Care Home: Avenue The (3)

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What the care home does well The interaction between people and the staff supporting them was respectful and sensitive and showed a good understanding of individual needs and abilities.Staff have training so they know how to help the people living there.People are supported to go on holidays and day trips so they live fulfilled lives.Health and safety checks are done so the Home is safe for the people who live there.People living in the Home told us ; "I can talk to the staff if I am not happy" "I like living here" "My room is nice" "The staff are good they help you" "I can havea drink when I want" "I like to cook my own food" What has improved since the last inspection? Some decoration work has taken place so the home is a comfortable place for people to live to live in.Staff have received training so they can meet peoples individual needs.People living in the Home are involved in the recruitment of staff, so their views are listened to.The manager is now registered so she can make sure the Home is well run for people. What the care home could do better: Care plans must provide enough information regarding health conditions so that staff know how to meet people`s individual needs. Care plans should detail in full peoples nighttime needs so they are met in a way that the person prefers.People told us" I would like more activities " " More staff and activities" Key inspection report Care homes for adults (18-65 years) Name: Address: Avenue The (3) Avenue The (3) Acocks Green Birmingham West Midlands B27 6NG 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: Donna Ahern Date: 0 4 0 8 2 0 0 9 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: 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 37 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 37 Information about the care home Name of care home: Address: Avenue The (3) Avenue The (3) Acocks Green Birmingham West Midlands B27 6NG 01216930182 01216930185 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Kelso Care Consortium Limited Name of registered manager (if applicable) Miss Christine Need Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 10 0 care home 10 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 10 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 10 Date of last inspection 2 5 0 7 2 0 0 7 Care Homes for Adults (18-65 years) Page 4 of 37 A bit about the care home The Avenue is registered to provide personal care and support to 10 adults who have a learning disability. Some people have additional needs in relation to behaviour that may challenge. Ten people were living there at the time of the visit. The accommodation comprises of two communal lounges, dining room, kitchen and a laundry. There are ten single bedrooms with en-suite facilities. These provide a good degree of privacy for the people. There is no wheelchair access to the front of the building. There is a graduated path to the rear of the property and a portable ramp is available to assist people who would have difficulty in accessing the building. The home is in a residential road close to Acocks Green shopping centre. The Avenue is ideally placed to access Birmingham city centre and a number of Care Homes for Adults (18-65 years) Page 5 of 37 local shops and places of interest. The current charge for living at the home is from one thousand and twelve pounds per week. Additional charges include outside activities, trips and outings , chiropody, hairdresser, newspapers and additional meals out. The copy of the last inspection report is available for people to read if they want to. Care Homes for Adults (18-65 years) Page 6 of 37 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 Care Homes for Adults (18-65 years) Page 7 of 37 How we did our inspection: This is what the inspector did when they were at the care home One inspector visited the Home and did the inspection in one day. The Home did not know we were going to visit. Before we did the visit we looked at things we had been told about the Home. We looked at information that the Home sent us about things that have happened there. We spoke to seven of the people who live there and asked them what it is like to live at the Home. We spoke to the manager, deputy and four staff. We looked around the Home to make sure it was clean and safe for people. We looked at records about staff and health and safety. We looked at the care records of three of the people who live there. Care Homes for Adults (18-65 years) Page 8 of 37 We sent surveys to people living in the Home and staff. We received 14 surveys and what they said is written in this report. . What the care home does well The interaction between people and the staff supporting them was respectful and sensitive and showed a good understanding of individual needs and abilities. Staff have training so they know how to help the people living there. Care Homes for Adults (18-65 years) Page 9 of 37 People are supported to go on holidays and day trips so they live fulfilled lives. Health and safety checks are done so the Home is safe for the people who live there. People living in the Home told us ; I can talk to the staff if I am not happy I like living here My room is nice The staff are good they help you I can have Care Homes for Adults (18-65 years) Page 10 of 37 a drink when I want I like to cook my own food What has got better from the last inspection Some decoration work has taken place so the home is a comfortable place for people to live to live in. Care Homes for Adults (18-65 years) Page 11 of 37 Staff have received training so they can meet peoples individual needs. People living in the Home are involved in the recruitment of staff, so their