Care Home: Burnham House

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What the care home does well Encourage and support service users to pursue their individual goals and aspirations in line with their wishes. Provide service users with meals that are reflective of their cultural and nutritional needs. Support service users to use their community resources to lead fulfilled lives. Implement good quality assurance systems aimed at developing and improving outcomes for service users. Encourage service users to maintain their friends and family networks with their best interests in mind. Maintain a dedicated staff team, that is skilled and committed to providing a stable service to the individuals living at Burnham House. What has improved since the last inspection? The service user guide has been updated in relation to the services provided in the home at the time. A number of improvements were carried out to the communal and private spaces in the home to include: bedrooms, toilets and bathing facilities. Annual appraisals for staff were more regularly provided. Food storage in the home was of a better and safer standard. There were better support arrangements in place for the manager. A business and financial plan has been developed and the business plan made available for inspection. What the care home could do better: The registered persons should ensure that the environmental developments listed in their business plan are carried out in a timely manner. This should also be the case for improvements that are identified in the daily running of the service. Arrangements should be made for the manager to complete the NVQ Level 4 in Management and Care in line with National Minimum Standard 37.2(ii) for Younger Adults. Key inspection report Care homes for adults (18-65 years) Name: Address: Burnham House 401 Cranbrook Road Ilford Essex IG1 4UL     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: Stanley Phipps     Date: 1 8 1 1 2 0 0 8 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Burnham House 401 Cranbrook Road Ilford Essex IG1 4UL 02085180707 02085546066 burnham@consensussupport.com www.consensussupport.com Consensus Support Services Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Manager post vacant Type of registration: Number of places registered: care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 8 The Registered Person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD Date of last inspection Brief description of the care home Burnham House is a care home providing personal care and accommodation for up to eight adults 18-65 with learning difficulties. The home provides a service to both men and women. In February 2006 the service was taken over by Consensus Healthcare Limited, who runs the home and accepts service users on the basis that they meet the homes criteria for admission. The home is located opposite Valentines Park in Ilford and is well served by public transport and is proximate to the Ilford Town Centre, Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 8 Brief description of the care home Gants Hill and Ilford train stations. There are a range of cafes, restaurants, shops and amenities that are easily accessible to service users. The home was opened in 2002 and consists of a large and newly refurbished two-storey building, which is indistinguishable from other properties in and around it. There is a reasonably sized and well-maintained rear garden, which is easily accessible to all service users. All bedrooms are single with two containing en-suite facilities situated on the ground floor. The home is supported by staff on a twenty-four hour basis that work closely with service users in developing their personalliving skills, confidence and self esteem by increasing their presence in community living. Service users are assisted to be actively involved in the running of the home by choosing what they would like to do, what they would like to eat, the type of leisure and educational activities they engage in and generally how they would like to spend their life. The home is geared towards enabling each service user to access healthcare, leisure, spiritual and recreational pursuits in line with their individual choices. A statement of purpose is made available to all service users in the home and is kept in the main Office. Given the level of disabilities service users are likely to have, this document is also made available to relatives and stakeholders. A service user guide is provided to service users following their admission to the home. 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 carried out an unannounced key inspection of the service with site visits on the the 7/11/08 and the 18/11/08. We focused on the key minimum standards and all the outstanding requirements that were made at the previous inspection. The inspection considered: information provided in the Annual Quality Assurance Assessment (AQAA) document that was submitted prior to the inspection. We assessed the feedback provided by service users, staff, relatives and external professionals where possible. We also conducted interviews with a sample of service users, staff and the manager. An assessment was carried out on the records required by regulation to include: policies and procedures, service user plans and assessments, staffing recruitment and training records, menu plans, activities, health and safety records, quality monitoring records and the complaints records. We also took a tour of the building and observed staffing interactions and practices which included that of; meal arrangements and medication. Care Homes for Adults (18-65 years) Page 6 of 30 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 registered persons should ensure that the environmental developments listed in their business plan are carried out in a timely manner. This should also be the case for improvements that are identified in the daily running of the service. Arrangements should be made for the manager to complete the NVQ Level 4 in Management and Care in line with National Minimum Standard 37.2(ii) for Younger Adults. 