Care Home: Cambridge

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What the care home does well Cambridge provides good care to people with specialised needs so they can develop their potential. All contact with them found them positive about their experience in the home with one describing it as "fine" with "no problems". This was also reflected in contact with relatives who were also positive about the care their family members were receiving. The home has an experienced staff group who are knowledgeable about the people in their care after a long period of acquaintance. The staff have all received vocational training and are skilled at their work. The registered manager has been in post for a number of years and has a clear commitment to the development of an individualised programme of care so that individual needs are met. The premises are adequate for their purpose and are domestic being homely in character. The agency has full policies and procedures to underpin its work which is carried out in a safe manner. What has improved since the last inspection? Since the last inspection the home has updated its Statement of Purpose and has ensured that its support plans are up to date so that information is current. Medication practices have improved in that the sheets recording medicines taken are now complete. The home has improved its recording of food taken by people living there so that their diet can be monitored. Formal supervision has been improved resulting in greater direction for staff in their work. Although the quality assurance is not complete there have been attempts to improve this process, particularly by a structured survey of each person living in the home. What the care home could do better: Within the context of an effective key worker role, it would be preferable if individual sessions between key workers and people they care for were recorded to provide a record of the work undertaken. The home has improved its medication practices but needs an up to date medication policy for the guidance of staff. The home has started a quality assurance system but this should be developed to provide a framework for continuing improvement. Equally, although the home is a safe environment for people living there there is a need to ensure that all necessary certificates are up to date. The premises would be improved if each person living there had a lockable facility in their bedrooms for the safekeeping of medication and monies if required. Most of all, the home still does not have a full training plan for staff which shows both the training that has been taken and that which is planned. This has been outstanding since the last inspection and must be addressed as a matter of urgency to show that training is being dealt with correctly. Key inspection report Care homes for adults (18-65 years) Name: Address: Cambridge 47 Downing Road Bootle Liverpool Merseyside L20 9LU     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: John Mullen     Date: 0 3 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Cambridge 47 Downing Road Bootle Liverpool Merseyside L20 9LU 01519338695 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.peterhouseschool.org Autism Initiatives care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: 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 The maximum number of service users who can be accommodated is: 4 Date of last inspection Brief description of the care home Cambridge is a home for the personal care and support for a maximum of four adults with learning disabilities. The home is owned by Autism Initiatives, a voluntary organisation experienced in this field and the registered manager is Simon Thomas. The homes fees are based on individual assessment and at the time of the inspection ranged from 950 to 1550 per week. There is an additional charge for toiletries, activities, hairdressing, and other sundry items. The home is situated in a residential area of Bootle within easy access of shopping and general community facilities. The premises consists of three units, two for single occupation and one for two residents. In addition, the home has two sleep-in rooms to accommodate staff. The home provides twenty-four hour staffing cover from a dedicated staff team led by a Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 4 Brief description of the care home registered manager and deputy manager. 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: The quality rating for this service is 2 stars. This means that the people who use this service experience good quality outcomes. This was a key unannounced inspection of Cambridge Care Home which included a visit to the service. All key standards were assessed in addition to a selection of other standards. The inspection encompassed information received since the last inspection including an Annual Service Service of 1st September 2008. In addition it included information provided by the agency through its Annual Quality Assurance Assessment document (AQAA). The AQAA gives an overall picture of the performance of the agency as well as factual information about the service. Interviews took place with registered manager and two support workers. Two users of Care Homes for Adults (18-65 years) Page 6 of 30 the service were case tracked; that is their support was examined in detail including interviews with them and telephone interviews with their relatives. Other people living in the home were observed and spoken to during the visit to the home. The premises were inspected and a large amount of documentation examined. 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: If you want to know what action the person responsible for this care home is taking Care Homes for Adults (18-65 years) Page 8 of 30 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. The home has a good understanding of the needs of people living there which it is meeting in a positive manner. Evidence: The AQAA stated that the deficits in information that had been found at the last inspection have now been rectified so that people who live in the home are fully aware of the roles and responsibilities of the home. A visit to the home confirmed this with a tour of the premises revealing that full information, including the philosophy of the home and the registration certificate, were prominently displayed to inform people living their and their visitors. In addition, the Service User Guide which is specific to each person, has been reviewed recently and contained all the required information on the home and its role. This was also the case with the Statement of Purpose which had been reviewed and updated in July 2009 and contained all the information required from that document so that people are fully informed. The AQAA stated that three of the four people living there had been resident for more than eleven years and the fourth for more than three years so that there has been no Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: recent need to provide assessment material. Examination of their files did find assessment material there although obviously not of recent origin. However, because the people living there have been resident for such a length of time their needs are well known to the staff group and this was confirmed by interviews both with the registered manager and support staff. Interviews with people living in the home confirmed that they felt the staff knew their needs and were actively trying to meet them. 