views are listened to. The manager is now registered so she can make sure the Home is well run for people. Care Homes for Adults (18-65 years) Page 12 of 37 What the care home could do better Care plans must provide enough information regarding health conditions so that staff know how to meet peoples individual needs. Care plans should detail in full peoples nighttime needs so they are met in a way that the person prefers. Care Homes for Adults (18-65 years) Page 13 of 37 People told us I would like more activities More staff and activities If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Donna Ahern 77 Paradise Circus Queensway Birmingham W Midlands B1 2DT 01216005300 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Adults (18-65 years) Page 14 of 37 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 15 of 37 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 16 of 37 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. People have the information they need about the Home so they can make a choice as to whether or not they want to live there. Evidence: We saw the certificate of registration on display in the hallway this had been up dated recently to show the change in registered manager details. The pre admission records for the person who came to live there most recently were not available for us to see we were told that Birmingham Adults and Communities had requested this information. We looked at the pre assessment for another person. Assessments had been completed before they moved in to ensure their needs could be met there and further assessments had been completed after they had lived there a short while to ensure their needs could be met there. Staff told us that the person who had most recently been admitted had settled and their needs were being met. Some of the people have lived at the Home for many years. One of the people told us. I Care Homes for Adults (18-65 years) Page 17 of 37 Evidence: didnt really get to look at other homes the social worker thought this was the best home for me, I have lived here a long time now and I am very happy. The service user guide and statement of purpose tell people what they can expect from the home and had been written in an easy read style. The manager told us they are consideration using photographs and pictures in the documents so making the information even more accessible to people. Care Homes for Adults (18-65 years) Page 18 of 37 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. Staff have the information they need and a good understanding of how to offer care and support to each person, which should ensure peoples needs are met in a way they prefer. Evidence: We looked at three peoples care plans. Care plans explain what each person needs are and the care and support they require to make sure these needs are met. The files looked at had information about how to meet peoples individual needs in relation to personal care, communication, health care, social activities, likes and dislikes. The manager talked about developing peoples care plans to include photographs and pictures, this would be really good for some of the people living there and would make the information easier for people to understand. The manager told us they are still working on the care plan of the most recently admitted person. As the person becomes more settled, they are getting to know and understand their needs better and were making changes to their care plan to reflect this. Care Homes for Adults (18-65 years) Page 19 of 37 Evidence: People told us who their key workers were. One of the people said I get on well with my key worker but there is a new member of staff that I get on really well with. I am going to speak to the manager and ask them if I can change my key worker Staff told us they look at peoples care plans on a regular basis so they know how to support people. Staff they were able to tell us information about how they support people to be more independent and how to keep people safe. Due to the specific needs of some of the people due to their disability observations for part of the visit were limited. When we were in communal areas of the Home we saw that interactions between people living there and staff were generally friendly and relaxed. Some of the people have limited verbal communication. We saw staff engage well with people. The manager told us staff do communication training as part of their induction training and most have completed basic makaton training. We saw assessments were in place that tells staff how they should support people to take risks whilst ensuring their safety as much as possible. Some risk assessments were due to be updated this will ensure that people continue to receive the support they need from staff to meet their needs. Regular house meetings take place and we looked at the minutes of some of the meetings. People were asked about their views and comments on holidays, day trips, activities and menu planning. Care Homes for Adults (18-65 years) Page 20 of 37 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. The people living there experience meaningful lifestyles so ensuring their well being. Evidence: We looked at care plans and daily records to establish that people are leading meaningful lifestyles and taking part in activities that they enjoy. We also spoke to four staff members and observed care and support on the day. Care plans stated peoples cultural and religious needs. The Home were providing a halal diet in keeping with one of the peoples faith and the wishes of their family. One of the people told us I like to go to my local church every Sunday; its just in Acocks Green I like going there and know lots of people. There are plans to support one of the people to attend