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. Service users now have updated information about the services provided at Burnham House on which they could decide the homes suitability for meeting their needs and aspirations. They have some assurance that their needs would be met, as a result of the detailed assessment that is carried with them, prior to agreeing to live there. Evidence: An updated statement of purpose and service user guide was in place, and available to both the current and prospective service users. The most significant change being that the details relating to the change in registered provider and the Commission were updated. Reference to the sensory room was also removed from the documents, as this was no longer used in that manner. As such, the key documents were reflective of the current position of the service, which accurately detailed what service users, both prospective and current could expect from Burnham House. The inspector looked at the assessment documents of the most recently admitted service user and found that a detailed assessment of the individuals needs was carried out. It was positive to see that the individual concerned had input from an Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: advocate and his sister. The assessment process was inclusive and in line with the homes admissions protocols. More importantly there was information and involvement from the placement authority, which meant that the home was able to get a good all round picture of the requirements of the individual prior to deciding that they have the resources to meet his needs and aspirations. The assessment was holistic and did take into consideration, the cultural needs of the service user. The homes assessment process remains sound. 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. Service users continued to benefit from having individual plans which reflected their goals and aspirations. They also enjoy good levels of support in making decisions that impact on their lives. This is enhanced by good risk planning to ensure that both their safety and independence is promoted Evidence: At the time of the visit, there was a change taking place with regards to care planning to reflect some of the changes that were implemented by the organisation. The service user plans seen were more person-centred and did cover the personal, cultural, social and health care needs of service users. In assessing the plan in place for the newly admitted individual, details relating to his strengths and weaknesses were taken into consideration, which is positive. Staff had a clear picture of how they could build on his strengths, while supporting to develop his weaknesses. There was good evidence of involving the service user and his relatives, as his care plan detailed that his sister was supporting him with his benefits, and he had advocacy input once per month. A health action plan was in place for the individual and there was evidence Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: that his care plan was regularly reviewed. Staff continued to work closely with all service users and working with a more person centred focus, provided greater opportunities for service users to make decisions about their lives. The use of advocacy support with service users was a good example of staff trying to ensure that service users interests were at the heart of what they did. It must be stated that all service users were supported to do what they wanted to, whether it was going to church, the library, college, bowling or indeed a holiday. It was noted that one individual, who had a passion for typing continued to enjoy opportunities in the home to do exactly what he wanted. It must be said that the staff worked flexibly and effectively to enable service users to make decisions that impacted on their lives. In most cases their inputs reflected positive outcomes for the service users. Risk assessments were in place for all service users, including one for the most recently admitted individual. They were linked to the service users plans, which were used as working tools by the staff team. Given the specialist nature of the service, the risk assessments were done on an individual basis to ensure that any restriction placed on an individual did not compromise their independence. In one case an Antecedent Behaviour Consequence (ABC) chart was in place for a service user, which was audited monthly to ensure that the support provided to him was specifically targeted to improve his quality of life in the home. In this case, it served a dual purpose of ensuring that other users of the service were not unduly affected by the behaviours exhibited by the individual concerned. All risk assessments were updated at the time of the inspection. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users continued to participate in activities which they enjoyed. They were also well-involved in their community and were supported to maintain their friends and family networks. Their individuality and rights were actively promoted, and meals provided at Burnham House were in line with their cultural and nutritional needs. Evidence: There was evidence that the management and staff at Burnham House continued to support service users to take part in activities that were based on their interests. Most of the individuals continued to participate in activities in which they were previously engaged. From an interview with one individual, he spoke of continuing his numeracy and literacy classes at college, which he enjoyed. He also indicated that he wanted to go to the job centre in pursuit of some part time work and commended his keyworker for supporting him with pursuing his goals. Every service user had an activity plan, which was monitored and reviewed on a regular basis. Some of the activities pursued Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: by other individuals included: bowling, trampolining, visiting the library, attending church and attendance to discos. It should be noted that the further options were explored with service users in relation to taking up more