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. The home promotes an active lifestyle for its users based on an individualised and safe approach to care. Evidence: An examination of files of people living in the home found that support plans were in place and had been reviewed at regular intervals to confirm their relevance. There was one exception to this where a support plan in relation to positive intervention showed no evidence of review since 2006 but this was an exception and did not reflect the overall picture. The support plans gave clear objectives for staff in meeting the needs of people living in the home so that they could be helped to develop. Evidence from minutes of team meetings showed that these support plans are regularly discussed to update information for staff. Interviews with support staff showed them well aware of the plans and confirmed that they saw them as central to the work of the home and gave them good direction in the tasks to be undertaken. The AQAA throughout showed that the policy of the home is to involve people who live Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: there in their own care so that they can be actively helped in promoting their own care. Interviews with them found that they were positive about the plans for their future. One confirmed he was attending a review in the near future in which his wishes to move to a tenancy were being discussed. He confirmed he had been fully involved in this process. The registered manager revealed that the home has undertaken a questionnaire with people living there to demonstrate their commitment to involving them in their future. Evidence of this was seen in their files. A telephone interview with a mother of one of the people living in the home confirmed that the latter had been involved in choosing the decor for her bedroom, which was confirmed by her and she displayed a great deal of pride in the result. Observations showed that residents were being actively encouraged to make decisions themselves during the visit to the home. The registered manager stated that the policy of the home is to encourage people to take risks within a responsible context so that their safety is assured and their skills are developed. He stated that there were no activities which had been restricted due to the problem of risk. An examination of files of people living there found full risk assessments were in place which had been reviewed regularly and consistently to confirm their relevance. Interviews with both the registered manager and support staff showed that they were well aware of the risks associated with individual people so that these could be managed effectively. A review of evidence has found that one incident of challenging behaviour has been managed effectively to reduce the risk to the person involved, which was confirmed by an interview with him during the visit and confirmed his positive view of the home. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home promotes an individualised lifestyle based on preferences and capacity. Evidence: The AQAA stated that two people were enjoying work experience although by the time of the visit to the home one had withdrawn although still seeking further work. In interview, the person still working expressed satisfaction with this which gave him a greater structure to his day. Other people in the home were not working but are being engaged in activities to occupy their time. This was observed during the visit to the home where activities both within the home and outside of it were being promoted by staff for the occupation of people living there. The registered manager confirmed that the home seek to promote activities, including employment, for people living there depending on their capacity and willingness so that they are actively occupied during the day. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: Both the last inspection and the Annual Service Review found no concern with the homes integration into the local community so that they are part of local life. Unfortunately, the registered manager reported there had been some minor vandalism by local children which had caused distress to one person. However, both he and other support staff spoken to stated that this was not typical of the response of local people who had been welcoming towards people living there. Both the registered manager and the support staff could show that the home uses local facilities constantly so that they are part of the local community. This was confirmed by the files of people who live in the home and observations on the day of the visit which showed that facilities are used depending on individual preferences. The Annual Service Review produced positive views from families about the home and their contact with it. This was duplicated by telephone interviews with relatives on this occasion which produced comments such as the care is very, very good and the home is second to none. The registered manager confirmed that although people living there come from a wide area they are supported to remain in touch with their families either by visits to them or family visits to the home. In addition, regular telephone contact is maintained to promote family ties. The registered manager confirmed that the home promotes the involvement of people living there in the routines to the extent that their willingness and capacity allow. A tour of the premises confirmed that they have keys to their bedrooms and that staff are particularly considerate in only entering their accommodation with their agreement. There is no area of the home restricted to people living there so that they can fully use the premises. Observed interaction during the day was positive and supportive. This was particularly noticeable in the case of one person who was showing distress at the time and who was helped by staff positively and sympathetically so that she regained her composure. The registered manager stated that the arrangements for meals and mealtimes are individualised to