a Mosque in keeping with their religious needs. People are provided with opportunities to attend a range of activities and day time Care Homes for Adults (18-65 years) Page 21 of 37 Evidence: occupation. People attend day centres, local colleges and are involved in voluntary work. One of the people told us Staff are really good for encouraging you to do things like going to college. I start college and then give up because I get bored. But the staff still asks what you would like to do they give you encouragement. I am now doing voluntary work with animals I love this and have been doing it for a long time A number of staff told us in the surveys they completed that it would be good if they had more time to support people to access the community. One of the people who completed the survey told us I would like to do more group trips together and another person told us they would like to do more activities. Staff are currently responsible for preparing and cooking all the meals. The manager told us she is looking at employing a cook. This should enable staff to have more time to support people to do the things they want to do. One of the people had been out to the local shops with support from staff. Some peoples college courses were not taking place due to the summer holidays. One of the people said I am enjoying a lie in because its the holidays. People said they help out with household tasks and routines. One of the people told us they like to cook their own meals. People told us The staff put the music on and we do some cleaning up and polishing I keep my own room clean I bring my washing down to the laundry. The company has a caravan that people can use for holidays and a trip in planned for September. Some of the people told us about a recent camping trip that a small group of people went on. People told us It was really good there was a lot to learn and staff got us to put the tents up I really enjoyed it and It was a good trip we had to make sure the tents were put up right, we are hoping to plan another trip. One of the people told us about the different day trips they enjoy going on. They travel with a local coach company and had just arranged their next trip which will be to London. People are supported to maintain close links with their family. We could see that family contact is discussed with people. On the care files we looked at there was good detail about how staff should support people to maintain these links. We saw that people freely accessed all areas of the Home only the door to the cellar is kept locked as there are steep stairs leading down to an area used for extra food storage. People told us they can have a drink or snack when they want to. Most people eat the evening meal at the same time; people told us they can eat their meal later if they want to. We were told that an internet order is placed weekly with a local supermarket. Additional food supplies are picked up by people who live in the home and staff as they require it. Peoples cultural choices have been provided for including Halal and Cantonese. Menus Care Homes for Adults (18-65 years) Page 22 of 37 Evidence: seen indicated that a good choice of food is offered at each meal time. The menu for the evening meal was sweet and sour chicken, boiled rice, beef burgers and home made chips and peas and a healthy option of cottage pie and baked potatoes. People told us I like to cook my own food and The food is nice. Care Homes for Adults (18-65 years) Page 23 of 37 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. The arrangements in place ensure that the personal care and health needs of individuals are met so ensuring their well being. Evidence: The Avenue accommodates people who have a range of care needs. Ages range from twenties to late fifties. Within this some people have specific and complex health care needs relating to mental health. All of the people have varying degrees of learning disability and associated needs including Autism and Aspergers syndrome. Care plans looked at had information about how to meet peoples personal care needs. People were dressed in individual style that was appropriate to their age, gender, the weather and activities they were doing. We saw staff take people to get changed if they spilt something on their clothes. We saw guidelines were in place for supporting people with their care needs during the night. Some additional information should be include on these so it is clear how staff are checking on people and why so people get the support they need from care staff. We saw that each person has a Health Action Plan in place which should help to identify Care Homes for Adults (18-65 years) Page 24 of 37 Evidence: peoples health needs and what needs to be done to meet these needs. The format is in a booklet layout. The plans we saw lacked detail and were not an active document of peoples ongoing health care needs. The manager told us they will be introducing a new easy read format and people will be encouraged to be more involved in their own health care monitoring. Care plans had information about the support people get from other professionals and there were details of health care appoinments and the outcomes so peoples health needs are well managed. Information was on peoples care plans advising staff how to support people with epilepsy and a general risk assessment was in place. A separate risk assessment on epilepsy was required so that it is clear what staff must do to keep the person safe. This will ensure that staff have all the information they need to know so they can support the person safely in the event of a seizure happening. Staff had received training in epilepsy management so they have up to date skills and knowledge in this area. We looked at