Care Home: Care Assist in Harrow

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What the care home does well The care home has a very welcoming atmosphere. People using the respite service have access to a homely environment, with quality furnishings, and decoration that is attractive, and meets their needs. The senior staff member managing (with support from the provider) the service at the time of the inspection was experienced, and motivated in ensuring that a quality service is provided to all the people using the service. People using the service and their relatives/visitors were positive about the respite service. Comments included: I `couldn`t fault` the service, `it`s very flexible`, `my (relative) is happy` using the service, and `we (relatives) are kept well informed`. It was evident during the inspection that staff interacted in a respectful manner with people using the service, and were sensitive with regard to meeting their privacy needs. People using the service have the opportunity to participate in a variety of activities and leisure pursuits. There is good interaction between staff and the relatives of people using the service. We were told by visitors and other relatives that they felt listened to and staff were approachable. Observation, records, and talking to staff indicated that staff had knowledge and understanding of each person`s needs, and cared about ensuring that these were met, by a quality service. What has improved since the last inspection? This is not applicable as the care home is a new service, and this is the first key unannounced inspection of the care home. What the care home could do better: The format of some records, such as information about the service provided by the care home, the complaints procedure, and menu could be recorded in a more accessible format for people using the service who might have difficulty in reading. It could be more evident that staff have received medication training, including an `in house` training/assessment (whilst being employed in the care home) prior to staff administering medication to people using the service. Each staff member should have a recorded individual training and development plan. Key inspection report Care homes for adults (18-65 years) Name: Address: Care Assist in Harrow 2 Whitehall Road Harrow Middx HA1 3AJ     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: Judith Brindle     Date: 2 3 0 7 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 31 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 31 Information about the care home Name of care home: Address: Care Assist in Harrow 2 Whitehall Road Harrow Middx HA1 3AJ 02088690070 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): p.mehta@careassistuk.net Care Assist in Harrow Name of registered manager (if applicable) Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is Six The registered person may provide the following categories of care of service only: Care home only - Code PC to service users of the following gender Female whose primary care needs on admission to the home are within the following categories: Mental disorder - excluding learning disability or dementia - Code MD Learning disability - Code LD Date of last inspection Brief description of the care home Care Assist in Harrow (2 Whitehall Rd) is a care home providing personal care, and accommodation for up to 6 people who are female and have a learning disability or mental health needs.The home was registered by the Commission for Social Care Inspection (Care Quality Commission from 1st April 2009) on the 17th February 2009. Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 6 6 6 6 Brief description of the care home The registered provider of services at the home is Care Assist Limited. The home is located within a residential in central Harrow a few minutes walk from shops, pubs, parks, and bus and train public transport links. The home has a forecourt that can provide off street parking for two to three vehicles. There are three bedrooms located on the ground floor and three located on the first floor of the care home. The homes bedrooms are single, all fully furnished to a high standard, and each have ensuite toilet and shower facilities. There are additional bathroom facilities on the ground floor and in the staff facilities on the second floor. Communal space is also furnished to a high standard and comprises of a large kitchen/dining/living room with access to two enclosed garden areas. The care home has a service user guide, and statement of purpose, (these provide information about the service). These documents, and information about the range of fees, which are based around the individual and their assessed needs, are available from the owner of the home. Care Homes for Adults (18-65 years) Page 5 of 31 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 unannounced key inspection took place throughout a day in July 2009. This was the first key inspection of the care home since it was registered with the Commission. There were no permanent residents living in the care home at the time of the inspection, but the home was providing a respite service to women who have a learning disability and/or mental health needs. We were pleased to meet and talk to people using the service and to visitors during the inspection. We also spoke to two relatives of people using the service following the inspection. The responsible individual of the registered provider was present during a significant part of the inspection. A number of feedback surveys were supplied to the care home prior to the inspection. At the time of writing this report the Care Quality Commission had not received any completed surveys. Documentation looked at included, residents care plans, risk assessments, staff Care Homes for Adults (18-65 years) Page 6 of 31 training records, and some policies and procedures. The inspection included a tour of the premises. 