Care Home: Ashcroft

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What the care home does well Residents continue to live in a clean and homely environment, which is decorated and maintained to a good standard. A health care professional described the environment as "always clean and tidy". Residents clearly benefit from the gentle, relaxed and age appropriate lifestyle provided at the home. All persons consulted about the home spoke positively about their experiences. Residents commented "everything happens here in a slow relaxed way" and "I like living here best bit is my freedom to go out by myself when I want". Relatives fedback "they go to extremes to comfort the fragile and immobile and boost their confidence" and "I have no complaints what so ever about the home he is happy and enjoys living there and would have no hesitation in telling Mike if there were any problems". A health care professional commented "It has a nice atmosphere to it and the home easily is able to meet my clients needs. It is a very positive place they promote his independence it is a familiar home and set up for him and staff provide as much support as he needs". Resident`s continue to benefit from personal and health care support that is individual, respects their privacy and dignity and encourages them to remain as independent as possible. A social care professional fedback "it is a very positive place they promote his independence it is a familiar comfortable home and set up for him". A health care professional fedback "I have never had any worries or problems with the care I perceived the clients are getting". Prompt medical advice and intervention is sought. A resident fedback "if not feeling well, they will call a GP or give me an ice pack on my head if I have a migraine they are very thoughtful". Residents are supported to make decisions in their lives and to participate, where possible, in the running of the home and in planning the support they receive. The routines of daily living are determined by the needs and wishes of residents. A resident said "I like living here as I can do as I like". Resident`s benefit by being supported to maintain relationships with their families and friends and their lives enhanced by being able to participate in age appropriate activities if they wish. The meals are good offering flexibility, choice, variety and catering for specialist dietary needs. Residents comments on food included "food looked after very well" and "food is good". Residents benefit from a staff team who are generally well trained and that know them and that have been robustly recruited and employed in sufficient numbers as is necessary to meet their needs. Without exception all persons consulted spoke positively about the staff. Comments made by residents included "fantastic encouraging, kind, compassionate, easy to get on with people, born to care humours, relaxed professionalism" and "staff can understand what I want and are very kind". Relatives feedback included "staff are knowledgeable about his needs" and "they use only experienced well trained and motivated staff". Resident`s benefit from a management team that is experienced and continues to develop their knowledge of good practices and legislation and who promotes a resident led service. A relative commented "Mr Ramful very helpful he has the residents best interest at heart" The home continues to acts on any feedback it receives regarding the quality of its services and facilities. A staff member fedback "mike welcomes ideas from staff and is happy to changes things". What has improved since the last inspection? In accordance with the previous requirement the commission is now being notified of any reportable events occurring at the home. The provider`s knowledge of his roles and responsibilities has improved significantly. This has helped to ensure that resident`s wellbeing and safety is being promoted through the correct reporting to external agencies of any specific events, allegations or accidents. The provider reported that further opportunities have been provided for residents to access the community through more outings. What the care home could do better: In order to ensure that residents mobility needs can be fully met and further promote their independence, additional environment adaptations and furniture is needed. To further improve staffs knowledge and skills of good working practices in supporting people who have a learning disability or mental health needs additional training in these areas is needed. The provider is aware of the need to continue with the external redecoration of the premises and agreed to complete this by spring 2010. Key inspection report Care homes for adults (18-65 years) Name: Address: Ashcroft Ashcroft 1 Wiggie Lane Redhill Surrey RH1 2HJ     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: Jane Jewell     Date: 0 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 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Ashcroft Ashcroft 1 Wiggie Lane Redhill Surrey RH1 2HJ 01737789656 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Roopesh Ramful care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 5 The registered person may provide the following category 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 category: Learning disability (LD) Mental disorder, excluding learning disability and dementia (MD) Date of last inspection Brief description of the care home Ashcroft is a semi-detached domestic house situated in a residential area half a mile from Redhill town centre. The home provides care and accommodation for up to five people who have a learning disabilities or a past or present mental health condition. Currently all residents are male and the majority are over sixty five years old. The home is owned by Mr and Mrs Ramful since 1990. Mr Ramful is the registered provider and Mrs Ramful is the registered manager. Care Homes for Adults (18-65 years) Page 4 of 31 1 0 1 2 2 0 0 8 5 5 Over 65 0 0 Brief description of the care home The home is presented across two floors with stairs providing access to the first floor. Resident accommodation consists of five single occupancy bedrooms which provide wash hand basins. Communal space consists of a kitchen, conservatory, lounge and office. There is a small rear court yard garden. The homes literature states that it aims to make sure that the care provided within the home is personal and unique. The provider reports that the fees for residential care are currently £450.00 to £977.00 per week, depending on the services and facilities provided. Extras such as: newspapers, hairdressing, chiropody, toiletries are additional costs. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: The quality rating for this service is Two star. This means the people who use the service experience Good quality outcomes. The information contained in this report has been comprised from an announced inspection undertaken over four hours, from 10:30am to 4.30pm, and information gathered about the home before and after the inspection. The provider had completed an Annual Quality Assurance Assessment (AQAA) within the date requested. This provided a good standard of information about the home which was used to inform the inspection process. This is the homes second key inspection within twelve months. The inspection was facilitated by the Provider (Mr Roopesh (Mike) Ramful) and the registered manager (Mrs Aruna Devi Ramful). The focus of the inspection was to look at the experiences of life at the home for people living there and the progress made towards addressing the shortfalls noted at the previous inspection. Care Homes for Adults (18-65 years) Page 6 of 31 The inspection consisted of being shown the communal areas, and being invited to view residents bedrooms, examination of the homes documentation and observations of residents daily routines and in their interactions with staff, during lunch time and over the morning and afternoon period. Four residents, two staff, a social care professional and a relative were consulted as part of the inspection process. Feedback surveys were sent to the home for distribution, in order to obtain the views on the quality of the services and facilities being provided. Nine were returned in total, four from residents who were supported to complete the form, one from staff, one from a relative and three from health care professionals. Their feedback is included in this report. There were four residents living at the home at the time of the inspection. Although the homes registration is for the care and accommodation of people who have a learning disability as the majority of residents accommodated are over the age of 65 years some key National Minimum standards for Older people have also been taken into consideration as part of this inspection. This includes Standards: 10( Privacy and Dignity) and 22 (Adaptations /Equipment). Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: Residents continue to live in a clean and homely environment, which is decorated and maintained to a good standard. A health care professional described the environment as always clean and tidy. Residents clearly benefit from the gentle, relaxed and age appropriate lifestyle provided at the home. All persons consulted about the home spoke positively about their experiences. Residents commented everything happens here in a slow relaxed way and I like living here best bit is my freedom to go out by myself when I want. Relatives fedback they go to extremes to comfort the fragile and immobile and boost their confidence and I have no complaints what so ever about the home he is happy and enjoys living there and would have no hesitation in telling Mike if there were any problems. A health care professional commented It has a nice atmosphere to it and the home easily is able to meet my clients needs. It is a very positive place they promote his independence it is a familiar home and set up for him and staff provide as much support as he needs. Residents continue to benefit from personal and health care support that is individual, respects their privacy and dignity and encourages them to remain as independent as possible. A social care professional fedback it is a very positive place they promote his independence it is a familiar comfortable home and set up for him. A health care professional fedback I have never had any worries or problems with the care I perceived the clients are getting. Prompt medical advice and intervention is sought. A resident fedback if not feeling well, they will call a GP or give me an ice pack on my head if I have a migraine they are very thoughtful. Residents are supported to make decisions in their lives and to participate, where possible, in the running of the home and in planning the support they receive. The routines of daily living are determined by the needs and wishes of residents. A resident said I like living here as I can do as I like. Residents benefit by being supported to maintain relationships with their families and friends and their lives enhanced by being able to participate in age appropriate activities if they wish. The meals are good offering flexibility, choice, variety and catering for specialist dietary needs. Residents comments on food included food looked after very well and food is good. Residents benefit from a staff team who are generally well trained and that know them and that have been robustly recruited and employed in sufficient numbers as is necessary to meet their needs. Without exception all persons consulted spoke positively about the staff. Comments made by residents included fantastic encouraging, kind, compassionate, easy to get on with people, born to care humours, relaxed professionalism and staff can understand what I want and are very kind. Relatives feedback included staff are knowledgeable about his needs and they use only experienced well trained and motivated staff. Residents benefit from a management team that is experienced and continues to develop their knowledge of good practices and legislation and who promotes a resident led service. A relative commented Mr Ramful very helpful he has the residents best Care Homes for Adults (18-65 years) Page 8 of 31 interest at heart The home continues to acts on any feedback it receives regarding the quality of its services and facilities. A staff member fedback mike welcomes ideas from staff and is happy to changes things. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience 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 good range of accessible information available about the home and the services and facilities it provides, in order to help residents and their families make informed choices. The home is able to identify and meet most needs of the people whom it supports and who have a range of low to medium assessed needs. . Residents are admitted on the basis of a comprehensive needs assessment to ensure that their needs can be met by living at the home. Evidence: The homes statement of purpose, which is a book that tells people who the home is for and the service users guide, which is the book that tells people how the home works, provides a range of information about the home and the services it provides. These documents have been reviewed and now provide some information in a picture format to make them more accessible to some residents and are displayed within the home. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: Although there has not been any new admissions to the home for many years, several needs assessments have been completed by the provider to assess the suitability of prospective residents for a recent vacancy. Information about the prospective residents were gathered from a variety of sources including the resident, their representative and health care professionals. This helped to ensure that as much information was gathered about the individuals assessed needs, to enable the provider to base their decision as to whether needs could be met by the home. Good practises were noted in a residents needs being re-assessed following hospital admissions and prior to any discharge back to the home. This identified the changes in their mobility needs and the environmental changes that would be needed to be able to accommodate their changing needs. There continues to be a range of residents needs being accommodated at the home with the majority of residents assessed as having low to medium level of needs. This includes residents who have, learning disabilities, residents who have mental health needs and residents who now have significant physical needs. All Current residents are male with ages ranging from late 50s to mid eighties and who have lived at the home for many years. It remains clear that the home continues to meet residents needs through providing a relaxed gentle lifestyle which suites the needs of older people. However some further environmental adaptations are need to ensure that mobility needs can be fully addressed. This is discussed under standard 29 of this report. All persons consulted about the home spoke positively about their experiences. Residents commented everything happens here in a slow relaxed way and I like living here best bit is my freedom to go out by myself when I want. A relative fedback they go to extremes to comfort the fragile and immobile and boost their confidence. A health care professional commented it has a nice atmosphere to it and the home easily is able to meet my clients needs. It is a very positive place they promote his independence it is a familiar home and set up for him and staff provide as much support as he needs. The manager confirmed that any prospective residents would be provided with the opportunity to visit the home in advance to assess the quality, facilities and suitability of the home with their family and representative and to be able to assess the compatibility with the current residents. The length and type of any visit would depend on the individuals needs and preferences. Residents are provided with a written contract of terms and conditions of residency with the home. This is used with residents and their families to make explicit the placement arrangements and clarify mutual expectations around rights and Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: responsibilities. A signed copy of the contract is retained in residents files. Care Homes for Adults (18-65 years) Page 13 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a person centred care planning process, which provides clear, up to date and accurate information about their needs which helps staff to provide consistent individual support which is based on each residents individual needs and preferences. The home balances the rights of residents to take reasonable risks as part of an independent lifestyle. Residents are supported to make decisions in their lives and to participate, where possible, in the running of the home and in planning the support they receive. Evidence: Each resident has a comprehensive person centred care plan in place which is designed to enable personal, health, communication, social, cultural and religious needs of each resident to be addressed. Four person centred plans were sampled Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: which had been implemented in consultation with residents and who had been involved in their development and review. Any changes in residents needs and preferences are identified through the regular review of care plans. Staff consulted with demonstrated a good understanding of the assessed needs of each residents and how they supported them to ensure they received continuity in their care. A social care professional fedback that whenever there is agreed action for the provider to take in response to their external review of the placement, that this has always been actioned. The home balances the rights of residents to take reasonable risk as part of an independent lifestyle against the risks faced and posed by themselves or others. This is generally supported through the written assessment of risks for example in areas such as diabetes, mobility, environment and self medication. To further support the management of risk however the manager agreed to assess a residents independent access to the community to help any potential areas for additional support. Residents were encouraged to make decisions in their daily lives and were heard to be given choices by staff about how they wanted to occupy their time and what they wanted to eat and drink. Consideration has also been given to new legislation (Mental Capacity Act) which affects residents rights to make decisions in their lives. The provider reported that they have attended training in this area and are looking at introducing capacity assessments as part of the care planning process in order to ensure that residents rights are being protected. There are many ways that residents participate in the daily running of the home which include undertaking light domestic chores such as shopping cleaning, light cooking and deciding how to spend their time. Staff consulted with showed a good understanding of good practises in preserving residents rights to privacy and dignity. Staff were able to give examples of how they promote these rights in their every day care practises. Residents confirmed that staff always knock on their bedroom doors and wait to be invited in and are always polite and respectful when assisting with any personal care. Care Homes for Adults (18-65 years) Page 15 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have opportunities to take part in age appropriate activities if they wish. The routines of daily living are determined by the needs and wishes of residents. Residents benefit by being supported to maintain relationships with their families and friends. The meals are good offering flexibility, choice, variety and catering for specialist dietary needs. Evidence: Services are generally designed to encourage residents to remain as independent as possible with residents enabled to maintain previous life skills learnt through participation in the daily running of the home or through part time employment. A health care professional fedback it is a very positive place they promote his independence it is a familiar comfortable home and set up for him . Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: There is a very flexible approach to organised activities and leisure pursuits with most residents saying they preferred to occupy their own time. A residents said activities prefers to sit in my bedroom but can join in if I want. A resident has a home entertainment system in their bedroom and derives much enjoyment from using it. Another resident enjoys drawing and was provided with all the materials they needed. Residents spoke of enjoying going for rides out, visiting a local church, local walks, pub evenings and shopping centres. All but one resident went on a holiday in the last year which they spoke of enjoying. Residents were looking forward to an immanent Christmas lunch at a restaurant with the provider manager and staff. Staff spoke of the range of occupations provided in the evenings which included playing scrabble and watching TV together. The home has its own transport which currently only the manager and provider are able to drive. The provider spoke of changing the vehicle in the new year to one more suited to people with more restricted mobility. This would then enable residents with a more restricted mobility to be able to access the community more easily. It was evident that residents are supported and encouraged to maintain links with their family and friends, through telephone contact and visits where possible. A relative commented that the home is very welcoming when they visit and are offered refreshments. Where residents have no close family or friends the provider fedback that they have tried to obtain independent advocates. Residents consulted continue to comment on the flexibility in the daily routines and the staffs respect for personal freedom and lifestyles. A resident fedback I like living here as I can do as I like. Two residents have their own front door key. It was evident that the routines of the day were determined by the needs and preferences of the residents for example what time residents rise or ate their meals. Although there is a formal menu plan each week this is used as a guide with residents confirming that there is much flexibility depending upon their preferences at the time. All residents spoke largely positively about the food, comments included the excellent quality of the food even when requesting a quick snack food looked after very well and food is good. A resident spoke of the specialist diet that they receive in accordance with their culture and health needs. A resident had a diabetic plan in place to ensure that staff had the guidance they needed to support this individual with a balanced diet. Another resident fedback that sometimes meals are cooked too early, this was relayed to the provider who was already aware of this and had taken steps to address this. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents continue to benefit from personal and health care support that is individual, respects their privacy and dignity and encourages them to remain as independent as possible. The medication systems are generally well managed promoting good health. Evidence: The majority of residents do not require direct personal care instead, staff provide emotional and practical support which residents continue to confirm is provided in ways that promoted their dignity and independence. Care plans provide clear guidance for staff on how to meet the changing physical needs of one resident. Residents are supported to access a range of health care services, to meet their individual needs. This included GPs, district, diabetic and community psychiatric nurses, dentists, psychologist and opticians. Residents confirmed that prompt medical advice or support is sought with a resident saying if not feeling well, they will call a GP or give me an ice pack on my head if I have a migraine they are very thoughtful. Staff spoke of the support they have received from various health care professionals Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: to be able to meet the health care needs of one resident, upon their discharge from hospital and the significant improvement to their health which have occurred. A health care professional fedback I have never had any worries or problems with the care I perceived the clients are getting. One resident is assessed as wishing to self medicate, which is supported by appropriate risk management strategies. Care plans now include a medication profile which records the medicine and any side effects for each resident. The medicine administration practises observed was seen to be safe and the records demonstrated that systems have been established to ensure staff are appropriately trained and records are accurate and provide a history of what was given by who and when. However it is recommended that additional instructions are provided for staff on the administration of As required medication, which make clear the individual requirements for when this medications was prescribed. This would help to ensure that staff know when to administer these medicines. The manager and staff continue to demonstrate a good awareness of the needs of older people and services and facilities were aimed appropriately for the age range of residents. Some environmental adaptations have been undertaken to accommodate a residents decreased mobility since the previous inspection. The manager demonstrated a clear knowledge of when a residents needs would go beyond that which the home could safely manage. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An effective complaints procedure and appropriate adult protection policies helps to protect the rights and interests of residents. Evidence: There is a written accessible complaints procedure in place for residents, their representative and staff to follow should they be unhappy with any aspects of the service. All residents and relatives consulted with said that they were aware of how to raise any concerns and continue to feel comfortable to do so and that where they have done so their concerns have been addressed promptly. A relative confirmed I have no complaints what so ever about the home he is happy and enjoys living there and would have no hesitation in telling Mike if there were any problems. The manager reported that there have been no formal complaints made since the previous inspection. When residents raise minor concerns relating to some of the difficulties of communal living, residents confirmed that the provider addresses these promptly and tries to be fare to everyone. There are written policies covering safeguarding adults and whistle blowing. These make clear the vulnerability of people in residential care, and the duty of staff to report any concerns they may have to a responsible authority for investigation. Staff consulted with, demonstrated an understanding of their roles and responsibilities under safeguarding guidance. Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: The provider demonstrated a much clearer understanding of his responsibilities to refer on any safeguarding concerns to the appropriate authority for action and has made two referrals since the previous inspection. On both occasions the provider was asked to look into these matters and took appropriate action to safeguard residents. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents continue to live in a clean and homely environment, which is decorated and maintained to a good standard. Residents private accommodation is personalised, safe and comfortable. Further adaptations are needed to the premises to meet increased mobility needs. Evidence: The home is situation within walking distance of local amenities such as shops with one resident saying how this was really important to them. Standards of maintenance remain good, with the home having undergone a gradual refurbishment over the last two years. The provider was aware of the need to now redecorate the external paintwork and agreed to have this completed by April 2010, when new windows are also due to be fitted. Much effort is made to create a homely feel to the premises through the decor and furnishings. Communal space consists of a lounge kitchen and conservatory which is used as the dining or quiet room. There is a ground floor office space and private area. There is a rear small courtyard garden which the provider had previously agreed to make more inviting and level the flooring. However, since the previous inspection a resident used this space to start to grow their own flowers and vegetables which has Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: delayed the levelling off of this area. The provider has agreed to ensure that this work is now done by May 2010. Residents bedrooms are individualised to reflect their lifestyles and preferences with all residents saying how much they liked their bedroom and it provided everything that they wanted. A resident spoke of the importance of being able to clean his own bedroom and the new furniture he has which he chose. There have been some environmental adaptations made in order to accommodation the needs of a resident who now has much greater physical needs. This has involved the rearrangement of their bedroom and lounge area in order to create more free space and the fitting of handrails. The provider had already identified the need to change a bath to a shower and to create level access to the front door. The lounge furniture was very low seated which did not enable a resident to be able to sit and rise easily or independently. These further adaptations are now necessary in order to promote residents independence. In addition the home have received support from an occupational therapist who has supplied the home with a height adjustable bed, wheelchair, commode and standing hoist to assist the resident when they were first discharged from hospital. Staff confirmed that they received the training they needed to be able to use this equipment. Fitted throughout the home are call points, which enable assistance to be summoned when pressed. An extension cord had been provided to ensure that a resident was able to call for assistance from their bed now that their bed had been moved from its original position near to a fixed call point. All parts of the home visited were observed to be cleaned to a good standard. A health care professional fedback environment is always clean and tidy. Systems are in place for the control of infection with staff undertaking hygiene and cross infection training. Staff were observed to be working in ways that minimised the risk of infection, by appropriate protective clothing when required. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a staff team who are generally well trained and that know them and that have been robustly recruited and employed in sufficient numbers as is necessary to meet their needs. However additional specialist training would help to further improve staffs skills and knowledge of learning disabilities and mental health conditions. Evidence: It was observed through the inspection that staff understood their roles and had good planning skills. Staff spoke about the good levels of communication between themselves and management. The tasks of the day appeared well organised and individual staff appeared confident in carrying them out. This helped ensure that residents knew who was supporting them. Residents, relatives and staff consulted with felt that generally there was sufficient staff on duty for residents to get the support they needed when they wanted it. Staff confirmed that there is some flexibility in the staffing hours should they need additional cover but generally there are two staff (including the manager or provider) on duty throughout the waking day. Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: There is a small staff team with some turnover of staff in the previous twelve months. Staff consulted with showed a good understanding of residents needs and were observed having a good rapport with residents who were clearly relaxed in their company. A staff member felt what the home does well is the good relationship between each residents and the staff it is like a family. Without exception all persons consulted spoke positively about the staff. Comments made by residents about staff included staff fantastic encouraging, kind, compassionate, easy to get on with people, born to care humours, relaxed professionalism and staff can understand what I want and are very kind. Relatives feedback included staff are knowledgeable about his needs and they use only experienced well trained and motivated staff. The personal files of three newly appointed staff were inspected and these showed that a good recruitment process is followed which includes the use of an application form, interviews, Criminal Records Bureau (CRB) checks and written references prior to employment commencing to help ensure that only staff who are suitable to work with vulnerable people are employed The provider fedback that much training has been undertaken since the previous inspection which have included the mandatory areas of training to enable staff to work safely with residents. This has been supplied by a local care association who have also provided support to the provider to continue to help raise standards at the home. New staff now complete the industry recommended induction which helps to ensure that all new staff entering into the care industry receive a consistent standard of induction. The provider fedback that in early 2010 new staff will also complete a three day induction course in learning disabilities. Staff consulted with had not yet undertaken specific training in mental health conditions or learning disabilities. This is necessary in order to increase staffs skills and knowledge of the range of residents needs Staff confirmed that there is a formal programme of supervision and direct supervision with the manager and provider working along side staff each shift. All staff consulted with felt well supported by to be able to undertake their roles. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a management team that is experienced and continues to develop their knowledge of good practises and legislation and who promotes a resident led service A range of regular health and safety checks helps to promote the health and safety of residents and staff. The home continues to acts on any feedback it receives regarding the quality of its services and facilities. Evidence: The management team consists of the provider and his wife who is the registered manager. The provider is actively involved in the day to day running of the home and undertakes working shifts. The provider fedback that the manager is scheduled to complete the recommended management qualification in February 2010. The manager has managed the home since 2001 and is a registered learning disability nurse. The provider reported that they and the manager have also undertaken training since the Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: previous inspection in order to keep themselves up to date in changes in good practises and legislation. Without exception all person consulted spoke positively about the management team with particular reference to their approachability. A sample of comments about management included Mr Ramful very helpful he has the residents best interest at heart Mike goes out of his way to help him and manager OK hands on gives direction and is very supportive. The provider demonstrated a clearer understanding of their reporting responsibilities in accordance with the previous requirement. This has ensured that the relevant external agencies have been appropriately notified of events and occurrences at the home further promoting residents safety and wellbeing. There are mechanisms in place for the provider and manager to obtain feedback on the quality of the services and whether it is achieving its aims and objectives. These include annual placement reviews, residents and staff meetings, feedback surveys. Examples were noted whereby improvements to working practises, communication with relatives and the environment have been made based on this feedback. A staff member felt that what the home does really well is listening to suggestions and uses staffs knowledge of residents to help make their lives better. A staff member fedback Mike welcomes ideas from staff and is happy to changes things if. Written guidance is available on issues related to health and safety. Records submitted by the manager prior to the inspection stated that all of the necessary servicing and testing of health and safety equipment has been undertaken. Systems are in place to support fire safety, which include, regular fire alarms and emergency lighting checks, staff training and maintenance of fire equipment and fire drills were reported to have been undertaken. The manager reported that they have undertaken a fire risk assessment. This records significant findings and the actions taken to ensure adequate fire safety precautions in the home. The provider confirmed that recommendations made by a visiting fire safety officer regarding the closure of bedroom doors has been addressed. Care Homes for Adults (18-65 years) Page 27 of 31 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 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 23 That the premises are 23/02/2010 suitable for meeting the mobility needs of residents, with reference to providing level access into the property, appropriate lounge furniture and suitable bathing facilities. To promote residents independence through being able to move around the home safely and bath safely 2 35 18 That staff receive specialist training in accordance with the needs of the service users accommodated with reference to learning disabilities and mental health conditions. 23/02/2010 To ensure that that staff have the range of skills and knowledge to be able to Care Homes for Adults (18-65 years) Page 29 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action support residents who have a learning disability or mental health conditions 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 20 That additional instructions are provided for staff on the administration of As required medication, which make clear the individual requirements for when this medications was prescribed. Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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