activities. This remains a strong area of the homes operations. Service users were also supported to use their community facilities some of which included: the shops, Ilford shopping centre, the local swimming pool, Valentines park, cinema, the barbershop, with as much as two individuals regularly attending church. While some use the transport facilities, many go out in the mini-bus owned by the home, which service users enjoy and look forward to. Many of the service users enjoy going out for a drive, which they find relaxing, while on a smaller scale, some enjoy going further afield into London using the trains and buses. Good arrangements were in place to ensure that service users can go out individually as well as in groups. At the last inspection the home worked well in ensuring that friends and families were encouraged to maintain links with service users. This continued and a good example of could be drawn from the fact that the sister of the most recently admitted service user was involved in his care. Relatives and friends were also invited to social events held in the home for example birthday parties. The inspector saw evidence of a barbecue that was held in September to celebrate two of the service users birthdays. In speaking to the individuals concerned they stated, We had a good time - the staff were really good. The inspector also saw evidence of a complaint raised by a relative and the timely response made by the manager of the home. It was also noted that relatives were invited to reviews to which some did attend. This remains a strong area of the homes operations. Two members of staff were interviewed during the course of the inspection and they were aware of the General Social Care Councils code of conduct as it related to promoting the rights of service users. They also had a thorough induction in which promoting service users rights were an integral part of their training. The inspector witnessed several interventions made by staff with service users and they ranged from simple to more complex tasks. In each of the cases seen, staff worked sensitively and in a dignified manner with them. It was clear that the service users were the centre of their attention. At the time of the visit, advocacy support was regularly provided for one service user. Menus were assessed as part of the inspection and they were varied, nutritionally balanced and in line with service users needs. A good system was in place to ensure that service users could inform the meals prepared and staff supported them to ensure that they enjoyed their food. They were also given support to make choices Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: that were of a higher nutritional value to them. One of the meals observed consisted of fish and chips with beans, which was in many respects a traditional choice. Service users supported or otherwise seemed to have enjoyed this. One individual chose not to have the fries as he felt he had enough carbohydrates for the day. Another was supported to prepare his meal as part of becoming more skilled and independent, which he absolutely enjoyed. A good supply of fresh and frozen food was in stock and drinks and snacks were widely available to all service users. There was evidence that service users were able to enjoy meals that were in line with their culture. 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. Service users continue to benefit from receiving personal support that was in line with their needs. The management and staff worked well to ensure that service users physical and emotional needs were met. The support provided with medication, promotes service users independence, health and well-being. Evidence: From looking at the service user plans, talking to staff and service users, the inspector was satisfied that good arrangements remained in place for providing personal support to each service user in the home. The objectives were primarily based on safety, comfort and the need to achieve positive outcomes for service users. Some examples included; the provision of same gender care, how service users wished to be supported with personal care, methods of communication and interventions that were based on the specialist needs of each individual. Feedback received from service users was very positive about the quality of the personal support provided by the staff. The actions carried out in each case were clearly detailed in the service user plans. All service users were registered with a GP and a good record was held of all health care appointments that were attended by service users. The quality of their health Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: care and well-being was enhanced by the specialist support arranged for them for e.g. psychology. Evidence was provided to demonstrate some intensive work that was carried out to improve the motivation of one individual. In another case there was input from a psychiatrist. It was reported that the company did employ a behavioural specialist who is anticipated to have an input in the home. Staff spoken to had a good understanding of the health care needs of service users, which was evidenced by the appropriate referrals and interventions made in supporting them. A key part of supporting service users with their health care was the support provided with their medication. At the time of the inspection two service users were in the process of taking their medication with limited support, which was very positive. There were sound policy guidelines to enable such an undertaking and this reflected that the staff were keen on building on service users strengths. There was a positive impact on the self esteem of the two individuals concerned. Medication administration and the related documentation examined - was of a good standard. Staff responsible for handling medication were provided with appropriate training and satisfactory systems were in place to monitor the use of medication in the home. Service users health was promoted by the safe handling of medication in the home. 