Care Home: Brendon Lodge

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What the care home does well People living at the home are involved in the development of their care plans.People living at the home are able to make choices about their daily lives.People have their healthcare needs met and are referred to the relevant healthcare specialist as required.People living at the home are supported to access the community and take part in leisure pursuits of their own choosing.There are sufficient staff on duty at any one time so people living at the home can be supported to take part in activities in and outside the home of their own choosing. What has improved since the last inspection? The home knows how to meet people`s needs before they move into the home because a new and improved assessment tool is being used.There are clear guidelines for the use of `as required` medications, so people get the correct dose when they need it.Internet facilities have been made available so people living at the home can keep in contact with their friends and families.Bedrooms have been decorated in the colour choice of whose bedroom it is.Staff have personal development plans in which a record is kept of all their training. What the care home could do better: The statement of purpose must accurately detail the service provided at the home.A manager must be appointed and this person needs to submit an application to the Commission to be registered as manager of the home.Staff must have formal supervision six times a year.Monthly visits to the home resulting in a written report about the running of the home must be completed and copies of these reports must be available at the home. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Brendon Lodge 27 Southleigh Road Warblington Havant Hampshire PO9 2QG two star good service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Gina Pickering Date: 0 5 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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 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 Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Internet address www.cqc.org.uk Information about the care home Name of care home: Address: Brendon Lodge 27 Southleigh Road Warblington Havant Hampshire PO9 2QG 02392498585 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : dolphin.homes4@btconnect.com Dolphin Homes Ltd care home 9 Number of places (if applicable): Under 65 Over 65 9 9 0 0 learning disability physical disability Additional conditions: The maximum number of service users to be accommodated is 9. 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 A bit about the care home Dolphin Care Homes Ltd has been the registered provider of Brendon Lodge since April 2006. People who have a learning disability or physical disability can live at Brendon Lodge. The home is near to Havant Town Centre where there are shops and other amenities. 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 How we did our inspection: This is what the inspector did when they were at the care home We considered information received about the home since the last inspection on 6th June 2007. This included information provided to us in the form of the homes Annual Quality Assurance Assessment (AQAA) in which the service tells us about improvements made in the past 12 months and how they propose to continue to improve the service. We sent surveys to people who live at the home and staff members. We received 6 surveys from people living at the home and 4 from staff members. We visited Brendon Lodge on 5th June 2009. We had conversations with 3 people living at the home, the parents of one person living at the home, 4 staff members and the person running the home. We also looked at various documentation and looked at various areas of the environment of the home. The home did not have a manager at the time of out visit. The new manager had been due to commence employment the day of our visit, but this start date had been delayed. One of the area managers for Dolphin Homes Ltd was running the home. For the purpose of this report she/he shall be referred to as the manager. What the care home does well People living at the home are involved in the development of their care plans. People living at the home are able to make choices about their daily lives. People have their healthcare needs met and are referred to the relevant healthcare specialist as required. People living at the home are supported to access the community and take part in leisure pursuits of their own choosing. There are sufficient staff on duty at any one time so people living at the home can be supported to take part in activities in and outside the home of their own choosing. What has got better from the last inspection The home knows how to meet peoples needs before they move into the home because a new and improved assessment tool is being used. There are clear guidelines for the use of as required medications, so people get the correct dose when they need it. Internet facilities have been made available so people living at the home can keep in contact with their friends and families. Bedrooms have been decorated in the colour choice of whose bedroom it is. Staff have personal development plans in which a record is kept of all their training. What the care home could do better The statement of purpose must accurately detail the service provided at the home. A manager must be appointed and this person needs to submit an application to the Commission to be registered as manager of the home. Staff must have formal supervision six times a year. Monthly visits to the home resulting in a written report about the running of the home must be completed and copies of these reports must be available at the home. 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 Gina Pickering The Oast Hermitage Court Hermitage Lane Maidstone ME16 8NJ 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. 