Care Home: Bromhall Road

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What the care home does well The service has a comprehensive activities programme, to ensure they can meet all the needs of residents. There is a good selection of meals provided at the home. Preadmission assessments are completed before prospective individuals move into the home, ensuring that the service will meet their needs and to ensure that they receive a personalised service. Trial visits are offered to all prospective individuals, to ensure they have information on the services and facilities provided at the home. Care planning is very comprehensive and person centred with particular attention given to meeting individuals` personal preferences and respecting their individuality. People who use the service can also be assured that at the time of their death, staff would treat them and their family with care, sensitivity and respect. The home has a clear complaints procedure, which includes timescales within which a complaint is to be investigated. The management of the home operate a open door culture welcoming complaints and feedback. The health and safety of staff and individuals living at the home is promoted by the home`s policies and procedures. The service has robust recruitment procedures ensuring the safety of residents and there are enough members of staff on duty to meet the needs of residents at all times. What has improved since the last inspection? At the last inspection three requirements were made in relation to, care planning, the recording of daily notes and areas relating to the physical environment. At this inspection all these requirements have been complied with. What the care home could do better: Three requirements have been made at this inspection in that the Registered Persons must check the recordings of expenditure to ensure they are correct and all incomings and outgoings of money are recorded correctly to ensure their accuracy. Also that residents are reimbursed the money they spent on their specialised bed as the practise of residents paying for specialised equipment is in breach of the Care Homes Regulations 2001. The Registered Persons must ensure that to minimise the risks of medication administration current practises are reviewed and safer storage systems are found within the home. The Registered Persons must also ensure that all parts of the home to which residents have access to must be so far reasonably practicable made free from hazards and unnecessary risks to residents are identified and so far as possible eliminated. Key inspection report Care homes for adults (18-65 years) Name: Address: Bromhall Road 110 Bromhall Road Dagenham RM9 4PH     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: Harbinder Ghir     Date: 2 0 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Bromhall Road 110 Bromhall Road Dagenham RM9 4PH 02085927690 02085927690 bromhall.road@theavenuestrust.co.uk glebe.house@theavenuestrust.co.uk Avenues Support Services care home 8 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) : Number of places (if applicable): Under 65 learning disability physical disability sensory impairment Additional conditions: Date of last inspection Brief description of the care home 110-112 Bromhall Road are 2 bungalows linked via a corridor and are owned and run by the Avenues Trust. The home is situated in a residential area of Dagenham close to local shops and transport links. There are ample parking spaces to the front of the building and the garden to the rear of the property is laid to lawn and flower borders. Residents residing at the home have a varying degree of physical and learning disabilities and sensory impairment, and are between the age range of 18 - 64 years. The fees currently charged by the service is £1.480.44 per week. 8 8 8 Over 65 0 0 0 Care Homes for Adults (18-65 years) Page 4 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: This was an unannounced inspection undertaken by Regulation Inspector Harbinder Ghir. The inspection took place on the 12th October and a second day on the 20th October was spent contacting relatives and representatives by telephone, seeking their views on the service. Their feedback has been included in the report. During the inspection the inspector was unable to talk to the residents residing at the home due to their complex communication needs. However, the inspector was able to talk to staff and their comments have been included in the report. As part of the inspection the inspector toured the home, read records of people who use the service and examined documents in relation to the management of the home. The inspector would like to thank everyone involved in the inspection process. Care Homes for Adults (18-65 years) Page 5 of 28 The Care Quality Commission received a completed Annual Quality Assurance Assessment prior to the inspection. Care Homes for Adults (18-65 years) Page 6 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At this inspection we looked at standards 2, 3, 4, 5. The service completes comprehensive pre-admission assessments, to ensure they can fully meet the needs of prospective residents. Trial visits are offered to all prospective residents, to ensure residents have information on the services and facilities provided at the home. Each resident has an individual written contract of the statement of terms, to ensure they agree to the services provided at the home. Evidence: It was not possible to examine up to date pre-admission assessments, as all residents have resided at the home since it opened in 1994. However, the service has a comprehensive pre-admission policy and procedure in place and admissions would not be made to the home until a full needs assessment has been undertaken. The policies and procedures highlighted that admissions to the home would only take place if the service is confident that staff have the skills, ability and qualifications to meet the Care Homes for Adults (18-65 years) Page 9 of 28 Evidence: assessed needs of prospective residents. New prospective residents would be able to visit the home as many times as they like and have an opportunity to stay overnight. Relatives and family would also be invited to visit the home. All residents were provided with a statement of terms and conditions. This set out simply and clearly and in detail about what is included in the fee, the role and responsibility of the provider, and the rights and obligations of the individual. Very positive feedback was received from relatives and representatives spoken to during the inspection. A relative informed We are very pleased with the care and have never been so happy. My loved one was a very quiet boy before he moved into the home. But now he is so relaxed and happy at the home. He goes to the pictures or bowling and is out when ever I ring. We are very, very pleased with the care there. Care Homes for Adults (18-65 years) Page 10 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At this inspection we looked at standards 6, 7, 8, 9. There is a comprehensive care planning system in place, which provides staff with the information needed, to meet the needs of residents. The right for residents to exercise choice and control is promoted by the service and they are actively consulted on, and participate in, all aspects of life in the home. Risk assessments are undertaken routinely, to ensure residents are supported to take risks as part of an independent lifestyle, and are always updated according to residents changing needs. Service users financial interests are safeguarded, but more robust systems need to be in place to ensure all incomings and outgoings of individuals finances is recorded and accounted for accurately. Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: Three care plans were closely examined. Care plans seen evidenced that the service involves individuals in the planning of care that affects their lifestyle and quality of life. Care plans were comprehensive; person centred and clearly set out residents health, personal and social care needs. Information was found specific to the religious, cultural and social care needs of residents and how the service was to meet these needs. The information provided in care plans was very detailed and individualised, and clearly recorded and described how residents wanted their needs met. For example one residents care plan informed how they communicated. The care plan stated, I have good communication skills. I understand what people say to me. I am able express some single words such as yes. Care plans were written from the residents point of view and concentrated on promoting the independence and aspirations of residents. The documents also included some information in picture formats and included information on residents likes, dislikes, how they communicate and what they are able to do independently and tasks they require assistance with. A key worker system also allows staff to work on a one-to-one basis and contribute to the care plan for the individual. Care plans were working documents and are reviewed on a six monthly basis or as and when required. Evidence was seen of reviews taking place with care managers also involving the resident and their representatives. Reviews focused on asking what has worked for the individual, where progress is being made, achievements, and concerns and identified action points. Evidence was seen of reviews being arranged to fit in with the availability of family so that they could be involved in the process. All three care plans had been reviewed on a regular basis. Risk assessments were completed for residents and identified risk areas in care plans including, the event of a fire, risks that may be presented by the building, mobility, falling and wandering. Assessments included clear guidelines for staff to follow in managing risks posed to people who use the service. Risk assessments were reviewed regularly and amended. Daily case recording notes were examined which are linked to the care plan and focus on the specific needs of residents rather than recording information in a general manner. Residents were involved in the daily running of the home as far as their abilities allowed. One resident was observed choosing his lunchtime meal. A rota was also seen in the homes kitchen and each residents care plan, which described what days residents were responsible for setting the table, participating in cleaning tasks and clearing and laying the table. Residents were also supported to bring their laundry down and place it in the washing machine. Residents rights to make choices were actively promoted; by them being supported to choose what to wear, to eat and which Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: activities they would like to participate in. The service is responsible for the finances of residents. Two residents records of money held were checked with the money held in safekeeping. For one resident on counting the money held in safekeeping they were short of 25 pence. This was replaced by the registered manager. Information highlighted that two residents had paid for their specialised beds. This was discussed with the registered manager. This was an identified need and all specialist equipment needed by residents must be paid for by the service not by residents. The Care Homes Regulations 2001 under Regulation 16 states The registered persons must provide in rooms occupied by service users adequate furniture, bedding and other furnishings, including curtains and floor coverings and equipment suitable to the needs of service users. It will be stated as a Requirement that the registered persons checks the recordings of expenditure to ensure they are correct and all incomings and outgoings of money are recorded correctly to ensure their accuracy. Also that residents are reimbursed the money they spent on their specialised beds as the above practise is in breach of the Care Homes Regulations 2001. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At this inspection we looked at standards 11, 12, 13, 14, 15, 16, 17. Residents are provided with support to maintain their independence and in areas of personal development according to their needs and wishes. Residents are engaged in community life, promoting their opportunities to be part of the local community. Residents are offered meals that promote their choices and respect their individual preferences. Residents are supported to maintain family links and relationships inside and outside the home. Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: Central to the homes aims and objectives is the promotion of the individuals right to live an ordinary and meaningful life, appropriate to their peer group, in both the home and the community, and to enjoy all the rights and responsibilities of citizenship. The home understands the importance of enabling younger adults to achieve their goals, follow their interests and be integrated into community life and leisure activities in a way that is directed by the person using the service. The service has supported two residents to attend a local day centre. Here they participate in range of community activities from gardening to arts and crafts. Each resident has a devised weekly activity programme, identifying their preferred activity each day of the week. Residents are encouraged to be part of the local community and are supported to use local leisure services. Residents go to the local shopping centres for meals out and visit local parks and attractions. The daily case recording log evidenced that they were supported to go out in the evenings, which included going out to eat, to the cinema or visiting local social clubs. The home provides meals, which are varied and nutritious and