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. Service users and their relatives are assured that when they raise complaints, they would be acted upon. Good systems were in place to promote the protection of service users living in the home. Evidence: The complaints record was examined and from the evidence seen, complaints were handled in a timely manner and in line with the homes complaints procedure. It was noticeable that complaints were made primarily by service users relatives or representatives. The complaints procedure remained widely available to service users in a format that they would more than likely relate to. In speaking with staff they indicated that they were familiar with the various communication methods used by individual service users, when they were unhappy. This was used to ensure that appropriate action was taken to promote their comfort and/or satisfaction. All actions taken were duly reported and recorded. The inspector spoke to three service users who indicated that they would complain if they were unhappy with any aspect of the service. At the time of the inspection there was one safeguarding matter since the last inspection. From the records, there was no further action to be taken by the home. An updated safeguarding procedure was available to staff, most of whom (ninety-four percent) had safeguarding training. Three of the staff interviewed had a good understanding of their role in protecting vulnerable adults and saw it as their duty of Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: care. The manager monitors the training of all staff on a monthly basis and in this way, is able to identify when staff would be due for refresher training in safeguarding. Service users were therefore generally safe from the risk of harm from abuse. Care Homes for Adults (18-65 years) Page 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users enjoy living in a home that is clean, comfortable and has improved from a maintenance point of view. Improvements to their bedrooms, toliets, and bathing facilities have also provided them with greater comfort and safety. It is important that all repairs and redecorative works are carried out in a timely manner to continue assuring the safety and comfort of service user. Evidence: At the time of the inspection, several improvements were carried out to the home as set out at the last inspection. A plan for redecoration and renewal of the premises was in place and this in itself was an improvement. Work had been carried out in the kitchen, main lounge, the front entrance hallway, and stairs. The manager explained that although there were still delays at times in getting repairs carried out, things had improved since having access to the organisations intranet. The home was in a better state of repair, more homely, and better-suited for the needs of the service user group. The lighting, ventilation and heating was satisfactory and all service users, appeared comfortable in the home. It is important for the registered persons to carry out their planned redecoration and renewal set out in their business in a more timely manner. Service users bedrooms were assessed and the improvements identified at the last Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: inspection were carried out. Some of the service users actually showed off their rooms and were pleased with the work done. All bedrooms were personalised and in line with service users preferences and specific needs. Staff worked closely with the service users to ensure that their rooms were kept tidy and it was noted that varied from individual to individual. However, it was commendable that the staff worked flexibly and consistently to ensure that all service users continued to enjoy the comfort of their private spaces. It was noted that there were improvements to the bathrooms and toilets, which were all in a better state of repair, when compared to the last inspection. Service users were observed accessing them with some ease throughout the course of the inspection. Four of the service users spoken to, were satisfied with the toilet and bathing facilities in the home. There were no concerns regarding the toilet and bathing facilities at the inspection. However, the registered persons should ensure that they keep on top of any repair and redecoration works as they arise. There were also improvements carried in the laundry area, which was heavily used by the staff. Some redecoration work was required following the installation of an air conditioning unit. The manager, provided evidence of reporting this however, nothing had been done to complete the work identified. While most of the service users do not access this space, it is an key part of the building which must be kept in a good state of repair. As stated previously in this report the registered persons should carry out repairs and redecorative works to the home in a timely manner. Hand washing facilities were in place throughout the home and staff spoken to had a sound understanding of infection control and their role in maintaining health and safety in the home. Care Homes for Adults (18-65 years) Page 23 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. Service users continued to receive care and support from a staff team that is trained and equipped with the skills to meet their needs. Sound recuitment practices ensure that staff are robustly screened prior to coming into contact with them. Evidence: Throughout the course of the inspection staff were engaging with service users in a positive manner. Interviews held with up to three members of staff, indicated that they understood the needs of the service user group, particularly the individuals that they were key working. This was despite the fact that some, had quite complex needs. Through observation, most of the service users were quite comfortable with the interactions and interventions that they had with the staff. There was good support with staff training and in this respect over fifty percent of the staff had achieved at least an NVQ Level 2 in Care, with some going onto Level 3. Service users continued receiving care and support from a staff team that had a sound