the arrangements for managing peoples medication. Medication is kept in a locked cupboard in the office. Staff had signed peoples individual medication administration record (MAR).This indicates that people have received their medication as prescribed. A record of medication coming into the home and returned to the community pharmacist had been kept which means that staff can check that medication has been given correctly and stored securely. We were told that a protocol was being written by the community nurse for one person, this will provide staff with clear information about when medication used on an as needed basis, should be given. Some people are prescribed controlled drugs. These have to be stored differently and signed for by two staff. We saw that they were stored securely and the correct systems for signing by staff were in place. When we spoke to staff they told us that they had completed medication training and updates as necessary. This should ensure they continue to have the skills and knowledge to give out medication safely. Care Homes for Adults (18-65 years) Page 25 of 37 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are effective systems in place to listen to and respond to complaints about the service. Arrangements are in place so people should be protected from harm. Evidence: The complaints procedure was available on display in the Home. An easy read version was available so it was easier for people to understand. We have not received any complaints about this Home Three complaints had been made directly to the service by people living in the Home and we were told that these had been resolved. Complaints are recorded into a hard back book which makes it difficult to evidence how a particular complaint has been dealt with and does not ensure confidentiality of information. The manager was keen to revise this system. Staff spoken with demonstrated a general understanding of their duty to safeguard people and how to report concerns on to senior managers. Safeguarding guidelines and the whistle blowing procedures were available in the office for staff to refer to. We looked at training records to determine that training in safeguarding vulnerable adults had been provided. Consideration should be given to discussing safeguarding and whistle blowing procedures in staff meetings to ensure that knowledge and understanding in this area is constantly checked. Some of the people due to their disability can display behaviour that can be difficult to Care Homes for Adults (18-65 years) Page 26 of 37 Evidence: manage in a group setting. We saw that records are kept of any such incidents and details of the action taken to support the person during and after the incident. We spoke to the manager about the recordings of how some of the incidents had been managed. She confirmed that where needed follow up with staff has taken place to advise them on how they could of managed the situation in a more positive way for the person and develop their own practice and understanding. The manager, seniors and majority of the staff team have attended awareness training in the mental Capacity Act (2005) and Deprivation of Liberty Safeguards. The Act governs decision making on behalf of adults and applies when people lose mental capacity at some point in their lives or where the incapacity condition has been present from birth. It is important that staff know how to put the act into every day practice and the procedure to follow when peoples freedom may be restricted. Care Homes for Adults (18-65 years) Page 27 of 37 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 homely, clean, safe and comfortable home that meets their needs. Evidence: The home was decorated to a satisfactory standard and there were no maintenance matters of concern at the time of our visit. There is a maintenance person employed at the Home which ensures that any damage to the environment due to behaviours is repaired without delay. Since our last visit the hallway, office, landing and stairs. A recent visit from environmental services awarded the Home the highest standard for kitchen and food hygiene ensuring good standards are in place so people are not put at risk of infection. There are two large communal rooms on the ground floor and a large dining room. This provides people with a good choice of communal space, this is important as at times some people through reason of their disability will need their own space from the other people living there. Some of the people told us that they will be having their bedroom painted soon and they will be choosing the colour that they want it painted. Three people showed us their bedrooms. Their bedrooms were very individual and reflected peoples tastes and interest. People told us I like my room and like to spend time in here . All bedrooms are en suite which provides people with a good degree of privacy. Care Homes for Adults (18-65 years) Page 28 of 37 Evidence: The rear garden is level enabling people to make full use of it. There is a shed facility which is the designated smoking area for people who choose to smoke. Care Homes for Adults (18-65 years) Page 29 of 37 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. Recruitment practice is robust and protects the people who live there. Staff receive the training they need to carry out their role effectively and meet peoples needs. Evidence: We watched the way that people interacted with staff on duty, which indicated that good relationships exist between people living there and the staff supporting them. People we spoke to knew who their key worker was. People told us I can talk to the staff they try and support you. We looked at the staffing rota for the week of the visit and the previous week. Staffing