Care Home: Ashtead House

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What the care home does well The service provides a happy, friendly and welcoming environment . People and staff were observed to have good relationships who were spending time and interacting with each other. Each person has detailed, comprehensive and accessible essential lifestyle and health action plans, which people have been involved in making, which are regularly reviewed and cover all areas of people`s lives. People are supported to maintain their Independence, make decisions and choices in their daily lives and participate in a range of activities. Comments recieved included, "I go to college";"I go out for dinner"; "They look after people well" ; "It feels like a real home" and "This is a good home". Two health and social care professionals said, "The service respects people`s privacy,and individualism providing them with happy and fulfilled lives" and "Excellent service " The service supports people to raise concerns and complaints and they have an accessible complaints procedure, which everybody knew about . People living in the home benefit from a stable staff team who know them well and receive lots of training. Two people living in the service said, "The staff are a good bunch" and "They have the best staff for the job" . What has improved since the last inspection? The service has complied with a requirement made at the last inspection about the necessary work needed to improve to the door frame in the hallway and the stair carpet has been replaced What the care home could do better: It was recommended as good practice that where any information is hand transcribed on to the medication administration record, this should be checked and signed by two members of staff Key inspection report Care homes for adults (18-65 years) Name: Address: Ashtead House Ashtead House 153 Barnett Wood Lane Ashtead Surrey KT21 2LR     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: Lisa Johnson     Date: 1 0 0 7 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 28 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 28 Information about the care home Name of care home: Address: Ashtead House Ashtead House 153 Barnett Wood Lane Ashtead Surrey KT21 2LR 01372810330 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: ashteadhouse@ntlbusiness.com Ashtead House Ltd care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users who can be accommodated is: 10 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: Learning disability - LD Physical disability - PD Date of last inspection Brief description of the care home The home is registered to accommodate ten adults with learning disabilities and who may have physical disabilities. The registered provider is Ashtead House LTD. The home is a detached property located a short distance from Ashtead town centre. Accommodation is situated on the ground floor and first floor. All bedrooms are single occupancy. There is no lift to access the upper floor. There is a communal garden at the rear and parking for several cars at the front. Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 0 10 10 Brief description of the care home The service supports people with daily living skills, activities and occupation of their choice and their emotional needs. People are supported to develop their skills and move from the home into more independent accommodation in the future if they wish. The current fees for this service range from £920 to £1,677.29 per person per week, depending on individuals assessed needs. Care Homes for Adults (18-65 years) Page 5 of 28 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: This site visit was part of a key inspection. The visit was unannounced and we arrived at 10.20 am and left at 4.40 pm. The last key inspection was carried out 10th July 2007 Information was provided to us by the service prior to this visit in the Annual Quality Assurance Assessment. (AQAA). This is a self-assessment that focuses on how well outcomes are being met for people using the service. We received the AQAA by the expected date, which was clear and detailed and gave us all the information that we asked for. Reference is made to this assessment throughout this report. We received six surveys from people living in the service, five health and social care professionals and two members of staff. During this visit we also met with three people who live in the service. We met with the registered Manager Ms. S Cassidy and two Care Homes for Adults (18-65 years) Page 6 of 28 members of staff During this visit we looked at staff recruitment, and training records, care plans, risk assessments, menus, Quality assurance systems, medication administration policies, health and safety records and policies and procedures . We also reviewed other information that we have received since our previous including notifications . Care Homes for Adults (18-65 years) Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 28 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. Peoples needs are assessed prior to admission to the home. Evidence: Since our previous visit there has been one person admitted to the service. Information supplied in the AQAA states that enquiries are made to the registered manager. A basic referral enquiry form is completed in the first instance. The service has a detailed assessment process. If the service is able to meet the needs of the person it is arranged for the person, family/advocates and social care professionals to visit. Information is provided,which is user friendly including the homes statement of purpose and service user guide. During this visit three peoples assessment information was seen, which covered their health, personal, emotional, communication, choice and decision making, finances, life skills, social, cultural and diverse needs. Transitions are planned and developed according to the needs of the person. During the first six weeks of placement further assessments take place to gauge as to whether the service is suitable to meet the persons needs. Care Homes for Adults (18-65 years) Page 10 of 28 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. The home has a plan of care that the person has been involved in making. Peoples needs and goals are met and they are able make decisions about their life. People are able to take risks as part of an independent lifestyle. Evidence: Each person has an accessible lifestyle plan, which is based on full needs assessment covering all areas of peoples lives. Care plans have been