Care Home: Arthur Court Residential Care Home

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What the care home does well A thorough assessment is completed before someone moves in. This is done to make sure that their needs for support can reliably be met and so that they know what to expect. One person says, `(things were made) very clear when I came so that I knew in advance what I could expect and how things would be. I could ask any questions I wanted and I got honest answers`. People receive the support they need in ways that are right for them. One health and social care professional says,`(the Service) is very good at assessing needs and suggesting appropriate ways forward. It provides intensive one to one support. The people I have placed there all have complex needs and are progressing well`. People have the opportunity to undertake a suitable range of occupational and social activities. People say that they are provided with good quality meals. People are helped to stay in good physical health. This includes being supported to obtain medical assistance as and when it is needed. There are reliable arrangements for handling and dispensing medication. The accommodation is presented to a comfortable domestic standard. Security checks are completed on new support workers. This is done to help make sure that they are trustworthy people. The people who live in the Service are consulted about how their home might be improved in the future. There is a regular check made of health and safety matters. This is done to make sure that there are no particular hazards that might result in someone having an accident. What has improved since the last inspection? A number of improvements have been made since our last Annual Service Review. These include the following things: The sun lounge has been redecorated and a new floor has been laid. New settees and chairs have been provided in both of the main lounges. New beds have been provided in five of the bedrooms. One of the stairwells and one of the toilets have been redecorated and recarpeted. One bathroom and another toilet have also been redecorated. A healthy living style group has been set up. This has been done to better support people who want to improve their general health by adopting a more sustainable lifestyle.People have been introduced to a wider range of occupational and social opportunities. A quick reference guide has been introduced to make the handover meetings more efficient. This has been done so that support workers can be briefed more fully about how each person is doing. Each person can have more frequent one to one meetings with their key worker. This gives more opportunities for people to discuss and review their progress. More support workers have obtained a relevant National Vocational Qualification. All of these things enable the Service to better meet the needs of the people who live there. What the care home could do better: The staff roster does not always give an accurate account of how many support workers are on duty. This makes it more difficult for the Registered Provider to demonstrate that enough staffing provision is being made. Some of the ongoing checks that should be made of the fire safety system are not being completed. This might reduce the level of fire safety protection in place. There are shortfalls in the training that the Registered Provider says that all support workers need to receive. This might result in some support workers not having all of the knowledge and skills they need. There is one requirement and one recommended development at the end of this Report. Key inspection report Care homes for adults (18-65 years) Name: Address: Arthur Court Residential Care Home 22/24 Christchurch Road Folkestone Kent CT20 2SL     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: Mark Hemmings     Date: 1 1 1 2 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 29 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 29 Information about the care home Name of care home: Address: Arthur Court Residential Care Home 22/24 Christchurch Road Folkestone Kent CT20 2SL 01303254906 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: pauline@kentcare.com ACL Care Homes Ltd care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 19 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - MD Date of last inspection Brief description of the care home Up to 19 people who have problems with their mental health can make their home in Arthur Court (the Service). Some of the people who live in the Service have complex forensic psychiatric needs. The premises are a detached four storey property, where the basement forms one of the floors. There is a passenger lift between the floors. When full, one of the bedrooms can be shared by two people. All of the other bedrooms are single occupancy. The bedrooms are laid out as bed sitting areas. There is a bed, bedside table, wardrobe and comfortable chair. All of the bedrooms have a private wash hand basin. Three of Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 19 Brief description of the care home them also have a private toilet and two also have their own shower. Each bedroom has a television aerial point. There are two lounges, a sun lounge and internet suite, a main kitchen, a smaller kitchen for independent cooking and two dining areas. There are three shared use bathrooms and two shower rooms. One of the bathrooms has a fixed hoist. This can be used if someone has reduced mobility. There are an adequate number of toilets. On the top floor there is also a staff toilet and bathroom. There are two telephones that people can use free of charge. There is an enclosed garden at the back of the property. This has some flower beds, a small lawn and a fishpond. In one corner, there is an outbuilding for people who want to smoke. To the side, there is access to the laundry. The Service has its own vehicle. The Registered Provider is a private limited company. The Service is set in a quiet residential street that is within easy walking distance of Folkestone town centre. There is on street parking and the nearest bus stop is just down the road. The nearest mainline station is about one mile away. The weekly charge for living in the Service runs from £409.00 to £789.00. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 quality rating for this Service is 3 Star. This means that the people who use this Service experience excellent quality outcomes. We arrived unannounced at the Service at about nine oclock in the morning and we there for about seven and a half hours. It was a thorough look at how well things are going. We took into account information provided by the Registered Provider in its self assessment. This is called the Annual Quality Assurance Assessment (the Assessment). We received this on time. It is adequately detailed. Further, we considered any information that we have received about the Service since our last Key Inspection. We completed this on 23 January 2007. We have done two Annual Service Reviews since then. The most recent of these was completed on 27 February 2008. This was an office based activity when we looked at all of the information we had about the Service at that time. During the inspection, we spoke with five people of the people who currently live in the Service. We spent time in the presence of four more people as they were relaxing in Care Homes for Adults (18-65 years) Page 6 of 29 the main lounge and were generally about the place. We spoke with both of the Directors of the company that is the Registered Provider. We also spoke with the Registered Manager and with six support workers. We looked around parts of the accommodation and the grounds. Also, we looked at a selection of key records and documents. These included things like the individual written plans of support, medication records, the activities plan, the menu, the staff roster, staff training records, financial records, policies and procedures and various health and safety certificates. Before we visited the Service, we asked various people to fill out a questionnaire for us. We wanted them to tell us what they think of Arthur Court. Fourteen of the people who live there, 11 support workers and two health and social care professionals kindly completed them for us. Later in our Report we will tell you some of the main things they are saying in their replies. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? A number of improvements have been made since our last Annual Service Review. These include the following things: The sun lounge has been redecorated and a new floor has been laid. New settees and chairs have been provided in both of the main lounges. New beds have been provided in five of the bedrooms. One of the stairwells and one of the toilets have been redecorated and recarpeted. One bathroom and another toilet have also been redecorated. A healthy living style group has been set up. This has been done to better support people who want to improve their general health by adopting a more sustainable lifestyle. Care Homes for Adults (18-65 years) Page 8 of 29 People have been introduced to a wider range of occupational and social opportunities. A quick reference guide has been introduced to make the handover meetings more efficient. This has been done so that support workers can be briefed more fully about how each person is doing. Each person can have more frequent one to one meetings with their key worker. This gives more opportunities for people to discuss and review their progress. More support workers have obtained a relevant National Vocational Qualification. All of these things enable the Service to better meet the needs of the people who live there. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. 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 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is written information about the facilities and services provided in the Service. People who are thinking of moving in are asked about what support they need and how they want this to be done. They are encouraged to visit the Service to get a first hand feeling of what it is like. People are told about the rights they will have when they move in and about their responsibilities. Evidence: Before someone moves in one of the Directors and the Manager meet with them so that they can find out what support they need and want. They also talk with health and social professionals such as mental health specialists and care managers (social workers). All of this is done to help them to build up a really good picture of how the person can best be supported. The person is then invited to visit the Service, usually on several occasions. This is done so that everyone is confident that moving into Arthur Court is the right thing to do. One person says, I came to have a look around lots of times to see whats what and to see if I liked the place and wanted to try out living here. Its been good and a place to go after hospital. Im settled here now and I accept the various rules that I need to keep to. I might moan now and then but I Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: know the doctor says that I need them. Another person says, (things were made) very clear when I came so that I knew in advance what I could expect and how things would be. I could ask any questions I wanted and I got honest answers. It wasnt painted out as being all rosy so that I could do what I wanted all the time. I was told about rules such as going out and being reasonable to other people. The Manager says that before someone moves in, she shares the information she has learnt with the support workers. One support worker says, we are told about new people long before they arrive so that we can get prepared to help them. There are usually quite a few introductory visits which are important because we can meet the person and start to get to know them as an individual. Some of the people who live in Arthur Court intend to make it their longer term home. Most though intend to use it as a stepping stone. This means that they want to practice the skills they will need for living more independently in the future. Care Homes for Adults (18-65 years) Page 12 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive the support they need in ways that are right for them. People are supported to manage their financial affairs. There is a sensible approach to risk taking. Evidence: Each person has an individual plan of support. These plans help support workers provide the right assistance for people. The plans are kept up to date by the support workers making daily notes. There is a key worker system. This means that each person has a support worker who takes a special interest in their wellbeing. Each person meets with their key worker on a one to one basis. Recently, the frequency with which these meetings can be held has been increased. This has been done so that people can receive assistance more quickly. Most people are actively supported by a specialist mental health team from the local health authority. This means that the plans of support are further reviewed within a detailed psychiatric framework. Support workers know how to respond to each person in ways that are helpful for them. One support worker says, its really, really important that we all know how Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: each person is going to be supported because they need consistent support that is the right thing for them. Its no good one person doing one thing and another member of staff doing something else. We talk about each person so that we all do the same thing to support them. In their questionnaire replies everyone says that they always receive the support they need. One person says, I meet with my key worker often so that I can talk about how things are going for me and work out what I need to do. One health and social care professional says, (the Service) is very good at assessing needs and suggesting appropriate ways forward. It provides intensive one to one support. The people I have placed there all have complex needs and are progressing well. Sensible steps are taken to support people to lead everyday lives of their own choosing. This includes support workers helping people to take sensible risks and to avoid situations that might be harmful. For example, some people need to be supported so that they are kept safe when they are out and about in the local area. The Registered Provider does not get directly involved in managing peoples financial affairs. Most people receive help from the local authority. The Registered Provider does help people set up the arrangements they will need for accessing their personal spending money. For example, people are helped to start up and operate their own bank account. Care Homes for Adults (18-65 years) Page 14 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are interesting occupational and social things for people to do. People are free to receive visitors and to spend the day as they wish. Good quality meals are served. Evidence: There is a range of occupational things that people can do if they want to. These include doing college courses, voluntary jobs, household tasks and undertaking their own shopping. There are also social things to do such as going out to places of interest and pursuing particular interests such as using computers and the internet. There was a lively atmosphere when we were in the Service. Some people were sitting in the main lounge relaxing, others were in the computer suite where they were on the internet. Some were in their bedroom and others were in town doing their shopping. One person says, we have a plan of the things we do each day. Ive worked this out with my key worker but all the staff know what it says and what I should be doing. I pretty much keep to it because its what Ive already agreed to and its things Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: that need to be done like laundry and cleaning my room and keeping on top of things. The Assessment says that the range of things that people can do is kept under review. It says that new and different opportunities continue to be offered. Each year people can choose to go abroad on holiday. They are supported to save up for these trips. The cost of these holidays is heavily subsidized by the Registered Provider. In the last year there have been various trips to Corfu, Gran Canaria and Egypt. In their answers to our questionnaire people say that they are happy with what they do each day. One person says, I go out and do what I want within reason. Im expected to be back at certain times which is fair enough because they need to know where I am. I dont get bored really Ive got plenty to do, Im not a child. Another person says, I like to be at home quite a lot because there is always something going on to see. I do go out and I went on holiday this year which was great. People are helped to keep in touch with members of their families. This includes using e-mails. Family members and friends are welcome to call to the Service at any reasonable time. People are encouraged to make their bedrooms their own private space. The bedroom doors have locks on them so people can keep their possessions secure if they want to. Some people are being supported to do their own catering. This involves shopping for food and then preparing their own meals. Other people prefer to have most of their meals prepared for them. One person says, I avail myself of the cooks dinners and they are very good in general. We have lots of choice and theres always enough to eat. Too much really, I need to lose some weight. One of the support workers says, there is always plenty of food in the Service and the residents get good meals from the cook. The diet is normally nothing fancy just the meals that you and I would take for granted. Theres always plenty to eat. The records show that people are having a normally varied and balanced diet. Care Homes for Adults (18-65 years) Page 16 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are helped in ways that are right for them. They are helped to stay well. There are safe systems to manage medicines. Evidence: The support workers are relaxed and informal in how they are. They help people to organise themselves without being intrusive. People are helped to wear neat and clean clothes so that they can look how they want. One person says, I get on well with the staff. They are good really and friendly. Its not like in hospital with nurses and stuff. This has a family feeling to it. You can talk to staff and theyre really interested in you. They wont do things for you that you can do for yourself but theyll give you advice. Another person says, theyre good and treat me okay, they always help even if I might be a bit cranky sometimes. Someone else says, I like to stay up a bit later than some of the others. Thats okay with staff as long as I dont make it too late and as long as were quiet enough to respect people who go to bed a bit earlier and want it quiet. For example we keep the television down if its later. In their questionnaire replies everyone says that support workers listen to them and act on what they say. People are helped to keep healthy. The records show that support workers keep a Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: tactful eye open so that a doctor can be called if someone is becoming unwell. People are supported to attend medical appointments if this is what they want and need. A new healthy living style group has been set up. This provides people with information about things such as the benefits of physical exercise and healthy eating. Some people are supported to manage their own medication. This involves support workers checking out that they are taking their medicines at the right time and in the right way. Support workers manage medication for other people who at the moment are not able to do it for themselves. There is a system to check that the correct medicines are received from the