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 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 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 . Assessment processes that include the provision of information and visits to the home mean people are able to make a choice about the suitability of the home for them. Evidence: The AQAA told us that people move into the home only after a full assessment process is completed and that an improved assessment tool is being used for this purpose. This includes assessments of the persons needs obtained from a variety of sources including a representative from the home visiting the person to assess their needs. People interested in moving into the home are able to visit the home and have several overnight stays as part of the decision making process. We looked at the documentation for the one person that has moved into the home since the last inspection. This evidenced that information about this persons needs had been obtained from several sources, including the family, the previous place of residence, relevant health care professionals, Social Services care management assessments and assessments made by the staff at the home. Visits to the home prior to moving in were detailed in these documents. We were told by one of the people living at the home that it was her/his decision to move into the home from where previously living. This person told us the decision was made by looking at information provided about the service offered at the home, visits to the home and overnight stays at the home. The parents of a different person living at the home confirmed that they had been provided with information about the home and their daughter/son had visited the home several times before the decision was made to move into Brendon Lodge. Evidence: Surveys we received from people living at the home indicated that it was their decision to move into the home and that they had received sufficient information about the home to make a decision about the suitability of the home for them. As part of the inspection we looked at the statement of purpose and service guide that is provided to interested people detailing the services offered by Brendon Lodge. It was noted that there were no details about the involvement of people living at the home about the development and reviewing of care plans and that details about the registered manager were incorrect. 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 living at the home know how their changing needs will be met by the use of clear care plans. People are encouraged to make choices and are supported to manage identified risks to lead an independent life as possible. Evidence: The AQAA told us that care plans are developed with the person using the service, any representatives they may have and involved agencies whether these are social care or health care. We looked at three care plans. Each of these provided details of the support each person needs, including how and where the person wishes the support to be provided. Care plans detailed the choices and wishes for each person. Two people living at the home confirmed their involvement in their care plan, and the parents of another person living at the home confirmed their involvment in the care planning process. Information in the plans is in the written word and pictorial images so people living at the home can understand the detail in the care plans. We were shown a plan that is written in the words of the person it is about and has photos to illustrate the indivuiduals needs and choices. This person told us about her/his involvement in the plans confirming she/he had full knowledge of all the details in the plan. We were told that this process is going to be introduced for all care plans at the home to furthur develop the individuality and personalisation of each plan. Evidence: Care plans that we looked at provided detail of the behaviours of the idividual. This included any challenging behaviour, how such behaviour exhibits, any known and possible triggers for challenging behvaiour and the managemnet of such behaviour. One of the people living at the home confirmed to us that she/he knows the detail about their behvaiours in the care plan and agrees with the detailed management of her/his behaviours. It was evident from discussions and from information provided that people living at the home are supported to make decisions about their life and daily activities. House meetings provide oppportunity for people to express thier wishes amd make choices about areas such as activites inside and outside the home and menu plans. Surveys from people living at the home told us they always or usually make decisions about what they want to do during the day, evening and weekends. Procedures are in place to assure the safety of peoples finances. The home looks after monies for people living at the home. Money is kept in separately for each person in a locked safe and accurate records are kept of all income and expenditure. Each persons money is checked by two staff members on a daily basis to eliminate the risk of any mishandling of the money. The home encourages people living there to be as independant as possible. Risk assesments are included in the care planning process for all aspects fo daily life, including accessing the community. Actions to be taken to reduce any identified risks are detailed. One person living at the home confirmed in dicussions her/his understanding of the idenitifed risks and the actions the home and she/he needs to take to reduce these. 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 . People living at the home have the opportunity to make choices about their lifestyle and are able to take part in activities and learning experiences they enjoy. People enjoy the meals provided at the home and are are involved in the choice of meals. Evidence: The AQAA told us that each person living at the home has an activity plan detailing their choice of activities for the week. This can include college attendence, paid or voluntary work and individual or group activities arranged in the home or in the community. When we visited the home five people were attending college that day, one person had made arrangements to meet with a friend and and three people were spending time at the home choosing to watch films or help staff with the preparation for a party happening later that day. Care plans that we looked at clearly detailed the social and leisure interests of the individual and the activity plan was noted to take into account thier preferences. One person told us about the courses she/he is undertaking at college and the live band concerts she/he has been to see. Comments included in surveys from people living at the home included the activities we do are good and stimulate us and I enjoy being independant and I sometimes like the activities People living at the home are encouraged and supported to make use of community facilities. Individual preference about accessing community facilities are detailed in the care plans for example one person prefers to have meals where the service is quick Evidence: and food can be eaten with fingers. Some people are able to access the community independently, this is supported by risk assessments with the person understanding the actions the home and her/himself takes to reduce any identified risks. This includes the persons understanding of the homes missing persons procedure that will