meet both capacity and wishes. During the day of the visit one person was being supported to eat by staff whilst another went out of the for a takeaway meal. This reflected the individualised approach to meals and mealtimes which is promoted by the home. A tour of the premises confirmed that there are individual menus for each person to reflect individual taste. Most are recorded by the person themselves although one is written for them. The completeness of the menus varied but it was noticeable that the male service users menus were much more complete than before, which reflected the efforts the home has made to record food since the last inspection. Because, in effect, some people who live in the home are essentially self catering, recording depends on their compliance and although not complete there Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: has been a distinct improvement in this matter. Care Homes for Adults (18-65 years) Page 17 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home are being provided with a good level of personal and healthcare support so that their individual needs can be met. Evidence: An interview with the registered manager showed that there was very little personal support being provided in the home due to the capacities of people living there. However, he did stress that the use of key workers was important to ensure a consistent and regular level of support for them. At present individual sessions between key workers and service users are not separately recorded although Autism Initiatives are intending to introduce this as a means of furthering the key worker role. Interviews with support workers found them very knowledgeable about the people they support due to their long period of familiarity. People spoken to were highly positive about the staff in the home with one stating that they were nice people and good listeners. There is a good ratio of male and female staff to ensure that any particular gender preferences by people living in the home can be met. A review of evidence has found no concern with the management of the healthcare needs of people living in the home. There has been one notified incident of the Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: admission to hospital of one person and documents seen in the home and a telephone interview with his mother confirmed that this matter was managed correctly and in accordance with good practice. An interview with the registered manager confirmed that the healthcare needs of people living in the home are being met within the context of their willingness to cooperate in certain areas. One person has been supported to manage her own medicines which has led to greater flexibility for her in her lifestyle. An examination of their files found health support plans in place which had been reviewed regularly to ensure that their health needs were being met as required. The last key inspection found some deficits in the recording of medicines which detracted from the effectiveness of the process. On this occasion, the sheets recording medicines were correct to show that this had been addressed. An interview with the registered manager, confirmed by support workers, also showed that they had been trained in medication practice to assist their competence. The staff expressed confidence in their abilities in this area which confirmed that they have been effectively trained. The tour of the premises also confirmed that medicines are being correctly stored for the safety of people who live there. However, the medication policy was not up to date and, therefore, did not necessarily reflect the most recent guidance in this subject. 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. The homes policies and procedures result in a safe service. Evidence: The AQAA said there had been no complaints over the last twelve months and the complaints book confirmed that the last complaint was in September 2007 to confirm this information. The complaints book showed that it was being audited by a senior manager as part of the quality audit of the company. The complaints procedure was seen during the visit to the home and it was also found to be in the Service User Guide which is prominently displayed in the home for the information of interested parties. Discussion with the registered manager took place over the definition of a complaint resulting in a common understanding of what this is and of the need to record when this situation arises. No person living in the home or family member contacted as part of this inspection had any concern about the quality of care in the home. The AQAA stated there had been no safeguarding issue over the last twelve months and a review of evidence found there had been no matter referred to us which has caused any concern. The registered manager stated that staff were trained regularly in this subject and staff interviewed confirmed this although one felt she needed refresher training. The lack of training records in the home does give difficulty in assessing the training needs of staff. The home uses Liverpool and Sefton Councils safeguarding policies as a basis for managing its approach which is in accordance with Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: good practice and provides full guidance in these matters. 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. The premises are a suitable vehicle for the safe accommodation of people who live there. Evidence: A tour of the premises found them fit for purpose and suitable for the accommodation of people living there. There is more space in one section of the home rather than in the main building although one person spoken to in the latter expressed some pride in her bedroom. The mother of this person, who is generally very complimentary about the care, did feel the premises are cramped although she also said that her daughter has been encouraged to improve her bedroom and is happy in the home. Another person living in the home, showing his part of the accommodation, expressed satisfaction with the standard of accommodation which he felt met his needs. Generally, the premises blend easily into the local neighbourhood and are comfortably furnished and decorated. A tour of the premises found them domestic in character which allows for a homely environment for the people living there. A tour of the premises found them reasonably clean and hygienic for the accommodation of people living there. In interview, the registered manager confirmed that the staff are generally responsible for the standard of cleanliness and sometimes have had to take a more active role due to the disinclination of some people living Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: there to always maintain standards. Individual living areas seen were of a reasonable standard and gave no concern about levels of hygiene. The home has a laundry that is domestic in appearance and meets the needs of the people accommodated. The AQAA confirms that the home has full policies and procedures to ensure that people are accommodated in a hygienic environment. 