Care Home: Candover House

What the care home does well The first person to move into the home had only been living there since early February and the second person had only been living there for about three weeks. Therefore both people are still settling in and staff are still getting to know them. However feedback from both families and from a care manager was positive about the service received so far. A relative said, "they react positively to any health and behavioural problems. Previous problems have been reduced considerably." Another relative said, "I feel this home has very good management and they have been extremely supportive." A care manager said, "I was very impressed with the quality of care given to my client. They have supported my client in having a better quality of life. There is good communication with the family and a person centred approach maintaining independence." Candover House is newly built and is decorated and furnished to a high standard. The staff team all have experience of working with people with learning disabilities and complex needs. They feel that they get very good support from an experienced manager. Staff said: "the manager is very experienced and helps us if we are unsure about anything". "The manager likes things done properly and makes it clear what he wants us to do. He`s always thinking what is best for the service users". "The manager expects high standards." What has improved since the last inspection? This was the first inspection of a new service. What the care home could do better: Fire alarms were being checked weekly but this had lapsed recently and systems need to be in place to ensure that this happens and that fire alarms are working properly. There are four recommendations and these are all related to making changes in line with best practice. This includes adding photographs and details of allergies to individual medication records, developing a night-time fire procedure and checking hot water temperatures more frequently. The service is still developing and changing as people move in and more staff join the team. The manager is very experienced and is committed to developing a good user focused service. He is fully aware of the work that needs to be carried out to achieve this. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Candover House 2 Candover Road Hornchurch Essex RM12 4TZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jackie Date     Date: 1 4 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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: Candover House 2 Candover Road Hornchurch Essex RM12 4TZ 01708471900 01708471900 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): North London Care (Havering) Ltd Name of registered manager (if applicable) Tony Netto Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maimum number of service users who cn be accommodated is 5. The registered person may provide the category of service Care Home - PC to service users of either gender, whose primary care needs on admission to the care home are within the Learning Disability-LD category. Date of last inspection Brief description of the care home Candover House is newly built and is situated in a residential street in Hornchurch, Havering. It is close to local shops, bus routes and other amenities. The communal space consists of a lounge, a very large open plan kitchen and dining area, a laundry and a large rear garden. Everything is new and the home is decorated and furnished to a high standard. There are five large single bedrooms on three floors. Two share a bathroom and toilet, two have ensuite toilets and showers and one has an ensuite toilet, shower and bath. The home does not have a lift and it is not envisaged that people with severe mobility problems will be provided with a service. At the time of the visit only two people were living at the home but two more people were due to move in Care Homes for Adults (18-65 years) Page 4 of 30 care home 5 Over 65 0 5 Brief description of the care home during the following few weeks. The fees for this service were between 1766 pounds and 2090 pounds per week. Information about the service provided can be found in the Service Users Guide. 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 first person moved into the home in February 2009. At the time of the inspection two people were living at Candover House. This inspection was unannounced and took place over seven hours. This was a key inspection and all of the key inspection standards were tested. Staff were asked about the care that people using the service received and were observed carrying out their duties. Due to the degree of their disabilities neither person living in the home was able to give any direct feedback but time was spent with them and observing their interactions with staff. All of the shared areas and two of the bedrooms were seen. Staff, care and other records were checked. Care Homes for Adults (18-65 years) Page 6 of 30 Feedback questionnaires were sent to people who use the service, staff, social workers and health care professionals. Completed feedback forms were received from five staff and one care manager. The relatives of both people living at the home had completed questionnaires on their behalf. Services are now required to complete an AQAA (Annual Quality Assurance Assessment) and an updated version was received at the time of inspection. Information provided in this document also formed part of the overall inspection. We would like to thank the people living at Candover house and the staff for their input during the inspection. 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 set out on page 4. Care Homes for Adults (18-65 years) Page 8 of 30 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 statement of purpose and service user guide provide people with all the information they need to make an informed choice about whether they wish to live in the home. The assessments completed by the home and the information and reports received from other professionals mean that staff have detailed information to enable them to determine whether or not the home can meet a persons needs. Evidence: Standards 1, 2, 3, 4 & 5 were tested. The service was registered in August 2008 and provided a statement of purpose and service user guide as part of that process. The service user guide has been made userfriendly with symbols and pictures to assist people to understand it. There have been two admissions to the home. The files for these two people contained Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: detailed assessment information that was gathered before they moved in. This included information from their care managers and relatives and also assessments carried out by the manager. Both people had transitions that were appropriate to them and both had visited with their relatives and care managers. For the second person that moved in staff had also visited the service where he was previously living and gathered information from staff there. Both people were supported to move into the home and this included visits and structured transition. A relative said that the manager and staff were very helpful with the transition and had been extremely supportive. Two more people are due to move in and the admissions have been staggered to facilitate each person settling in. Transition visits are planned and as one of these people was first assessed last year the manager is going to update these assessments. Each person had a contract and copies of these were seen in their files. These detailed clearly what the person was entitled to. For example both individuals have a specific number of one-to-one hours in their contract. 