be invoked at an agreed time if the person has not returned home or contacted the home. At present nobody living at the home is in paid employment, but the home has tried to source employment for one person living at the home. At present this person is doing voluntary work once a week with underprivileged children. The AQAA told us the home has made stronger links with the families of people living at the home. The plans of care detail the family and friend links that people have including their involvement in the care and support of the person. It was evident from information in the plans that the home supports and encourages people to retain contact with family and friends. Internet facilities have been provided so people can keep in contact with friends from where they lived prior to moving into Brendon Lodge. The parents of one person living at the home told us that staff at the home support thier daughter/son and them to retain their close relationship. We were told by staff that routines at the home are flexible to meet the needs and wishes of people living at the home. Individual preferences about daily routines are included in the care planning documentation. We were told by people living at the home that staff respect thier wishes and they are able to make choices about what they do and when they do it. Part of the daily routines include housekeeping. Care plans and activity plans detail the individuals involvement and support required in housekeeping including laundering and cleaning their bedrooms. The menu plan for four weeks is displayed on kitchen wall. We were told by staff that this plan is developed with people living at the home and is used as a guideline for preparing meals. On the day we visited the menu had been altered as a party was occurring in the evening. Records are kept of meals provided to people living at the home. Conversations we had with people living at the home indicated they enjoy the meals provided at the home. Care plans detail nutritional assessments for people living at the home and any involvement of relevant health care professionals. 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 . Effective care planning means people receive care and support in the way they like and their health care needs are met. Medication practices mean people have their health protected. Evidence: Care plans detail the assistance and support each person needs regarding meeting their personal care needs. This includes personal preferences about bathing, details of what a person can do for themselves and what they need support with, any preferences of gender of carer providing personal care and support and personal preferences regarding toiletries. If a person requires the use of equipment, such as bath hoists, and shower chairs, clear details of how to use the equipment is included in the care planning. Each bedroom has an en suite bathroom which facilitates the maintenance of privacy whilst some one is receiving personal care. There is also a large bathroom with an assisted bath for the use of people if they wish. For those people that require it, there are overhead tacking hoists in their bedrooms, for which staff have had training and details about how to use it is included in the individual care panning documents. Individual records detail the health care input they receive. Each person has a document that details all their health care needs.ability. Records indicated that individuals have recently had involvement from clinical psychologist, speech and language therapists, physiotherapist, and dentists. Independent assessments of peoples mental capacity have been completed for people requiring medical treatment who have not been able to make informed decisions about their health care themsleves. The AQAA told us that all staff complete a medication management training course Evidence: provided by a local further education college before they commence administering medications to people living at the home. Annual assessments of the competency of each staff member are also completed to ensure the safe administration of medications. Staff training records have evidence of this training occurring. One staff member we spoke with that had recently been appointed confirmed to us that she does not administer medicines and will only administer them after she has completed the relevant course. We looked at a sample of Medication Administration Record sheets and found them to clearly identify the name of medication, the dosage required and the time and date when administered. For medications prescribed to be taken as required clear information is included in the medication records detailing the indications that show the medication is needed, the expected outcome after having the medication, the dose and any contraindications to having the medication. The manager confirmed that the prescriptions for each person living at the home are seen before medications are ordered. This means it is assured that people are receiving the medications that their medical practitioner has prescribed for them. We looked at the storage of medicines, which was in a clean and orderly manner. 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 . People living at the home are protected against the effects of abuse by a staff team that has a good understanding about safeguarding procedures. Procedures are in place to enable people to voice complaints. Evidence: The AQAA told us the complaints procedure is located in all the care plans and there is a user friendly version in the entrance hall for anybody to access. In the care planning documents we looked at there was a copy of the complaints procedure that included timescales for responding to complaints. The copy located in the entrance hall was in large print and had pictorial images to help people living at the home understand the process. Responses that we received from surveys indicate that people living at the home know who to speak to if they are unhappy or have any concerns and they are aware of the complaints procedure. The home informed us they have received two complaints in the past twelve months, both of which were responded to within 28 days as per the complaints procedure. The complaints log book details the complaint, action taken and the response to the complainant. Regular house meetings provide opportunity for people living at the home to raise any concerns about the service before they escalate to being a complaint. We were told by two people living at the home and the parents of one person living at the home that the home responds promplty to any concerns raised. The home has a procedure about safeguarding of vulnerable people that includes the local authoritys procedures for safeguarding and managing safeguarding alerts. Training records detail staff have received training about safeguarding adults and conversations with the staff group at the home at the time of our visit indicated a good level of understanding about safeguarding procedures. This means that people at the home are safeguarded from the effects of abuse with staff having a good understanding about what actions must be taken if they suspect an act of abuse has Evidence: occurred. The AQAA detailed that one safeguarding referral has been made in the past year. Discussion with the manager at the time of our visit indicated that this was an appropriate referral with relevant actions being taken to safeguard people at the home. 