Care Home: Bedes Close

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What the care home does well People are provided with a warm homely environment. There is an enthusiastic staff team who provide care to a good standard. There is on going training for staff so that people are not at risk. The home involves other agencies to advocate for people to make sure their wishes are respected. The home provides people with aids and equipment to encourage maximum independence. What has improved since the last inspection? Since the last key inspection there has been changes to the recording of risk assessments to make sure they are meaningful and identify any possible risk; this will ensure staff know the action they must take, to make sure people are safe. There has been some improvement in the way care plans are written. This is to make sure the quality of care people receive is recorded. The home have carried out individual activity assessments to establish people`s daily social needs; so that they are provided with a fuller and more active lifestyle of their choice. A new system is in place to review people`s health care needs to make sure that peoples needs are fully met and no health care needs get missed. There is a system in place to make sure that the complaints procedure is followed and complaints are properly recorded; in a manner that informs people that their complaints will be acted upon and resolved in the given timescale. The home have improved staffing levels to make sure people`s needs are always met. What the care home could do better: The home should continue to make sure that all identified potential risks to people are assessed, so that staff know how to manage the risk. They should also continue to make sure that all risk assessed have a care plan which clearly shows staff what action they must take to manage or minimise the risk. Some consideration should be given to formalise the checks of wheelchairs and bed safety rails. A dated record should be kept of the checks. This would ensure that people and staff safety are not compromised and equipment is safe for use. Some consideration should be given to allocate more staff to cleaning, so that extra attention is given to cleaning throughout the bungalows. This will make sure people live in a clean environment. Care plans should be person centered to reflect what people want now and in the future, indicating the care and support that staff needs to provide to enable this. Key inspection report Care homes for adults (18-65 years) Name: Address: Bedes Close 8/10/11 Bedes Close Thornton Bradford West Yorkshire BD13 3NQ     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: Valerie Francis     Date: 0 2 1 1 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 30 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 30 Information about the care home Name of care home: Address: Bedes Close 8/10/11 Bedes Close Thornton Bradford West Yorkshire BD13 3NQ 01274831811 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): patfeane@sjogcareservices.org.uk www.sjog.co.uk Saint John of God Hospitaller Services Name of registered manager (if applicable) Mrs Katherine Mary Grady Type of registration: Number of places registered: care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Bedes Close is registered to provide nursing care and accommodation for up to eighteen people with learning difficulties. It is situated in an urban area of Bradford, close to open countryside but with easy access to shops, pubs, churches and a post office. The service consists of three purpose built bungalows interlinked by walkways. There are six bedrooms in each bungalow, each bungalow has its own kitchen where meals are prepared, and all have their own sluice and laundry areas. 1 5 1 0 2 0 0 8 18 Over 65 18 Care Homes for Adults (18-65 years) Page 4 of 30 Brief description of the care home There are communal gardens for the use of residents. One of the bungalows also has a conservatory. Care Homes for Adults (18-65 years) Page 5 of 30 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: We visited the home unannounced; the visit lasted over six hours, during this time we talked to people, staff and the manager about their work and the training they have completed. We also observed staff interaction with people. Some records, policies and procedures the home have to keep were checked. We also spent time talking with people who live in the bungalows. We looked at five peoples care records to check that a plan had been formulated to provide support to people according to their needs and wishes. We focused on the key standards and what the outcomes are for people living in the home. This is what we used to write this report: We looked at information we have received about the home since the last key inspection. We asked for information to be sent to us before the inspection, this is called an Annual Quality Assurance Assessment questionnaire( AQAA). Care Homes for Adults (18-65 years) Page 6 of 30 We sent surveys to people living in the home. However, none was returned. We were told at this visit; that the fees for living at the home range from 970 pounds and 12 pence to 1325 pounds 07 pence, this does not include toiletries, activities, clothing, holidays and staff escorting people on holidays. We have reviewed our practice when making requirements, to improve national consistency. In future if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The home should continue to make sure that all identified potential risks to people are assessed, so that staff know how to manage the risk. They should also continue to make sure that all risk assessed have a care plan which clearly shows staff what action they must take to manage or minimise the risk. Some consideration should be given to formalise the checks of wheelchairs and bed safety rails. A dated record should be kept of the checks. This would ensure that people and staff safety are not compromised and equipment is safe for use. Some consideration should be given to allocate more staff to cleaning, so that extra attention is given to cleaning throughout the bungalows. This will make sure people live in a clean environment. Care plans should be person centered to reflect what people want now and in the future, indicating the care and support that staff needs to provide to enable this. Care Homes for Adults (18-65 years) Page 8 of 30 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 30 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 30 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 wanting to use the service and their representatives are given information about the home; this enables them to make an informed choice. People who are admitted to the home have their personal and health care assessed; to make sure that the home is appropriate for all their needs. Evidence: The home had recently updated the statement of purpose and service user guide, which gives information on the services they provided. This information we were told is readily available in all the bungalows. However, on the day of the inspection this was not the case. The manager said that this