meet the dietary needs of residents. Staff were aware of special dietary requirements for each resident which were also displayed on the kitchen wall. There was plenty of fresh fruit and vegetables at the home. There is a four weekly menu and residents can also refuse their choice of meal on the menu on the day and staff prepared alternative meals specified by the resident. It is recommended that picture menus are made available to meet the communication needs of people who use the service. These menus can particularly be useful or used for residents who have very limited verbal communication. Residents also go out with the support of staff to do the food shopping. Evidence was also seen of residents going out to local restaurants and being provided with take away meals of their choice. People who use the service have the opportunity to develop and maintain important personal and family relationships. Residents are supported to contact family by telephone and visit them. Relatives and residents spoken to as part of the inspection, spoke very highly of the service and the staff team at the home. I havent got any complaints about the home. We are always welcomed, offered a drink and it feels very nice at the home. Y is always smiling and we are always happy to leave him. We have no complaints at all. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At this inspection we looked at standards 18, 19, 20, 21 Residents receive personal support and care in the way they prefer and require. The service must ensure that the storage of medication is reviewed, to ensure residents are safeguarded during medication administration. The ageing, illness and death of service users are handled with respect and as the individual would wish and residents wishes in the event of their death are recorded in their individual care plans. Evidence: Residents at the home receive personal care and health care support using a person centred approach with support provided based upon the rights of dignity, equality, fairness, autonomy and respect. Each resident has a devised health plan which identifies the health care needs of residents including specialist health, nursing and dietary requirements, which are clearly recorded and act as an indicator of change in Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: health requirements. The plan also identified residents daily routines including the type of support they need in relation to personal hygiene and according to their level of care needs. All residents have a designated key worker to promote their privacy and dignity, and all personal care is provided in private. Attention is paid to personal preferences in relation to the provision of personal care, for example whether one prefers a shower or a bath. Personal support takes account of individual preferences and residents choice of dress and appearance is respected. Residents were well dressed and groomed. Residents are supported by staff to attend appointments with health care professionals and their health is closely monitored and prompt referrals are made. There was evidence of the involvement of multi-disciplinary health care professionals where required were made to dentists, chiropodists, general practitioners and community psychiatric nurses. Steps have been taken to find out the wishes of residents in the event of their death, including contacting relatives or representatives where the resident is unable to express their views. There are policies and procedures for staff to follow in the event of a death; to ensure the death of a resident is handled with respect and as the individual would wish. Medication administration records (MAR) were closely examined. Medication records were fully completed, contained required entries, and were signed by two members of staff. The medication file contained photographs of each individual, a medication pen picture and information about each medication. All of the residents have regular medication reviews conducted by the General Practitioner, which is very good practise. However, the medication in each side of the home is stored in the managers office in each home which is a long walk to the lounge. Staff take out all the pills and put them into a pot and take them to the resident for administration and then come back to sign the medication administration record. However, this practise is not practical and not safe. On administering each medication the medication administration record should be signed straight away. If a resident refused to take one medication staff could have difficulty in identifying which medication they refused to take. Also carrying medication around the home is not a safe practise in itself, as staff could become distracted by other residents, telephone calls or an emergency. Therefore to minimise the risks of medication administration it is a requirement that the current practise is reviewed and safer storage systems are found within the home. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At this inspection we looked at 22 and 23. People who use the service can be assured their views are listened to and acted on. The service records all complaints and concerns to ensure any dissatisfaction with the service is recorded regardless of source. All staff have received up to date training in Safeguarding Adults, which ensures the protection of residents. Evidence: People who use the service are supplied with a complaints procedure, which is in picture format. The complaints procedure is clear, concise and easy to follow and was displayed around the home. A complaints logbook is kept by the home, which was viewed. No formal written complaints have been received by the home since the last inspection. The Care Quality Commission is regularly notified of any incidents taking place at the by a regulation 37 notification. All staff had attended Safeguarding Adults training which is also covered in the induction programme. The service has comprehensive Safeguarding Adults procedures and protocols in place. Care Homes for Adults (18-65 years) Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At this inspection we looked at standards 24, 25, 26, 27, 28, 29, 30 Residents live in a comfortable environment and decor is of a good standard and provides a homely and pleasant living environment enhancing residents comfort. But further health and safety checks would improve the environment of the home. Evidence: The home is made up of two large bungalows linked via a corridor located in a residential area of Dagenham. The house was comfortable, bright, airy, clean and free from offencive odours. Furnishings and fittings in communal areas were of good quality, domestic and unobtrusive. Each home provides a main lounge, a kitchen, laundry room and communal bathrooms. Residents rooms were seen during the inspection. The rooms were comfortable with good quality furnishings and