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 well maintained, comfortable and safe home that provides the relevant equipment so their needs can be met. Evidence: The statement of purpose details there are six en suite bedrooms in the main building of the home with each having specialist en suite facilities. There is an addition a large assisted bathroom, toilet facilities, a lounge, dining room, conservatory and garden areas. The AQAA told us the home is adapted to suit the individual needs of people living there. It was noted that the admission process means that no one moves into the home until specialist equipment and adaptations to relevant areas are made to the home to ensure the environment meets their needs. For those people living at the home that need hoist assistance when moving over head tracking hoists have been provided in their bedrooms. Facilities in the en suite bathrooms are individualised to meet the specific needs of the person whose bedroom it is. Each bedrooms is personalised with belongings of each individual, reflecting their personal interest and hobbies. The AQAA told us that in the past year all bedrooms had been decorated in the choice of colour of the person whose bedroom it is. This was confirmed in conversation with people living at the home and staff members. Separate to the main building is the annex, which is described in the statement purpose as a three bedroomed bungalow with communal lounge/dining room and kitchen facilities that provides a stepping stone to independent living. One of the people living in the annex described her/his satisfaction with the facilities, and the level of independence it gives them. Weekly health and safety audits of the environment identify maintenance issues that are then raised with the maintenance department of the company. Clear records are kept of audits, the date when maintenance issues are raised and when the work is completed. Evidence: Housekeeping of the home is completed by the staff and people living at the home. The tidying of individual bedrooms is planned into the weekly routines of each individual. The degree of staff support to each person with this activity depends on the individuals needs. The home was clean and tidy on the day of our visit to the home. Surveys received from people living at the home indicate the home is always clean and fresh. Comments included the cleaning is done twice a day and comments about what the home does well included the cleaning of the home. The parents of one person living at the home told us that the home always has a homely appearance making it a comfortable place for their daughter/son to live. The laundry is located away from food preparations areas reducing risks of contamination of food stuffs. A separate laundering facility is located in the annex for people living there to do their laundry with the support of care staff. This again reduces the risk of any cross contamination from dirty laundry as it does not have to enter the main house. Training records detailed that staff have undertaken training about the control of infection. 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 . People living at the home receive support and care from a staff team in sufficient numbers and with the relevant skills and experience. Recruitment procedures protect the wellbeing of people living at the home. Evidence: The statement of purpose provides people with details about the staffing structure at the home and the skills and experience of people working at the home. A rota displayed in the dining area of the home details which staff are on duty at any one time. Staff told us there are sufficient staff on duty to meet the needs of people living at the home. During our visit to the home one person living at the home requested a lift to the local train station, there were sufficient staff on duty for a member of staff to take this person out as well as a another member of staff being out collecting another person from a local college. This suggests there are sufficient staff to provide support in a flexible manner to enable people living at the home to make spontaneous decisions about what they want to do. People living at the home told us there are usually enough staff on duty to attend to their needs. We were told in the AQAA that each member of staff has a personal development plan in which their training is detailed. We looked at a sample of these plans. The service has purchased a training programme that all staff undertake to cover various aspects of care practices. This includes food hygiene, infection control, dementia, medications, health and safety, protection of vulnerable adults, fire awareness and moving and handling theory. A different training provider is used to give staff practical training about moving and handling, first aid, fire safety and evacuation procedures. As well as all staff maintaining their personal development plan the company employs a training coordinator who has responsibility for maintaining details of everybodys training and ensuring every staff members training is updated as required. Further training about how to met the individual needs of people living at the home are sourced as and when needed. Examples of such training include the management of challenging behaviours Evidence: from a professionally recognised organisation, meeting complex communication needs and palliative care. Staff told us that the home will support them to attend courses and obtain qualifications that have the potential to result in improving comes for people living at the home. Staffs personal development plans also detail formal supervision sessions. Records of supervision sessions indicated that since there has been no registered manager at the home formal supervision sessions have not been occurring at regular intervals, which means staff will not receive the required six sessions in twelve months. The manager told us that with her area manager responsibilities and the running