understanding of basic care and indeed, their needs. The recruitment files of three of the most recently recruited staff were examined and found to be in order, as all key checks were robustly carried out. Some of the key checks carried out included; CRB checks, the acquisition of at least two satisfactory references, medical declarations, the verification of identification and where possible Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: evidence of staffs eligibility to work in the United kingdom. Two of the staff interviewed confirmed that they submitted completed application forms and attended employment interviews. The recruitment process was robust and served as safety mechanism to ensure that service users were not at risk from coming into contact with staff that may be unsuitable to work with them. A training needs analysis remained in place for all staff and this was now audited on a monthly basis. All staff were provided with their mandatory training along with training that was specific to carrying out their duties with the service user group. Staff also had access to specialist training in areas such as; conflict management, medication, epilepsy, COSHH, safeguarding vulnerable adults and autistic spectrum disorders. The manager had a good record of the training needs of the staff, as she not only kept the training needs analysis under review, but also had a monthly compliance audit of all mandatory training for the staff team. All staff interviewed felt confident that they could meet the needs of the service user group, based on the training and support that was provided by the organisation. Service users were therefore assured that their needs would be met by a staff team that could meet their needs individually and collectively. Care Homes for Adults (18-65 years) Page 25 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. Good management systems including those related to quality assurance, remained in place to promote the welfare and best interests of service users living at Burnham House. Improvements in health and safety practices and the support systems in place for the management of the service, gives greater assurances that the overall quality of the service would continue to improve. Evidence: There has been a change in the management of the home since the last inspection and the current manager had been managing the service for just under two years. From observation she held a good rapport with the staff and service users alike. From feedback received, it was noted that she could be approached by service users, their relatives the staff and external professionals. In discussion with her, she demonstrated a sound understanding of the service users needs, and the service aims. At the time of the visit she did not achieve her NVQ Level 4 in Management and Care, but had plans in place to pursue the qualification. From the training records seen she undertook key pieces of training in areas related to the service. Updated policies and procedures were in place to guide staff and an on-call system was available to Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: provide back up support outside of normal working hours. The service has continued to make improvements in providing improved outcomes for service users. There were good systems in place for the quality monitoring and development of the service. This included an internal audit of the service, surveys involving relatives, service users, staff and external agencies, and regular monthly monitoring (Regulation 26) visits. More importantly, a business and development plan was developed for the service, which took into consideration the views gathered. There were clear actions in place with time lines and the individuals responsible for carrying the developments. There was also a process for monitoring the outcomes of the identified actions, which is really important. Although the environment stood out as an area, which suffers delays in implementing planned interventions, the process and intended outcomes in the business plan were positive for the service as a whole. There was an improvement in health and safety practices at Burnham House in that food storage had improved. Staff were in receipt of refresher health and safety training and from interviews held, they had a good understanding of their role in promoting health and safety in the home. Risk assessments were in place for all safe working practice topics and certificates for gas, electric and fire were updated and available for inspection. There was a record of accidents/incidents, and the maintenance of equipment used in the home. All other health and safety records that were inspected were satisfactorily maintained. Service users therefore remained safe living at Burnham House. Following the last inspection the manager confirmed that a business and financial plan was in place for the service. The inspector was given a copy of the very detailed business development plan, which would be monitored by the Commission in relation to its implementation. There were no reports of unpaid bills at this inspection and so there were no immediate concerns about the the financial aspects of the service. There was updated insurance cover for the business and all staff spoken to had a good understanding of the organisational structures and who they should be reporting to. The new manager informed that she has supervision and support from her direct line manager, which is important to ensure that the service continues to develop. Care Homes for Adults (18-65 years) Page 27 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 28 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 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 24 The registered persons should carry out its maintenance plan for the home and any other works identified, in a more timely manner. The registered manager should undertake the NVQ Level 4 in Management and Care as outlined in National Minimum Standard 37.2 (ii) for Younger Adults. 2 37 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. 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