25 National Minimum Standards for Adults, including Key Standards, were looked at during the inspection of Care Assist (Harrow) 2 Whitehall Road. Following this unannounced key inspection the responsible individual supplied the Commission, with a completed Annual Quality Assurance Assessment (AQAA) document. This record includes required information about the quality of the service provided by the care home, and of any planned improvements. Reference to some aspects of this AQAA record is documented in this report. We thank the people using the service, their relatives and visitors, care staff, senior staff member and the responsible individual for their significant assistance in the process of inspection. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our Care Homes for Adults (18-65 years) Page 8 of 31 order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 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 31 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. People who may use the service have the information needed to choose a home that will meet their needs. People using the service have their needs assessed, with their participation (or family member/friend), prior to receiving respite care in the home home, which makes certain that the home knows about the person, and the support that they need. Evidence: The statement of purpose and the service user guide documentation that provide information about the service were not accessible in the home during the inspection. We were told by a senior staff member that a visitor had recently been provided with the last copy of the brochure (service user guide). Annual Quality Assurance Assessment (AQAA) told us that a Care Assist Break with a Purpose prospectus (Service Users Guide) is given to the family. We spoke with two relatives of people using the service who told us that they were supplied with comprehensive information about the service prior to their relative receiving respite care in the home, which enabled them to have knowledge and understanding about the service provided by the care home. Comments included we received lots of information about the care home. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: Following the inspection we were supplied with documentation about the service provided by the care home. We were told that at the time of the inspection, the home had no permanent residents but had a number of people staying for one or more days receiving respite care and support. We were told that there are some people using the service who regularly stay in the home, for overnight stays, weekends, and that some of these people were planning to spend a week or more staying in the home. The home has an admission policy. Annual Quality Assurance Assessment (AQAA) told us that following a referral, a staff member visits the persons home by mutual arrangement, to carry out a preliminary and basic assessment. It was evident from looking at the care plans that people using the service had received an initial assessment of their needs. This includes assessment of the persons care and support, health, communication, nutritional, behaviour, and financial needs. The persons likes and dislikes are also recorded in this assessment. It was evident from records that the person planning to use the service is fully involved (with their family members), as far as they are able to be in the assessment of their needs. A number of questions put to the person (and/or their family member), and their answers to them, were recorded. Assessment information looked at also included risk assessment, of each persons needs. Relatives of people using the service told us that they are listened to by staff, and that there is on-going discussion about the needs of the person using the service. Records told us that people planning to use the service and their relatives/significant others participate in an assessment meeting prior to their admission to the home for respite support. We were told that there is close liaison with care managers from the funding Local authority with regard to assessment of prospective residents needs. Feedback from relatives of people using the service and visitors told us that the people using the service had the opportunity to visit the home on a number of occasions prior to commencing respite care and support. These visits included tea visits to meet staff and to get to know the home and the service that it provides. AQAA told us during these visits additional assessments are made based on observation of the persons interests, abilities and aptitudes, and that an individual care plan is developed from this assessment. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service have an individual plan of their needs, which includes details of the care and support that they require from staff. People using the service are supported, and encouraged to make decisions and choices about their lives, and are supported to take risks as part of an independent lifestyle. Evidence: Each person using the service has a plan of care. Three care plans were looked at. These care plans are based upon an assessment of the persons needs. This assessment includes personal care, health care, cultural/religious needs, social needs, and activity preference. Care plans included a map of the persons social and family connections/needs, and a profile of each person using the service. This profile included the preferences of the person, with regard to activities that they enjoyed, food, communication, and personal care needs. It was evident that family members were involved in the development of the care plan particularly when the person using the service has significant communication needs. Records told us that these care plans, Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: were up to date and working (up dated as the persons needs change) documents. The care plans included risk assessment, such as mobility, medication, nutrition and