was due to the recent review of the documents. We did not see that the documents had been produced in easy read, such as words, pictures and symbols. The manager told us that since the last key inspection they have looked at the way they carry out admissions to the home. They make sure the process gives people the opportunity to take their time to move into the home. They also involve the other Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: people who live in the home in the admission process. We looked at the assessment process carried out for the new person who moved in the home since our last visit; we found that the person was given the opportunity to visit the home on several occasions and had stayed overnight. Beside the information from the previous home, an assessment of care and support needs were carried out by the home using all the information that was given from other agencies and observation during their visits. This information was then used to decide if the home can meet this persons care and support needs. In the AQAA we were told that there is a referral policy which included assessments and risk assessments and there is a referral panel for the assessment, they also consult with people who already use the service, to make sure that the person wanting to move into the home and the people living there is in agreement with the move. Care Homes for Adults (18-65 years) Page 12 of 30 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. People who use the service are involved in decisions about their life and play some role in planning their care and support they receive. Evidence: The home base the care and support given to people on the activities of daily living, that covers the care and support given to people. The manager said progress has been made to improve the standard of care plans and risk assessments. We were told that people are encouraged to take risks and risk assessments are in place. There are risks assessment in place for most of peoples identified risks. However, there are no care plans to support the identified risks. One persons care plan said their food must be chopped up as they are at risk of choking, but there was no plan in place, to show how this would be managed if choking occurred. During discussions with the manager it was also identified that some risks had not been assessed. We Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: saw that each person has a named nurse and a key worker (support worker) who have responsibility for the care of the person and had contact with their representative if this was applicable. It was apparent that care plans are reviewed regularly with the person and or their relative and others involved in their care. In the AQAA we were told that what the service does well are: nursing notes, daily diaries, life plans and review care plans and risk assessments. They also told us in the AQAA what they could do better are: Improve on clinical skills of the nursing team to offer more choice and support to people who use the service in their nursing needs. Regular supervision of all staff to ensure that they are consistently acting on the needs of the people who use the service and reviewing documentation. Care Homes for Adults (18-65 years) Page 14 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is working towards promoting, encouraging and developing social and practical skills; which would ensure that people have the opportunity to participate in leisure activities in the community. People are also given the opportunity to exercise their choice and rights in their daily life. Evidence: The manager told us that since the last key inspection they have put together an activity plan for the bungalows, with information from peoples individual activity assessment. We were told that some people attend regular day care and some have day care sessions with specialist services. There are also regular social activities by staff and on Mondays and Tuesdays from 9am until 4pm the aromatherapist visits people in the home. We looked at the information in peoples care files and we saw that there were Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: activity assessment documents, which outlined what people liked. However, there were no individual plan to show how people liked to spend their time doing their identified activities. During discussions with staff, they told us that they knew what people like to do and would engaged them in different activities. We were told that there was a plan in place to take some people away on a holiday the week following this visit. During our visit the mini bus driver and two staff took three people out to the shops in the nearby village. When people arrived back it was clear that they had enjoyed the outing. The aromatherapist visited during the time we were there and had one to one sessions with people. People spent their time relaxing during and after their session. We saw that staff give people one to one attention; one person had their nails painted and was given a hand massage. It was clear that the person was enjoying the process. People also spent their time watching television and in conversation with staff. However, during our visit we saw that people in one bungalow spent their time moving around the home not engaging in any real activities. In the AQAA we were told activities plans are now up and running, social activities are now much more regular and staffing levels meet these requirements. From the information seen it was apparent that peoples social plan need to be more person centerd, showing what they liked and disliked and their preferences and the involvement of other agencies. We were told that people are supported to keep in touch with their relatives. The manager said that they encourage peoples family, friends and representative to have contact with people and have a say in their support and the running of the home. We were told that there were regular relatives meetings. The manager told us that from these meetings the relatives have set up a relatives consultancy committee. During our discussion with the manager we were told that there is a proposal to purchase a car which has wheelchair access and also make it possible for all staff to drive the minibus. This will improve peoples outing in the community. There is also a plan for all staff to have person centred planning training so that they Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: can commence the implementation of person centered plans. During our visit to all the bungalows it was apparent that staff knew people and what they liked. In the afternoon of our visit, in one bungalow we saw that that people were sitting around the television watching the DVD film hair spray which had been requested by one person, but it appeared that others also enjoyed watching it. Another person was seen sitting in the dining area with a cup of tea at her request and was engaged in a board game. During our visit the housekeeper spent most of the day shopping for two of the bungalows. We were told that people have fresh fruit and vegetables each day. The manager told us that the menus