levels have recently been increased to five staff a day to meet the needs of the people who have recently come to live there. The manager told us that they are in the process of appointing new staff and they are currently using some agency staff until these posts are appointed to. It was positive to hear that people living in the Home are involved in the recruitment process and we were told that their feedback and opinions on prospective employees are valued and acted upon. We spoke to four staff during this visit who demonstrated that they had a good understanding of peoples individual needs. We asked staff about meeting the needs of Care Homes for Adults (18-65 years) Page 30 of 37 Evidence: people who have come to live at the home more recently and they told us they felt their needs are being met. We spoke to staff about the training they had received and we looked at the staff training records to confirm they have the training they need to meet the needs of the people living there. This include mandatory training and training specific to peoples needs including Epilepsy, Autism, Aspergers, Makaton, Communication training and Challenging Behaviour. The manager told us further training in Supporting people with behaviour that can be challenging will take place ensuring staff have the skills to manage and diffuse difficult situations. In the surveys staff completed they told us that further specialist training including physical intervention would be good so they continue to have the skills to support people. The AQAA told us that there are 17 staff and 13 of these have NVQ level 2 or above. This should contribute towards ensuring that the staff team have effective knowledge of social care. We looked at staff recruitment records for the two most recently employed people. Criminal Records Bureau checks (CRB) had been made and written references received before employees began work so that people were protected from the risk of having unsuitable staff work in the Home with them. Staff told us that they have supervisions and records seen confirmed this. This should ensure staff have the opportunity to reflect on their practice and consider their individual training needs. Regular staff meetings take place, which provide an opportunity for staff to discuss good practice and development issues. Care Homes for Adults (18-65 years) Page 31 of 37 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. Arrangements in place ensure the well being of people living in the Home. Evidence: The manager was recently registered with CQC. She was previously the deputy manager and has worked at the Home for several years. She has NVQ level 4 The Registered Managers Award and has continued to keep her own knowledge and training up to date. We saw that the manager is very involved in day to day practice. She was regularly involved with direct contact and discussions with people living there and also directed staff in their role. Recommendations we made during the visit were responded to positively. The provider carries out visits to the home to monitor and report on standards. Reports were not available for every month that we asked for. The reports of the visits should be available as evidence that these have taken place and to ensure the provider takes responsibility for monitoring the Home. The manager told us she is keen to further develop the Homes quality assurance systems Care Homes for Adults (18-65 years) Page 32 of 37 Evidence: so that there are continuous self monitoring tools in place. This provides a focus for improving standards across all areas of the Home. Results of any surveys completed by people or their representative about the running of the home should be published. We looked at some health and safety records including Fire appliances and equipment we saw that these are checked and serviced regularly. The AQAA informed us that gas and electrical equipment had been serviced as required. A work place fire risk assessment was in place detailing the managers responsibility to safeguard people. Individual fire risk assessments detailing how staff would support people in the event of the firm alarm activating should be in place. This should address any issues such as how a persons specific disability may limit them to respond. Care Homes for Adults (18-65 years) Page 33 of 37 Are there any outstanding requirements from the last inspection? Yes  No  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 34 of 37 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 Description 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 Description Timescale for action 1 19 12 A risk assessment must be in 11/09/2009 place for the management of peoples epilepsy. So people get the support they need to keep them safe. 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 9 Risk assessments should be kept up to date so that staff have the information they need to promote peoples independence and keep them safe. Guidelines in place for the support people require at night should detail how and why checks are made so people get the support they require from staff to keep them safe. Reports of visits by the owner should be available in the Home to ensure that they carry out their duty of ensuring the Home is managed in peoples best interest. Quality assurrance systems should be developed and 2 18 3 39 4 39 Care Homes for Adults (18-65 years) Page 35 of 37 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 include the views of the people living there. 5 42 Information about how to support individuals safely in the event of the fire alarm being activated should be in place so ensuring peoples safety. Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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