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. Peoples care plans provide staff with the information that they need to enable them to meet individual needs in a way that people prefer. The risk assessments are appropriate and people are supported to take risks according to their needs and to have the opportunity to try things and to develop their skills as safely as possible. Evidence: Standards 6, 7, 8, 9 & 10 were tested. Both people have a care plan and these contain information about them and the support that they need. These were very detailed and covered all of the necessary areas. Plans are used on a daily basis to assist staff and to ensure that peoples needs are being met. Peoples ability to contribute to their care plans is extremely limited but their relatives have been actively involved. A care manager said, Candover House Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: have had a positive approach to my suggestions and recommendations. They are good at listening to service user views and wishes. One person has had a six-week review and their parents and care manager attended. The other person has only been at the home just over three weeks. The AQAA (Annual Quality Assurance Assessment) states that people will also have a three-month review and then the reviews will be on a six monthly basis unless an earlier one is required. As part of the care plans there were behaviour management plans. Again these were clear and detailed. For the newest person it had been agreed that in the early stages of the placement they would keep the same routine as at the previous placement. However there were plans to work towards more independence. As it is very early days the plans are regularly looked at and amended as needed. At this stage the plans are not in a user friendly format but the manager has the necessary format and software and these will be developed in the future as people settle and staff get to know individuals better. Daily diaries are kept and also various monitoring charts, e.g. epilepsy, bowel movements, sleeping patterns. The daily diaries are detailed and give a lot of information about how the person has been, what they like etc. There are detailed risk assessments relevant to each person and the activities that they do. They are in the form of shared risk taking documents and have been agreed by the relevant people as being in each persons best interests. These identify risks to people and indicate ways in which the risk can be reduced to enable people to be supported as safely as possible. Peoples records and other information are securely store in the office and staff are aware of issues of confidentiality. 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. People are being encouraged and supported to be as independent as possible, to take part in activities and to be part of the community. People are supported to keep in contact with their relatives and visitors are made welcome at the home. People are given meals that they like and that meet their needs and preferences. Evidence: Standards 11, 12, 13, 14, 15, 16 & 17 were tested. The staff team have been gradually developing activities with the people living there. For one person some of this is quite simple things such as going to Tesco or out for a Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: cup of tea, as these were not things that they had previously done. They also go out for regular walks, have lunch out, go bowling and to the local YMCA. They will being using the facilities at a small local day service for two days each week. Facilities there include a gym, swimming pool and a sensory room. The other person had only been there for a couple of weeks and their activity plan was also being developed. On the day of the visit the person was going to the boot sale to buy some books and it was evident that they really wanted to do this. They are also being introduced to more exercise with regular walks. Records show that they have been shopping, to the YMCA, to the park, to the local shops and also to the forest. Both people had helped to make cakes the day before the inspection. There is a small house car that can be used to take people out. Both people have complex behaviour and need one to one support when they go out. A member of staff said that they try to get people out as much as possible and that this was different things at different times and what fits for them. Care plans included ways to help them both to be more independent. For example introducing a knife and fork at mealtimes instead of a spoon. A care manager said, the service is good at maintaining service user independence. During the course of the day it was observed that people were asked what they wanted to do and also where they wanted to spend the time. During the course of the day people spent some time in the communal kitchen, the garden or their own room as well as going out. The families of both people are very much involved and visit regularly. On the day of the inspection one person spoke to her father on the telephone and it was evident that this is a regular occurrence. The other person goes home regularly and has overnight stays. A care manager said that the home had good communication with his clients family. A relative said that the manager and staff were really helpful in her sons transition and had been extremely supportive. Individual plans give information about mealtimes and this includes what people can do, what they like and what they need. Both people need high fibre diets with plenty of fresh fruit and vegetables and fruit smoothies are made to encourage people to have plenty of fruit. The improved diet has lessened one persons dependence on a prescribed medication. Menus showed a varied and healthy diet and records are kept of what people eat. Therefore people are given meals that meet their likes and their needs. Neither person has any specific cultural dietary needs. Care Homes for Adults (18-65 years) Page 16 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. People who use this service receive personal care that meets their needs and preferences and staff support them to get the healthcare that they need. People are given their prescribed medication safely. Evidence: Standards 18, 19 & 20 were tested. Both people need a lot of support with their personal care and information about how they need and like to be supported is in their individual plans. For both people routines are important and these are clearly detailed in their individual plans so that staff can support them in a consistent manner. Both people have got ensuite shower rooms, which gives extra privacy. However one person prefers a bath and therefore uses the communal bathroom. The manager/proprietor said that as this had been identified as a preference they will be removing the shower and fitting a bath in the ensuite. The male staff do not support the female user with any personal care. Both people are registered with the local GP and receive specialist input when needed. Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: For example from the consultant psychiatrist. The files show records of medical appointments and checks and it was evident that the manager is very aware of health issues and is proactive in addressing these. For example one persons need for a prescribed medication has lessened due to a change in diet and regime. This persons relative said, they react positively to any health and behavioural problems. Previous problems have been reduced considerably by programmes that have been designed by the manager. One persons care plan confirms that they can indicate pain and will say panic to describe an imminent seizure. This person does not co-operate with the GP, optician or dentist but arrangements have been made for home visits when required. Any accidents or incidents are recorded. The person that has been there for longer has a health action plan and this covers weight, screening, pain control, medication, bowels and epilepsy. Records are kept to monitor these things. This person is waiting to see the occupational therapist and has regular contact with a consultant psychiatrist. Therefore people are supported to receive the healthcare that they need Neither of the people living in the home are able to self medicate and medication is administered by staff that have been trained and assessed as competent. The three staff files examined contained medication assessments carried out by the manager. Most medication is administered via a monitored dosage system and is stored in an appropriate locked metal cabinet fixed to the wall in the office. Staff have been trained to administer Buccal Midazolam for severe epilepsy and there are clear protocols in place with regard to this. We observed that staff took this medication with them when needed. One person also has a monitoring device for epilepsy. In line with good practice the MAR (Medication Administration Record) file contains a list of staff that are able to administer medication and specimens of their signature. It also contains guidance as to what medication people take, why and possible side-effects. Medication records were properly completed an up-to-date. It is good practice to have a photograph of each person and details of any allergies in the MAR file and it is recommend that these be added. It is also recommended that guidance on the action to be taken in the event of a medication error being made also be included. This will mean that staff will quickly and easily have the information needed to hand to assist them to deal with such a situation correctly and quickly. Systems are in place to ensure that people receive their prescribed medication as safely as possible. Care Homes for Adults (18-65 years) Page 18 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. People living at Candover House are safeguarded by the working practices at the home and by the support of the staff team. Evidence: Standards 22 & 23 were tested. There is a complaints procedure, which relatives have received, and this has been simplified into a service user complaints booklet. Due to the degree of their disabilities neither person would actually be able to make a complaint. However one persons relative said that they could not complain but could show displeasure. They also said that they knew how to make a complaint. There was one recorded complaint from the next door neighbour and this had been appropriately recorded and dealt with by the manager. All staff have received safeguarding training from their previous employers and this will be updated in due course as required. Staff spoken to were aware of safeguarding issues and their responsibilities in this area. As previously stated the male staff do not support the female service user with personal care. The staffing section later in this report gives information that confirms that there is an appropriate recruitment procedure and this also helps to safeguard people living at Candover House. Again as stated previously there are detailed risk assessments and strategies to deal with risks Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: and this also helps to safeguard people. Neither of the people using this service are able to manage their own finances and in both cases their families hold appointeeship. Therefore the arrangement is that families provide cash as and when required. At present only the manager accesses this cash, which is stored in separate purses in the safe. At the time of the visit this was not a large amount for either person, just enough for day to day spending. When money is spent receipts are obtained as far as possible. The cash held for both people was checked and was correct and receipts were on file. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a new house that is suitable for their needs. It is comfortable and decorated and furnished to a high standard. Evidence: Standards 24, 25, 26, 27, 28, 29 & 30 were tested. Candover House is newly built and is situated in a residential street in Hornchurch, Havering. It is close to local shops, bus routes and other amenities. The communal space consists of a lounge, a very large open plan kitchen and dining area, a laundry and a large rear garden. Everything is new and the home is decorated and furnished to a high standard. There are five large single bedrooms on three floors. Two share a bathroom and toilet, two have ensuite toilets and showers and one has an ensuite toilet, shower and bath. The home does not have a lift and it is not envisaged that the service will be provided to people with severe mobility problems. Neither of the two people living at Candover House needs any specific aids or adaptations. One person with an ensuite shower prefers to have a bath and at present uses the communal bathroom. The manager said that he would be obtaining quotes to get this ensuite shower replaced with a bath if possible. Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: At the time of the inspection only two bedrooms were being used and both these were gradually being personalised. Both had personal items, photos etc and in one room the curtains and bedding had been changed to West Ham colours as requested by the family of the person. The staff have schedules for cleaning and the home appeared to be clean and hygienic. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported and protected by the recruitment practices of the service. People are supported by a small but experienced staff team who have received appropriate training to enable them to meet peoples needs and provide a good service. Staff have the opportunity collectively and individually to discuss their own development or any problems and developments within the service. They feel well supported by the manager. Evidence: Standards 31, 32, 33, 34, 35 & 36 were tested. This is a new service and therefore a newly recruited staff team. However all of the staff team have previously worked together in homes run by another organisation and all have a lot of experience of working with people with learning disabilities and complex/challenging behaviour. At the time of the inspection there were five staff employed plus 1 regular bank staff. Two more people are due to move into Candover House in June and two more staff have therefore been recruited. A deputy has also been appointed and will start in June. At the time of the inspection two staff were on Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: duty during the day and at night there was one waking and one sleep in staff. When the next person moves in the manager said that they would then have two waking night staff. From discussions with staff, examination of the rota and observations on the day it was evident that the staffing levels were sufficient to meet peoples needs. There was evidence that staff have received the necessary training with their previous employer. Staff spoken to confirmed they had had an induction and records of this was seen in their files. They also said that they had received supervision and that they had talked about training and would be renewing some of the training that they had previously had. There were certificates of training in files to confirm training in a variety of appropriate areas including: health and safety, autism awareness, safeguarding, moving and handling, infection control, food hygiene, first aid, and epilepsy. Files also confirmed that staff have had medication assessments carried out by the manager. The manager has completed a training matrix to identify exactly what training people have had and also what updates are needed so that he can arrange these. All of the staff employed so far have NVQ level 2 or have almost finished this and some staff have NVQ level 3. Therefore staff have had a lot of training relevant to the needs of the people using this service. There is a satisfactory recruitment process. Application forms are completed and interviews held. A random sample of staff files were checked and contained the required information to demonstrate that staff had been appropriately recruited. This included application forms, health declarations, two references, proof of identification and CRB (Criminal records Bureau) checks. Staff have job descriptions and contracts. Staff, and records, confirmed that there had been a staff meeting and that supervision had started. Therefore staff have had the opportunity to discuss their work and the people that were moving into the service. Staff spoken to and staff feedback forms all confirmed that there was a good team with very good support from the manager. Staff said, Tony likes things done properly and makes it clear to us what we need to do, Tony supports and backs you and expect you to do things right. He is clear about his expectations. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Candover House benefit from a service that is very well managed by an experienced manager. They live in a safe home. Evidence: Standards 37, 38, 39 & 42 were tested. The proprietor is the manager for this service and is a registered nurse for people with learning disabilities and has a Certificate in Management Studies. He has two units to complete to achieve NVQ level 5 in management. He is very experienced in working with people with learning disabilities and complex needs and challenging behaviour and has managed services and been a service manager. The manager was assessed as having the necessary experience and qualifications when he was registered by the Commission prior to the service opening. Feedback from staff was very positive. They said that they get a lot of good support and guidance from the manager, that he likes things to be done properly and makes it clear what is needed and that he expects high standards with no cutting corners. Staff also said, the managers door is always open. Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: Service users needs always come first and there is good communication between management and staff. The manager is very experienced and helps us if we arent sure about anything. A relative said, I feel this home has very good management. A care manager said, I was very impressed with the quality of care given to my client. The service has only been open for a short while and the manager is in regular contact with the relatives of both people living there. Therefore he has had feedback from them and also feedback from the six week review of the first person that moved in. At present the manager is on call when hes not at the house. Due to the fact that this is a new service he has spent a lot of time there helping people and staff to settle in. The house was a new build last year and therefore all services to the building are new and were certified safe last year. Some have required retesting and this has been done. For example there was a current landlords gas safety certificate dated April 2009 and portable appliances had been tested in May 2009. All of the necessary health & safety checks are in place and being carried out. This includes door guards, emergency lighting and the keypad for the front door. Hot water temperatures are checked monthly and there were records of this. However it is recommended that this be carried out on a weekly basis to further lessen the risk of scalding. There is a fire risk assessment and an emergency evacuation plan. However it is recommended that a night time fire procedure be put in place to ensure that staff are clear as to the action that they need to take in the event of a fire during the night. Fire call points had been checked weekly up until recently but this had lapsed in the last few weeks. Fire alarm call points must be tested on a weekly basis to ensure that they are working correctly. Overall people are living in a safe well maintained home. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 42 23 Fire alarm call points must be tested on a weekly basis. This is to ensure that they are working correctly. 30/06/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 20 It is recommended that the MAR (Medication Administration record) file also contains a photograph of each person receiving medication and details of any allergies. This is in line with good practice and helps to lessen the risk of errors being made. It is recommended that guidance be put in place on the action to be taken in the event of a medication error being made. This will mean that staff will quickly and easily have the information needed to hand to assist them to deal with such a situation correctly and quickly. It is recommended that a night time fire procedure be put in place to ensure that staff are clear as to the action that they need to take in the event of a fire during the night. It is recommended that hot water temperatures be checked on a weekly basis rather than monthly to further lessen the 2 20 3 42 4 42 Care Homes for Adults (18-65 years) Page 28 of 30 risk of scalding. Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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