adapted to meet the level of understanding for the person by incorporating pictures and symbols. During this visit we viewed three peoples care plans, which were detailed and comprehensive identifying how their individual goals are to be achieved. Information seen demonstrated that people are consulted about their care plans,which were signed by them to confirm their agreement. Each person has a designated key worker and regular meetings take place with people to discuss and review their care plan. The outcomes of reviews were also made Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: available in accessible formats. All care plans have been reviewed and were up to date and annual reviews also take place. Two members of staff surveyed said that they are always given up to date information about the needs of people they support. Care plans consider peoples equality and diversity needs throughout and also included their religious observance. One persons plan sampled considered information about their needs in relation to the mental capacity act. People are supported to make decisions and choices about their lives. The service holds regular meetings with people where they are able to raise their views and feedback surveys are conducted. People have been able to choose where they would like to go on holiday, and their preferred decor. Some policies have been adapted in friendly formats such as the complaints procedure. People are supported to manage their finances as independently as possible and where people require support this is clearly documented in their care plan. The staff duty rota on display contains a photograph of each member of staff to assist people in identifying who is duty. A person living in the service likes to organise this and was observed changing the photographs in the afternoon. Another person living in the service was recently involved in the staff recruitment process, where they were able to ask the prospective candidates a question, which was important to them. People are supported to take risks as part of an independent lifestyle. During this visit we sampled some of the risk assessments for three people, which included, using transport, safe handling finances, moving and handling, bathing and emotional needs. All risk plans had been reviewed and up to date, which are discussed and agreed with people. Care Homes for Adults (18-65 years) Page 12 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples preferences, social, cultural, diverse ,religious and recreational interests andneeds are met. People maintain contact with their family friends , representatives and the local community. People are supported to exercise choice over their lives and they are provided with varied and well balanced meals. Evidence: Each person has an individualised weekly activity schedule, which meets with their needs and preferences. Detailed information about peoples activities is included in their essential lifestyle plan. Some people attend a range of day services. A person living in the service said. I go to college where I do computers and cookery. Peoples goals are discussed with them and a persons plan sampled stated that they would like to do some work in the future. Another persons care plan identified that they attend music therapy. Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: People maintain links with the local community and use facilities including, visiting the cinema, going bowling, and going to the pub. Comments received from people included, I go out for dinner and I go to the leisure centre. Trips take place to the theatre,seaside and places of interest. A person living in the service told us that they are going to the music festival in Reading this year with a member of staff and that they visit night clubs. Peoples religious needs are supported and they attend places of Worship. The home provides a large, flat screen television, DVD, and computer a football game was available, which one person was seen enjoying and game consuls have been purchased. People receive an annual holiday, which they are able to choose.A person told us about their holiday they were going on shortly. Each persons care plan contained circles of support which contained information about people that are important to them. People maintain links with their family and friends who can visit when they wish and some people visit their families. We were informed that people could have their visitors to stay over if this was their preference. Information was seen in a care plan where a person had been provided with support and advice regarding intimate relationships.Some people attend self advocacy group. People are supported to participate in the running of the home. Tasks include, room cleaning and meal preparation. One persons care plan identified that they like help peeling the vegetables and likes to make drinks, which was observed during this visit. Another person was preparing their lunch with staff in the kitchen. Good interaction was observed between people and staff who were spending time with each other. The homes menu is planned four weeks a head and people are supported to choose their meals, which was confirmed by two people spoken with. Pictures are provided to assist people in this process. The menu provides choices, was varied, well balanced and specialist nutritional advice is sought. Mealtimes are flexible to meet peoples needs and routines. This was observed at lunchtime where people were taking their meal at different times. People can help themselves to drinks and snacks. One person was observed to have a bottle of their favourite alcohol in their bedroom which they enjoy.Two people spoken with said that they enjoyed their meals and can choose their preferences. Care Homes for Adults (18-65 years) Page 14 of 28 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. Peoples health and personal care needs are met and their preferences for supportare respected. The home supports people with their medication in a safe way. Evidence: Each person has a health action plan in place, which provides comprehensive information about peoples individual wishes and preferences ensuring that they maintain independence and control over their lives. This included information about peoples likes, dislikes, and preferred routines such as times of rising and going to bed. One persons care plan identified that they like to have their breakfast in bed and like to choose their clothing. The staffing ratio is of mixed gender, which ensures that same personal care is