for each bungalow are made up by the housekeeper, who we were told had had training on nutrition and was in close contact with the dietitian. We were told that menus are made up from foods that people liked, some people were able to tell staff what they wanted and for others staff had to observe their body language to see if they liked the food they were given. Meals are served to people in a variety of ways: chopped, mashed or pureed. This is to make sure that people are able to swallow their food easily. We noted that peoples nutritional needs had not been assessed which would help to identify if people were at risk of malnutrition. We saw that some peoples weight had been checked monthly, to check people are not under weight. We saw that staff supported people with respect and in a dignified way. Care Homes for Adults (18-65 years) Page 17 of 30 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 home is working to-wards providing people with care that meets their health and person need. To ensure all their care needs are met. The current medication practices could put people at risk. Evidence: Peoples care plans showed some information about their health needs. They have access to health care facilities that is relevant to their specialist needs. We saw some information and observed interaction between people and staff that showed that people are encouraged to make decisions about their daily life. For example one person likes to be in his room and in the home and he is supported to do this as it was his wish. However, we found that there was some elements of risk and there was no risk assessment in place to show what action staff would have to take if this person had to leave the home. This was discussed with the manager who agreed that this would also have to be assessed under the mental capacity act deprivation of liberty. Although it was recognised that the skin and haircare of a black person in the home needed different attention and through our discussion with staff they knew what to do, the plan in place did not show how this person skin and haircare would be cared for. Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: So that their cultural needs were met. Although we found that most of the care plans seen gave some good information with the actions that staff must take when meeting peoples care and support needs. They were not person centred. This would reflect the care being given and will contain more information about peoples preferences. We looked at the way in which peoples medication was delivered; we saw staff administering medication were patient and allowed people time to take their medication; staff informed people what they were doing before giving their medicine. We saw that one person had swallowing difficulties and all of her medication was prescribed in liquid form. We saw that there was a plan in place for one persons medication to be given covertly, this had been agreed with their GP and the family. We saw that another persons information showed that their medication should be given with yogurt. We also saw in some records that peoples medication are given covertly, but there was no record that this had been agreed with their GP and their representatives. This was discussed with the manager. We looked at one medication trolley and found that some medications was out of date. We were told that peoples daily medication are ordered monthly. However, we found that people were still having medication from previous months despite being told that the home did not carry any excess medications; we also found that there was no gaps in the administration record. Medication administration records in all of the bungalows were inspected; we found that all medication was given as per chart and staff administering had signed to indicate this. We were told that a new nurse was designated to over see the medications in all of the bungalows but had not checked all the trolleys at this time. The matter of medication storage was discussed with the manager who said that they had not had an audit by the chemist for some time; we suggested that the manager contacted the dispensing chemist for them to carry out an audit of medication at Bedes close. Care Homes for Adults (18-65 years) Page 19 of 30 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 systems in place to make sure people are safe. All complaints are taken seriously and acted upon to ensure people are protected from abuse. Evidence: Information and complaint procedure is available in the home. Staff told us that they know what to do if they had any concern; this would be discussed with the manager. In the last six months there has been four complaints three of which had been referred to us. There are procedures in place to make sure people are protected from abuse. During our discussion with staff it was clear that they knew the different types of abuse and what steps to take to make sure that any situation of abuse is reported. We have made three referral to safeguarding adults, following complaints made about the home. Care Homes for Adults (18-65 years) Page 20 of 30 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. People live in a home that has enough space and facilities for them to lead the life they need. Evidence: We looked around all three bungalows and we found that peoples rooms were to a good standard reflecting their personality. The sitting rooms and bathrooms needed redecorating. The electrical ventilators needed cleaning the manager said many of these were out of order and there was an improvement plan in place along with the redecoration and refurbishment program to have these replaced. Although generally the home was tidy, all of the bungalows needed thorough cleaning as many of the floor in kitchens, bathrooms and toilets needed deep cleaning. The manager said the cleaning schedules have been reviewed and updated and the domestic staff cleans one bungalow fully once a week with spot cleaning the other days. In the AQAA we were told the bungalows requires decoration and repairs to all areas and in the next twelve months there are plans to commence repairs and redecorations for the whole site. Two kitchens are to be replaced, two old boilers in the kitchens are also to be replaced and office to be updated. We saw that the home provides staff with a variety of moving and handling equipment to assist them with handling people; such as tracking hoist, which is available in some bedrooms. Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: We saw that several wheelchairs needed cleaning; this had been reported in the last key inspection. The manager said that key workers carried out visual checks of wheelchairs and bed safety rails. However, there were no records in place to show these checks had been carried out; a record is only made if there was a fault that needed repairing. We found that bathrooms and toilets were cluttered with incontinent pads and other unused equipment. The manager told us that she was aware that there was very little facility for storage; and additional storage unit had been purchased. Peoples personal laundry is carried out by the staff and bedding is sent to a central laundry. We saw that staff assisting people observed infection control procedure where gloves and aprons were worn when assisting people with personal care. Hand washing and drying facilities are available in communal bathrooms, toilets and bedrooms. Staff cooking meals wore aprons when cooking. Care Homes for Adults (18-65 years) Page 22 of 30 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. Staff are trained and competent to meet the needs of the people who use their service..le are protected by the homes recruitment and selection process. Evidence: The staff rota seen, showed that during the day there are two support staff in each bungalow and one nurse in charge. At nights there are three support workers and a nurse in charge, the nurse is allocated to one of the bungalows and carries out checks of each bungalows during the night and administers peoples medication. However, although we acknowledge that this arrangement for the nurse to visit the other units has been risk assessed. This should be kept under review so that staff and people are safe at all times There have been several staff changes over the last twelve months which has resulted in the use of the organisations bank staff. At the time of the visit there were several staff vacancies: five support workers and four nurses. The manager said that interviews had taken place and four staff were in the interview stage; all the vacant hours are covered by the organisations bank staff. This is to make sure people have enough staff to meet their needs. The agency has a part time house keeper and full time driver and one domestic who Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: works five days a week from 9:00 am to 3:00 pm this person carries out the cleaning of all the bungalows. We looked at three staff files these showed that recruitment and selection is properly managed by the home and the organisation; interviews are held, references and CRB Criminal Record Bureau and POVA protection of vulnerable adult first checks are made; to make sure staff are fit to work with vulnerable people. Induction training is based on the skill for care common induction standards. Staff said their induction had been good and informative and prepared them to do their job. Staff also said there is on going training . We looked at the training matrix and saw that staff have updates of training for such as moving and handling. Support workers told us that they would like additional training about peoples individual diagnosis. Which they feel would help them to understand more about the individual and their illness/ disability. The manager told us that although staff are given overview training on the mental capacity act, there was a plan in place for all nurses to be given training on deprivation of liberty. We were also told that because there is a capacity issue with people who use their service. The home uses the National Health IMCA Independent Mental Capacity Advocacy, who advocate for people to help with their decision. In the AQAA we were told that training consists of NVQ 2 in care for support staff and induction training for all staff. We were also told that staff have human resource and pastoral care support. They also told us that since the last key inspection they have implemented flexible working so that staff work days and nights, improving the continuity of care and also improving teamwork. The manager said she feel what she could do better is more frequent supervision for the staff team. Care Homes for Adults (18-65 years) Page 24 of 30 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 overall well managed in the interest of the people who use the service. Evidence: In the AQAA we were told the new service manager she now been in place for 14 months. Has commenced registered managers award course. The deputy service manager is in post to support the manager. The organisation carries out service reviews every six months, Health and Safety audit every two months and regulation 26 inspections. We were also told that policies and procedures are accessible and implemented. There are regular staff meetings which gives staff the opportunity to discuss any issues they may have as a group and the general running of the home. These meetings are minuted and are made available to staff who have not attended the meeting. We were told that the manager operates an open door policy and is always available to support and advise staff and monitor the care of people; and is available to people and their representatives. Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: From discussion with staff it would appear that the manager is committed to provide positive leadership in a relaxed atmosphere. Staff were positive about the manager. Staff said they receive regular supervision, where they can discuss the care of people and their personal development. We were told that the organisation was in the process of updating their policy procedure, so that they comply with current legislation. The regional manager carries out monthly audits of the service with information of any improvement that needs to be made. There is an annual health and safety audit carried out by the organisation and there is a parent /carers group which reports back to the home any concerns. We discussed the service audit done by the organisation. We were told that the audit does involve staff and health and social care professional who are involved in the care of people living in the home to gain their views on the service. We saw records showing that all the required health and safety checks to the building and equipment used had been carried out in the given timescales. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 All identified potential risk to 31/12/2009 people must be assessed and recorded. So that staff know how to manage the risk 2 20 13 medication given to people, must be in date as indicated on the label. To make sure people medication are safe for them to take. 30/12/2009 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 All risks assessed should have a care plan which clearly shows staff what action they must take to manage or minimise the risk. If people are to have their medication given covertly, then they should be made aware of this. More time needs to be allocated to cleaning and extra attention should be given to cleaning throughout the site, Page 28 of 30 2 3 20 24 Care Homes for Adults (18-65 years) 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 to make sure people live in a clean environment. 4 29 Some consideration should be given to formalise the checks of wheelchairs and bed safety rails with a record kept of the date of the checks, this would ensure that people and staff safety is not compromised and equipments are safe for use. Some consideration should be given to get the views of staff and health and social care professionals and other about the service the home provides. 5 39 Care Homes for Adults (18-65 years) Page 29 of 30 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. Care Homes for Adults (18-65 years) Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!