that under regulation 26 of the Care Home Regulations that there is an expectation that a senior person will visit the home on a monthly basis and complete a report on the conduct of the service. The responsible individual confirmed on the day of the inspection that this will be undertaken in this way. and the documentation in relation to these visits will be forwarded to the Commission. A discussion took place with the homes manager and confirmed that the Care Quality Commission has to be informed of all notifiable incidents as there is a legal requirement to do this and ensure professional practice is followed. The manager confirmed that they would ensure that this now takes place. The manager had been informing the identified persons placing authority of all incidents and had clear documentation in place in relation to this. A range of health and safety documentation was seen that included a gas certificate, electrical installation certificate, fire evacuation procedures and servicing and testing of the homes fire fighting equipment and emergency lighting. The home has a current public liability insurance certificate. Information was seen from the enviromental health department and was found to be in order. However the documentation to evidence that portable appliance testing was not available in the home and the manager was going to request the documentation from head office and forward this onto the Care Quality Commission. Care Homes for Adults (18-65 years) Page 26 of 33 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 33 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 9 15 The Responsible Person must ensure that guidelines are in place for when the strategies identified fail for example when an identified person exhibits behaviours that are challenging when out in the community. This will ensure that clear procedures are in place for staff in relation to how best to support the identified person and promote peoples health and safety. 16/07/2009 2 9 15 The Responsible Person must ensure that all risk assessments are up to date. This will ensure that the risks to the people both living and working in the home are minimised. Peoples health and safety will then be promoted. 16/07/2009 3 19 13 The Responsible Person must ensure that guidance 20/07/2009 Care Homes for Adults (18-65 years) Page 28 of 33 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 is in place for staff in relation to the use of the identified piece of medical equipment being used. This will ensure that staff have the up to date knowledge and skill to ensure that peoples individual needs are met. 4 20 12 The Responsible Person 16/07/2009 must ensure that all staff are provided with up to date medication training. This will ensure that staff can follow professional practice and safeguard peoples health and wellbeing. 5 20 12 The Responsible Person must ensure that staff have up to date training in relation to the identified item of medical equipment being used. This will ensure that staff have been provided with up to date training to ensure that peoples needs can be fully met. 6 24 23 The Responsible Person 16/07/2009 must seek advice from the fire brigade to see if a restrictor can be fitted on the skylight in relation to the 16/07/2009 Care Homes for Adults (18-65 years) Page 29 of 33 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 top floor bedroom skylight window. This will ensure that the health and safety of the people living in the home is fully safeguarded. 7 27 23 The Responsible Person must ensure that the downstairs toilet that has a water stain evident on the toilet ceiling has the ceiling painted. This will ensure that the home continues to be maintained to a high standard. 8 27 23 The Responsible Person 20/07/2009 must ensure that the shower heads and shower hoses are replaced in the identified ensuite shower rooms and the shower tray is replaced. This will ensure that all ensuite shower rooms are effective and fit for use by the people living in the home. 9 35 23 The Responsible Person must ensure that all staff undertake training in health and safety, fire safety, cosHH, manual handling, protection of vulnerable adults, infection control and 01/09/2009 20/07/2009 Care Homes for Adults (18-65 years) Page 30 of 33 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 medication training and certificates in relation for all training undertaken must be available on staff files. This will ensure that staff have been provided with the knowledge and skills to ensure that peoples needs can be fully met. 10 37 37 The Responsible Person must ensure that the Care Quality Commission is informed of all notifiable incidents. This will ensure that legal reguirements are met and professional practice is followed. 11 42 13 The Responsible Person must ensure that a copy of the Portable appliance testing Certificate is available at the home for inspection. This will ensure that all health and safety documentation is available for inspection. This will ensure that professional practice is followed. 20/07/2009 20/07/2009 Care Homes for Adults (18-65 years) Page 31 of 33 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 5 The Responsible Person is strongly recommended to ensure that the identified person has a contract of terms and conditions on file at the home and this is available for inspection. It is recommended that the one identified care plan that has minor gaps within the information is fully completed.The care plan is signed by the person the document refers to. This will evidence that the person has been fully involved in the process and has agreed with their care plan. The Responsible Person must ensure that a referal is made to the psychologist as recommended in the review documentation. This will assist to ensure that the persons needs are met. we recommend that the General Practioner is consulted about the identified gel which the identified person uses that has not been prescribed. This will ensure that there is no adverse effect from using this with other medications. 2 6 3 9 4 20 Care Homes for Adults (18-65 years) Page 32 of 33 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. 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