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. The home employs a good standard of staff although it cannot demonstrate that all are fully trained. Evidence: The home is fully staffed and the registered manager expressed confidence in the ability of staff to meet the needs of people living in the home. With the exception of one member of staff recently transferred from another unit, the staff are very experienced in this home including both the manager and deputy manager which provides a solid foundation for the work. All staff hold at least one vocational qualification and some are taking this at a higher level to further advance their knowledge. People who live in the home who were spoken to expressed confidence in the staff group. Others, who were observed interacting with them, displayed an appropriate and positive relationship. One family member interviewed stated that as a team they are very, very good. Staff interviewed displayed a sound and appropriate approach to the work. Previous experience with this home, confirmed by the Annual Service Review, showed no concern with the recruitment and selection of staff. The AQAA confirmed that full recruitment and selection procedures are in place for the safety of people living in the home. There is no recruitment and selection material on file in the home to confirm Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: this approach. However, a recent inspection of Autism Initiatives domiciliary care agency included a visit to the Human Resources Department as a part of that inspection. This showed that this department is well aware of its responsibilities under regulation and guidance for the protection of people using the service through robust and comprehensive recruitment procedures. That inspection found that there was no concern in this area and confirmed other evidence about this. The AQAA stated that the home was now providing more training for staff to further their knowledge. This inspection could not verify this as being the case. Interviews with support workers found that they felt themselves well trained and could give examples of the training they had received. However, there is very little documented evidence for this in the home and the registered manager accepted that he could not demonstrate the training undertaken and planned for each member of staff. Evidence from other Autism Initiatives inspections has shown that a full training programme is available for staff to maintain their knowledge. However, this has not been translated into practical evidence within this home so that a training programme can be demonstrated. The AQAA stated that staff were being formally supervised, including through appraisals, so that they are both supported and directed in their work. Interviews with staff confirm this to be the case and all staff spoken to felt that they benefited from a sound basis for support both formally and informally. Records seen showed this to be the case although there was difficulty in gaining access to full records due to problems of access to the computer. 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. The home is well managed to produce a safe service in the interests of people who live there. Evidence: There has been no change in the position of registered manager since the last key inspection which provides continuity for the home. The post holder has been in place for five years and has now gained the Registered Managers Award to complete his qualifications for this post. A review of evidence has found that the registered manager has informed us about relevant matters and that he completed the AQAA to a good standard which showed his understanding of both the role of registered manager and the needs of people who use the service. All contacts with staff, people living in the home and families both during this inspection and through the Annual Service Review found no concern with the management of the home which was felt to be of a good standard. The AQAA states that the company is developing its quality assurance system to further provide a method for continuing improvement. There was some evidence for Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: this with a survey of people living in the home having been undertaken to ascertain their views. In addition, there was evidence of external monitoring of the home by a senior manager as part of a quality audit. However, the registered manager admitted that the advances made thus far do not constitute a full quality assurance system whereby the home can devise a plan for continuing improvement. A tour of the premises found it a safe environment for the care of people living there. There were no obvious matters affecting their health and safety which caused concern. Documentation seen during the visit to the home, confirmed the AQAAs statement that regular health and safety checks are being made for the safety of people living there. This included monthly checks on the premises, checks of water temperatures and the certification of the gas supply. However, the certificate relating to the electricity system was out of date which was a surprise to the registered manager. He immediately arranged for this to be remedied with an inspection to be carried out within days of the visit to the home. A review of evidence has found no concern about the safety of this service which has always appeared to be at a good level. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes R 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 1 35 18 There is a need for a training 01/01/2008 plan so the home can demonstrate that training is being provided systematically to update knowledge. 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 18 The individual sessions between key workers and service users should be individually recorded so that a record of this interaction can be clearly kept. The home should obtain the most up to date guidance on medication so this is available as a reference for staff. The bedrooms should have a lockable facility so that valuables and medicines can be safely stored if required. The quality assurance system needs to be developed so that the home can progress further. The home needs to review its certificates on a regular basis to ensure they remain up to date. 2 3 4 5 20 24 39 42 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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