of the home she had not been able to complete supervision sessions. But from discussion with staff members it was clear that issues about the running of the home and care practices were being discussed in staff meetings, at handover sessions or on an individual basis as needed. The AQAA told us that ten of the thirteen staff members employed at the home have NVQ level 2 or above in care. On the day of our visit one of the recently appointed staff members told us she had commenced NVQ level 2 and another staff member told us she was studying for NVQ level 4 in care. This means the home has exceeded the required minimum of having 50 of staff members employed with NVQ level 2 in care. The personal development plans of staff indicate they had completed induction training that meet Skills for Care common induction guidelines. Staff members and the person running the home told us this induction programme also included specific care practices for people with learning disabilities. This means that even a recently appointed staff member is provided with the skills to meet the needs of people living at the home. The statement of purpose details that staff are only appointed after a thorough recruitment process has been completed. An agreement has been made that staff recruitment records are held at Dolphin Homes Ltd main office base. However a record is held at the home of the start date of each member of staff and when their references were received and when checks against the Criminal Records Bureau and Protection of Adults list were received. These records indicated that staff do not commence employment before the necessary recruitment records have been received. Staff members told us they did not commence employment at the home until the home had received all their recruitment checks. This means people living at the home are supported and cared for by people who have the relevant skills and experience and of of a suitable character to work in the care industry. 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 . There is no registered manager at the home, but the interim management arrangements mean that people living at the home have confidence in the home and their views and opinions are considered. Health and safety of people living at the home is protected. Evidence: The AQAA detailed that a new manager was due to commence employment at the home on 5th June 2009. We had been notified by the service in December 2009 that the previous manager was leaving employment in January 2009 and that one of the area managers was going to manage the home until a new manager was appointed. We were told by the area manager on the day of our visit that the new manager had not yet commenced employment and there was not amended start date yet for the new manager. Staff told us that the lack of permanent management of the home had affected their morale and the moral of some of the people living at the home. These comments appeared to relate to a period of time when it was uncertain as to the management arrangements at the home at the end of 2008 and beginning of 2009. All staff and people living at the home spoke highly of the support presently being provided by the area manager who is running the home. Comments were received from people living at the home in surveys about the management arrangements it would be nice to have a manager that stays longer than a few months. The previous manager had only remained in post from May 2008 till January 2009. Quality assurance systems are in place and used effectively to monitor the environment and care planning documents. This includes the use of annual surveys of people living at the home, reviews of care planning documents, house meetings and continued dialogue with people living at the home. Changes made as a result of Evidence: listening to the views of people living at the home include the provision of internet access, choices of individual and group activities and colour and decor schemes for communal and private rooms. A monthly report regulation 26 report) on the conduct of the care home is required to be completed by the organisation. This includes a visit to the home and discussions with people living at the home. These reports must be made available to the manager of the home. The reports had been being completed by the area manager, but as she is presently managing the home she is not able to report on the running of the home. There were no Regulation 26 reports for the service since January 2009. Policies and procedures are in place for health and safety issues. Staff training records and their development plans detail training has been provided about health and safety issues such as moving and handling, infection control and first aid. Monthly health and safety audits of the environment are completed. Records detail that concerns relating to the environment result in a request for action being made to the maintenance team and records kept of when the requests have been actioned. We looked at certificates for the servicing and maintenance of equipment at the home. These evidenced the health and safety of all at the home is protected by the regular maintenance of equipment and services as recommended by relevant legislation or manufacturers guidelines. The fire log book was seen detailing the fire safety checks the home completes. The accident book is completed for all accidents or incidents occurring. 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 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 1 4 The statement of purpose must accurately detail the service provided by the home. 06/08/2009 So people are provided with accurate and up to date information about the service to help them make an informed decision about moving into the home. 2 36 18 Formal supervision sessions 26/08/2009 must be provided for all care staff six times a year which covers all aspects of practices at the home, the philosophy of care in the home ans the career development needs of staff. So people living at the home are cared and supported by staff who are appropriately supervised. 3 37 8 A manager must be 30/08/2009 appointed and arrangements made for this person to submit an application to the Commission for registration as manager of the home. So the home is effectively monitored and managed. 4 39 26 Visits must be taken in accordance with Regulation 26 and reports of the visit must be available at the home for inspection at all times. 30/07/2009 So the home is effectively monitored and managed. 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 Helpline: Telephone: 03000 616161 or Textphone : 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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