chemist. Once in the Service, medicines are stored securely. The Assessment says that all members of staff who give out medication have been trained so that they know what they are doing. There is a procedure for administering medicines. This is designed to double check that the right medicines are given to the right people at the right time. There is a record that is filled out on each occasion that a medicine is given. These are being completed correctly. Care Homes for Adults (18-65 years) Page 18 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a complaints procedure and there are arrangements to make sure that complaints are dealt with properly. People are kept safe. Evidence: There is a complaints procedure. In their questionnaire answers, people say that they know how to make a complaint and who to speak with if they are not happy about something. One person says, if I wanted to complain about something I would. I think staff (would) listen to me and act on what I say. I would feel confident about saying anything I need to. Another person comments, you can say what you like to staff and they will do things to put things right. The Registered Provider has a detailed policy and procedure that explains how it will investigate and resolve complaints. The Directors say that all complaints will immediately be referred to them. This is so that they can make sure that the matter in hand is resolved fairly and as quickly as possible. Since our last Annual Service Review neither we nor the Registered Provider have received any complaints about the Service. People who live in the Service are confident that they are safe and that their wellbeing will be promoted. The support workers are confident that people are being kept safe. One support worker says, (the wellbeing of the people who live in the Service) is Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: paramount. Our job is to keep people safe and to help them manage their mental health so that they lead full lives. I have never seen anything but kindness here. Its like a big family really which sounds odd given the range of needs here, but it is and we try to get people to take care of each other and to support each other. The Directors say that the Registered Provider is committed to promoting diversity in the Service. By this they mean respecting each person who lives there as an individual who is inherently valuable in their own right. One of the Directors says,(we are) fully committed to providing people with a service that maintains and promotes each persons dignity and which supports their ability to choose and their self worth. The main principle is that we help people to live with mental ill health not for it. The records show that as part of their introductory training support workers receive guidance about the need to guard against any form of prejudice or discrimination. The Manager says that this commitment to promoting diversity is also expressed in practical terms. For example, in the way that each person receives individualised support that recognises their abilities, preferences and wishes. New obligations have been placed on all registered providers for managing situations in which it may be necessary to deprive someone of some of their liberties. The Registered Providers responsibility is to make sure that any limitations will only be done in the best interest of the person. The Directors say that they have the necessary systems to deliver the additional safeguards. Care Homes for Adults (18-65 years) Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The accommodation is comfortable. Some of the routine fire safety checks are not being completed. The kitchen is well equipped. There is a suitable laundry. Evidence: The building provides a suitable range of facilities for the people who live there. These are in line with what the Registered Provider has committed itself to deliver in its Statement of Purpose. This is a legal document that the Registered Provider has to have to describe the Service. Copies of the document can be obtained from the Registered Provider. The building is well maintained on the outside. On the inside, the accommodation in general is decorated to a comfortable domestic standard. A number of improvements have recently been completed. The sun lounge has been redecorated and a new laminate floor has been laid. New settees and chairs have been provided in both of the main lounges. New beds have been provided in five of the bedrooms. Some of the stairwells and one of the toilets have been redecorated. A new shower has been installed. The Directors say that this programme of improvements will continue. There is a modern automatic fire detection system. Some of the ongoing checks that should be completed to make sure that the system remains in good working order are Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: overdue. There is a requirement about this matter at the end of this Report. The local Department of Environmental Health says that the kitchen is well equipped and that it is being run in the right way. The kitchen is clean and organised. The records show that the refrigerator and the freezers keep foods cold enough. There is also a system to make sure that foods are used promptly once they are opened. The Manager says that good food handling practices are in use. People say that the accommodation is kept comfortably warm. The radiators are fitted with guards. This has been done to reduce the chance that someone will be burnt if they fall against them. The hot water system is temperature controlled. This has been done so that the water does not get hot enough to scald someone. There are an adequate number of bathrooms and toilets. There is also an adequate amount of communal space. The laundry is in an outhouse at the back of the property. It is clean and well organized. There are three washing machines. There is no dryer. There is an area in the laundry where clothes can be hung to dry. There is also an outside drying line. Most of the people who live in the Service do their own laundry. One person says, I have a set day when I do my laundry and I then have to get it dried and sorted so that I have enough to wear. My key worker helps me out with this in that she reminds me each week about when it needs to be done so that it doesnt get on top of me. Care Homes for Adults (18-65 years) Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff roster is not accurate. There are enough support workers on duty. Support workers have the necessary skills to support people in ways that are right for them. Security checks are completed on new support workers. Evidence: The various records show that there are at least three support workers and one team leader on duty from early in the morning until later in the evening. Often, there are additional support workers on duty. There is also a cook on duty during the afternoon. There is a waking staff presence at night. In their questionnaire replies support workers say that there are enough members of staff on duty. One support worker says, we do have enough staff on duty because the guys want to do their own things and dont need contact with us all the time. They need their own time and space and dont need to be rushed along. Theyre settled and make gradual progress. When we were in the Service, we kept a look out for things that might give us a clue about how well the place is being staffed in practice. We noticed that one person was being given individual support to organize preparing their lunch. Another person was being helped to get onto the internet. A third person was being supported to plan their food shopping. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: Parts of the written staffing roster do not give an accurate account of who is on duty at any particular time. Without this it is more difficult for the Registered Provider to demonstrate to us how aspects of the staffing arrangements work in practice. The Directors say that in future the roster will give an accurate description of how the Service is being staffed. The records show that the Registered Provider completes a number of security checks on new support workers. These include things such as confirming their identity, taking up references and doing a police check. This is done to make sure that they are trustworthy people to work in the Service. One support worker says, I came for a full interview and I know that they took up references and the police check before I started. It was all very thorough. I knew from that they would be a good employer as indeed they have turned out to be. Everyone is very approachable including (the Directors). In their questionnaire replies support workers say that they received sufficient introductory training when they first started working in the Service. One support worker says, I really did get good training when I came. I wasnt sure if I could do it and they gave me plenty of time to get used to the residents and then I was helped to begin to understand their mental health needs and how each person has individual needs about how they are supported. Its a skilful team of staff here and I have been given a really good introduction to working with mental health. The Registered Provider wants all support workers to receive ongoing training. The records show that there are some gaps in this provision. The Directors recognize this and they have appointed a new training consultant. Her role will be to develop a new system to make sure that everyone receives the training that they need. There is a recommendation about this matter at the end of this Report. Most of the support workers have now completed a relevant National Vocational Qualification (NVQ). This Award is designed to further develop their ability to provide people with the assistance they need. Care Homes for Adults (18-65 years) Page 24 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Service is well managed. The Manager is registered. There is a quality assurance system. There are suitable health and safety arrangements. Evidence: The Manager is registered with us. She has worked in the Service for a number of years. She has both of the two formal qualifications that are recommended by the National Minimum Standards. Both of the Directors have relevant management and academic qualifications. The Directors and the Manager work together as a team. The Manager is based in the Service and the Directors call to the Service almost every day. Between them they have a thorough knowledge of how the Service runs in practice. Support workers say that there is good team work between them. There are handover meetings at the beginning and end of each shift. A new recording system has been introduced to help make sure that these meetings thoroughly review each persons progress. One support worker says, the handovers are very important because we Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: need to provide a consistent service, the last thing the residents need is any break down of communication. That could result in them feeling uncertain and that would have a bad effect on their mental health. Another support worker says, (the Manager) is great. Shes always there to help and to give advice. You really feel that you are part of staff team that all pulls together. People who live in the Service are regularly asked what they think about their home as part of everyday life. Also, there is a system of monthly house meetings. These are where people who live in the Service can review how things are going and can suggest improvements. Recently, the Registered Provider has asked people if they are satisfied with what is done to consult with them. The results show that people consider themselves to be fully involved in decisions that are made about their home. There is evidence to show that changes are made when people suggest improvements. The records show that there are regular fire drills. There is also a system that makes sure that all members of staff know how to operate the fire safety procedure. The records show that all items of equipment used in the Service remain in good working order. The records show that there have not been many accidents or other adverse events in the Service since our last Annual Service Review. The Manager says that she monitors each event. This is done so that she can see if they can be prevented from happening again. The Registered Provider has a system of completing health and safety audits. These are done to help make sure that there are no hazards that might result in someone having an accident. There is evidence that when something is noticed it is quickly put right. The Manager says that there are no particular hazards that need to be addressed at the moment. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 24 23 The Registered Provider must consult with the local fire authority to confirm what checks need to be completed of the operation of the Services fire safety equipment. To ensure that an adequate level of fire safety protection is maintained. 01/01/2010 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 35 The Registered Provider should ensure that all support workers receive the training that is specified for them in its training plan. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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