provided. The service supports people who have a range of diverse needs. Each persons file contained information about their health and emotional needs and the support that they require. One person was identified at being risk of developing pressure areas. Tissue viability assessments had been completed and appropriate equipment and detailed guidance for staff to follow when supporting this person was documented. Further information seen demonstrated that moving and handling assessments had Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: been conducted including guidance for using the hoist. People are registered with a General Practitioner and have access to the chiropodist and dentist. Information supplied in the AQAA states that people are provided with information about the local general practitioner, chiropodist and dentist and they are assisted to exercise a degree of choice when accessing these care services. The home has good links with the community team for people with learning disabilities (CTPLD) and they are also supported by a range of other clinicians including district nurses, psychiatry, speech therapy and diabetes clinics and full support is given for people to attend health care appointments and consultations. The service demonstrates that detailed records are maintained of all health care appointments. Four health care professionals surveyed state that peoples social and health needs are always properly monitored, reviewed and met by the service and the service always seeks advice and acts on it to meet peoples needs and improve their wellbeing. Comments included, The home meets the identified needs of people well. The service communicates well and any issues relating to people that attend our service we have an immediate response. Relationships are sound, professional and productive and its a pleasure to work with themand The service respects peoples privacy and individualism making them happy and fulfilled. The registered manager has recently attended training on pain management and they are intending to incorporate this in all peoples care plans. Each persons care plan considers how their privacy and dignity is to be respected such as knocking on doors. During this visit staff was observed to be attentive and respectful of peoples privacy. A person living in the service said that staff generally respect their privacy, although occasionally some staff may forget to knock on their door before entering. During this visit we viewed the homes medication administration practices. Medication was stored appropriately. The quantities of medication received by the home were recorded. Medication is dispensed by a local chemist using the monitored dose system (MDS). Where people have been assessed as not being able to self administer their medication their consent has been obtained for staff to administer this. Protocols were in place for the administration of as required medication. Staff receive regular medication training and updates. A medication profile was in place for each person and a photograph was available with their medication administration record for identification. Medication administration records sampled during this visit were appropriately recorded. One medication administration record Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: sampled had two items recorded, which been hand transcribed by staff and it was recommended that this is checked and signed by two members of staff ensuring peoples safety and wellbeing. Protocols were in place for the administration of as required medication. Care Homes for Adults (18-65 years) Page 17 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If people have concerns they know how to complain and they are safeguarded from abuse. Evidence: We looked at information provided to people, which tells them about how they can make complaints. During this visit we saw a copy of the homes complaints procedure, that was seen on display in the hallway, which is also provided in an accessible format. The complaints procedure is also available in the service user guide. Information also includes the contact details of the Commission and other external agencies. The timescale for responding and acting on any complaint received is included. Information supplied in the AAA states that people are encouraged to have the opportunity to raise any complaints at home meetings, during their one to one meetings with their key worker and with the registered manager. Since our previous visit six complaints have been received, which were recorded Information in respect of any investigation and the action taken was documented and all complaints have been resolved in the agreed timescale Surveys received from people state that people know how to make a complaint and who they could speak to. A person spoken with at this visit said, , The manager and Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: Staff. The service has safeguarding vulnerable adults from abuse procedures in place and they have obtained the most recent local authority procedure. Financial policies and procedures are in place to safeguard peoples financial affairs. A member of staff spoken with during this visit was aware of the safeguarding procedures and staff training records sampled confirmed that they have received safeguarding training. Staff also receive training in conflict management to support the needs of people, who may exhibit verbal or physical aggression. There have been two matters referred following the local authority safeguarding adults procedures, that were brought to the attention of the Commission, which have now been concluded. Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is safe, comfortable, homely and clean. Evidence: The service is situated in a residential area in Ashtead. The service provides a homely environment, which is accessible to people living there. Information supplied in the AQAA states that the service has now developed a maintenance plan to forward think and organise improvements needed in the home. There is a large, open plan sitting /dining area and separate kitchen. The service is planning to remove the existing carpet in the hallway and replace this with more appropriate flooring. There is a large, well maintained garden to the rear of the property, which includes garden furniture and a built in barbecue, which we were told is often used in the summer months. Since our previous visit there were some concerns about security at night time. The home has installed a key pad lock to the front door, this does prevent people from opening the door from the inside as the code is clearly marked. Information supplied in the AQAA states that if improvements are to be made such as redecoration, people are informed and encouraged to provide their views. Since our previous visit a bathroom has been created on the ground floor as the existing facilities only had a shower, which now provides people with more choice. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: During this visit a person living in the service invited us to visit them in their bedroom, which was comfortable, reflected their gender and it was personalised to their preference. During this visit the home was seen to be cleaned to a good standard and was hygienic. Hand washing facilities were available throughout the building and infection control procedures are in place, staff recieve training and separate laundry facilities are provided. The home has recieved a visit from the enviromental health office, which was satisfactory. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are supported by staff that are competent and trained to meet their needs and they are protected by the homes recruitment policies and practices. Evidence: At the time of this visit there were four members of staff on duty. The staff rota was viewed, which reflected the named staff that were on duty. Flexible support is provided to meet the needs and interests of people. Four members of staff are provided throughout the day with the manager working supernumerary to this. People benefit from a stable staff team,that know them well. There has been minimal turnover. At night time people are supported by a waking and sleep-in member of staff. People are supported by a staff team that are of mixed gender and ethnicity. The manager stated that over the last twelve months the home has worked towards employing staff who are equipped to meet the needs and compliment the cultural needs of the current client group. A person living in the service said, They are the best staff for the job and another person said, The staff are a good bunch. New staff receive induction following Skills for Care core induction standards and Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: seven out of thirteen care staff employed have obtained National Vocational Qualifications (level 2 or above). Other staff are completing the programme The service has a staff training matrix in place. During this visit we looked at the training records for three members of staff, which demonstrated that they receive up to date statutory training and training, which meets the specialised needs of people living in the service including, epilepsy , makaton, diabetes awareness, autism and Aspergers. The registered manager has attended training on the mental capacity act and deprivation of liberty safeguards. All staff have either completed or are scheduled to refresh training on equality and diversity. Staff surveys returned state that staff receive good training that provides them with knowledge to meet the differing needs of people who live in the service. Staff recruitment is based on equal opportunities. During this visit we sampled four members of staff personal files, which contained the required information including two written references, protection of vulnerable adult first checks (POVA) and enhanced criminal records bureau checks (CRB) Information seen during this visit demonstrated that staff receive and regular formal one to one supervision, which was also confirmed by two members of staff spoken with and from records,which were sampled. Care Homes for Adults (18-65 years) Page 23 of 28 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 home is well run in the best interests of people living there and their wellbeing,health and safety is protected. Evidence: There is a registered manager in post, who has many years of experience of working in social care settings and with people that have a learning disability. The manager has obtained an advanced City and Guilds management qualification and has demonstrated that they have undertaken regular refresher and specialist training. The manager was observed to have an open and inclusive approach and made themselves accessible to both people and staff throughout this visit. Two staff surveys received stated that they are supported by the manager and one person said, The manager has an open door approach and is accessible to everybody. Regular team meetings are conducted and staff said that there was good team work and communication. Monthly quality monitoring visits are conducted by the registered provider where the Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: views of people living in the service are obtained. Some of the reports from last year were not available for viewing, although we were informed that these had been archived, However it is advised to ensure that these are made available for inspection. Since our previous visit further audits using Care 4 system are now carried out by the companys quality assurance team, which are carried out every three to four months, which look at specified areas. Annual quality assurance feedback surveys are carried out, to gain feedback from people using the service, relatives, health and social care professionals and staff. The outcomes are analyzed and formulated into visual graphs, which were seen on display in the service. A number of positive comments have been received by the service, which have also been included in information supplied in the AQAA. The service has a range of health and safety procedures in place. Monthly health and safety audits are carried out and water temperature monitoring is conducted. Staff training records sampled demonstrated that they receive statutory training including first aid, moving and handling and food hygiene health and safety. Information supplied in the AQAA and from records sampled during this visit confirm that regular servicing and maintenance of equipment takes place. Records are maintained of any incidents and accidents that have taken place and the service lets us know about matters they are required to inform us about. Care Homes for Adults (18-65 years) Page 25 of 28 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 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 20 It is recommended as good practice that medication administration records are handtranmscribed that these are signed and checked by two members of staff. Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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