were also personalised by residents. The service had been very thoughtful in decorating the home to meet residents needs. As residents had chosen the paint colours for their bedrooms and decorated their rooms to their own preferences. The home has a goodsized rear garden, which provided adequate garden furniture. The home is under going a re-decoration programme and as stated above some residents bedrooms have been decorated. However, the carpets throughout the Care Homes for Adults (18-65 years) Page 19 of 28 Evidence: communal areas of the home were badly stained and need replacing. Washing powder in one laundry room and CO SHH products were left out which residents could have access too and put them at risk. All parts of the home to which residents have access to must be so far reasonably practicable made free from hazards and unnecessary risks to residents are identified and so far as possible eliminated. This will be stated as a requirement. Care Homes for Adults (18-65 years) Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At this inspection we looked at standards 32, 33, 34, 35, 36 Recruitment practises are robust and ensure residents are in safe hands at all times. Adequate staff training is provided to all care staff, to ensure they are equipped with the skills and are competent to do their jobs. The service has a good skill mix of staff, ensuring adequate numbers of staff are on duty to meet the needs of residents. Evidence: The service does not store staff recruitment files at the home and these are kept at the services head office. A data sheet was provided for each member of staff confirming their Criminal Record Bureau check number, employment history, confirmation of reference and identity checks which was examined for three members of staff. Files viewed all evidenced that staff had been on induction programmes and all received ongoing mandatory training, including training in manual handling, safeguarding adults, medication administration, health and safety, first aid and food Care Homes for Adults (18-65 years) Page 21 of 28 Evidence: hygiene. Staff had also received training in epilepsy awareness and rectal diazipam. Staff supervision records evidenced that staff were supervised at least six times a year, ensuring staff are provided with the skills, training and knowledge to perform the tasks required by their employment role. Members of staff spoken to also commented that they were supervised regularly. Staff meetings are organised on a monthly basis and staff spoken to confirmed that they always take place, allowing them an opportunity to discuss issues or any concerns they have. Staff rotas evidenced there are sufficient numbers of staff on duty to meet the needs of residents during the day. There are always six members of staff on duty during the morning and four to five members of staff on duty during the afternoon and two waking members of staff on duty at night. One relative informed that The staff are very caring and are very welcoming. Care Homes for Adults (18-65 years) Page 22 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At this inspection we looked at standards 37, 39, 42. Residents benefit from an experienced manager who recognises their needs and adequately manages the home. The systems for service user consultation are in place, which ensures that the home is run in the best interests of people who use the service. The welfare of staff and residents is promoted by the homes policies and procedures. Evidence: The service recruited a new manager in January 2009 who has registered with the Care Quality Commission. The registered manager communicates a clear sense of direction, leadership and openness. The manager trains and develops staff that are generally competent and knowledgeable to care for people who use the service. The service works in partnership with families or close friends, as appropriate and professionals. It was evident from speaking to staff that they feel supported and well Care Homes for Adults (18-65 years) Page 23 of 28 Evidence: looked after. Relatives spoken to also spoke very positively about the manager. One relative said Calvin (manager) is very nice and he is very friendly. Quality assurance systems are in place and surveys were sent out to families, representatives and stakeholders in September 2009. An analysis of last years surveys were seen which were compiled into a report format and where a dissatisfaction with the service was expressed the service had planned actioned to address these dissatisfactions. The home works to clear health and safety policy. Health and Safety records were inspected. All documentation was in order and appropriately completed. Certificates viewed included certificates verifying up to date portable appliance testing, electrical installation, gas safety, employers liability insurance and records of fire drills and fire alarm testing. Water temperatures are taken throughout the outlets in the home on a regular basis and bath temperatures are manually taken before a resident has a bath are not recorded. A completed Annual Quality Assurance Assessment was received before the inspection and was supported by a wide range of evidence. It informed of the changes the service has made and where they still need to make improvements. Monthly regulation 26 visit reports were available to view at the home. Visits had been completed on a monthly basis and provided comprehensive information on the day-today operations of the home. Care Homes for Adults (18-65 years) Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 16 The Registered Persons 30/11/2009 must check the recordings of expenditure to ensure they are correct and all incomings and outgoings of money are recorded correctly to ensure their accuracy. Also that residents are reimbursed the money they spent on their specialised beds as the practise of residents paying for specialised equipment is in breach of the Care Homes Regulations 2001. . 2 20 13 The Registered Persons must ensure that to minimise the risks of medication administration it is a requirement that the current practise is reviewed and safer storage systems are found within the home. . Care Homes for Adults (18-65 years) Page 26 of 28 30/11/2009 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 3 30 13 All parts of the home to 30/11/2009 which residents have access to must be so far reasonably practicable made free from hazards and unnecessary risks to residents are identified and so far as possible eliminated. . 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 17 It is recommended that picture menus are made available to meet the communication needs of people who use the service. These menus can particularly be useful or used for residents who have very limited verbal communication. Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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