diet, and personal hygiene and vulnerability risk assessment. AQAA told us that under supervision, respite service users are enabled to take risks commensurate with their assessed abilities, and having taken into account the expressed concerns of their family. AQAA told us that the aim of our respite service is to give the user a break with a purpose, and to structure the plan so that there is continuity of development visit by visit.and we were told that each respite user has a key enabler, chosen from the staff team in discussion with the individuals, who takes particular interest and responsibility for ensuring the care plan is followed, monitored, and developed. The care plans told us that people using the service were listened to and had their choices respected, and were involved in decisions about their care as far as they were able to be. Recorded guidance was seen in the are plans which indicated how peoples needs could be met by the home. Examples of this included staff guidance with regard to meeting the persons communication needs. During the inspection people using the service were seen to be offered a number of choices by staff. AQAA told us that people using the service are encouraged to make choices and to develop their independence, and that choices and decisions included menu planning and shopping, activities, outings, using public transport, etc, and spending their own money on these occasions and that choices are built into the care plans and recorded in the staff communication book. Comprehensive daily progress records of each persons needs were recorded. Care Homes for Adults (18-65 years) Page 14 of 31 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 who use the service are able to make choices about their lifestyle, and are supported to develop their life skills. Social, and recreational activities meet individuals expectations. The people receiving respite care have their rights respected, and their responsibilities are recognised in their daily lives. Meals are varied and wholesome, and meet cultural and religious needs of people using the service. Evidence: The care plans showed us that people using the service had the opportunity to tell staff about the activities and leisure pursuits that they enjoyed. These preferences were recorded in their plan of care. AQAA told us our respite service users enjoy varied cultural, creative, and age-related activities, and the people using the service are supported to access community amenities and facilities. During the inspection people using the service returned from an outing to pick strawberries at a farm. They Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: indicated (people using the service have varied communication needs) that they had enjoyed the trip, and two people told us that they had had a good time. Several people using the service watched a DVD in the afternoon of the inspection. They told us that they liked the film. Daily records told us that the leisure pursuits that people had taken part in included; listening to music, manicures, visiting the local park and spending time in the garden. A visitor told us that their relative is relaxed and has things to do. AQAA told us that care is taken to ensure a balanced and healthy diet is provided whilst allowing the exercise of individual choice, and that the large modern kitchen/diner ensures a pleasant environment for cooking and eating. We were also told that the homes multi-ethnic staff team ensures that specific cultural preferences are catered for. During the inspection we saw that the a variety of food items were stored in the home, and we were told that people using the service are supported to have snacks when ever they wished. We were shown the menu of one person who was receiving respite care at the time of the inspection. This included evidence of varied and wholesome meals that met the cultural needs of the person using the service. A senior staff member told us that this menu is followed closely and that the persons family had been fully involved in the development of this menu. We discussed developing the accessibility of menu information for people using the service who might have difficulty in reading. Following the inspection the senior staff member told us that she had developed a number of photographs/pictures of meals that she would be using in the home to ensure that the menu was accessible as possible to people using the service. The senior staff member also told us that the home meets the individual dietary needs of all the people using the service, and that she was in the process of discussing each persons dietary preferences, recording them, and ensuring that they be provided. She told us that at present Asian and British meals are provided to people using the service, and that as the respite stays, and permanent residents move into the home, this will be further developed to ensure each persons dietary needs and preferences are met by the home. Drinks, meals and snacks were offered regularly to people using the service during the inspection. Meals eaten are recorded. Care Homes for Adults (18-65 years) Page 16 of 31 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 health and personal care that people receive is based on their individual needs,and the principles of respect, dignity, and privacy are put into practice. Systems are in place to ensure that medication is stored, and generally administered safely to people using the service, but it needs to be evident that all staff who administer medication have received appropriate medication training. Evidence: The people using the service are at present receiving respite care and support, so their health care needs are being met with support from their relatives and significant others. The three care plans that were looked at included information with regard to meeting the health and personal care needs of each person using the service, and included a medical profile of each person. This profile includes GP contact details, medical condition of the person, dietary needs etc. We were told that when permanent residents move into the home they will have access to treatment and care from a number of health care professionals including a GP, and chiropodist, as well as specialist appointments at clinics at hospitals. During the inspection staff were observed to have knowledge and understanding of meeting the privacy and dignity needs of people using the service. Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: The home has a medication policy. AQAA told us that the administration and control of medications is carried out in accordance with Care Assists policies and procedures (which accord with current legislation), and with the agreements reached with the respite service user and their families through the assessment and care plan process. Each bedroom has an individual locked cabinet for storing the persons medication. We were told that due to home presently only providing respite care, there was little medication needing to be administered to people using the service. We were told that all the people using the respite service require support with taking their prescribed medication. Medication administration records looked at were fully signed, and up to date, but details of the dosage of a medication was not fully recorded on the medication chart. This was discussed with the senior staff member and amended during the inspection, she told us that this would always be recorded in future. Training records that we looked at told us that most staff had received medication awareness training during their previous employment. Medication training including in house medication training was discussed with the senior staff member. She confirmed that all staff who administer medication receive in house medication training and that medication awareness is included in the staff induction programme (which we were told meets Skills for Care Common Induction Standards). A staff induction document that was looked at was not fully recorded (including the medication section). The home needs to ensure that it is evident that all staff have received up to date medication training including evidence of in house training. To ensure that it is evident that staff administering medication have a basic knowledge of how medicines are used and how to recognise and deal with problems in use, and understand the principles behind all aspects of the homes policy on medicines handling and records. The senior staff member told us that this training would be arranged and that a check list/assessment with regard to in house medication training to assess staff competency in administering medication would be put in place. Care Homes for Adults (18-65 years) Page 18 of 31 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 who use the service, have access to an effective, robust complaints procedure, and are protected from abuse, and have their rights protected. Evidence: The care home has an up to date complaints procedure, which includes details of the stages of complaint and the timescales for responding and looking into complaints. Development of the format of the complaints procedure to improve its accessibility to people using the service (and others) who might have difficulty reading, was discussed with the senior member of staff. The senior staff member told us that she would look into developing and improving the format of the complaints procedure. No complaints were recorded. We saw a recorded compliment from a relative of a person using the service, comments included all the staff are good, and I highly appreciate the service. Feedback from visitors told us that they felt confident that any concerns/complaints would be listened to and that appropriate action would be taken to resolve any complaints that they might raise. A visitor told us that they had no concerns about the service. The home has up to date clear and robust policies and procedures with regard to the protection of people using the service. This is linked to the lead Local Authority MultiAgency safeguarding procedures. Staff had signed that they had read the care homes safeguarding policy. AQAA told us that no form of abuse is to be tolerated, including that between respite service users and that staff supervision of service users is close, Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: and happy relationships are regarded as paramount in a small community. Records told us that staff had received abuse awareness training during recent previous employment, and during National Vocational Qualification health and care level 2 or 3 training courses that they had achieved. A senior staff member told us that she had plans for all staff to receive safeguarding adults training. She also told us that this was regularly discussed with staff. It was evident from talking to a staff member that she had knowledge and understanding of the appropriate reporting and recording procedures with regard to complaints and/or an allegation or suspicion of abuse. The care plans looked at included clear guidance with regard to meeting the needs of people using the service who could on occasions challenge the service. The senior staff member told us that she had knowledge and understanding of the Mental Capacity Act 2005/Deprivation of Liberty Safeguards. Training with regard to this was discussed. She told us that she would look into accessing training for staff. This should take place. Following the inspection we were told that a risk assessment with regard to the front door being secured so that staff need to let visitors and others outside the home, was in the process of being completed. Assessment of the financial needs of the people using the service was evident in the care plans looked at. We were told that relatives support people using the service with their financial needs. Care Homes for Adults (18-65 years) Page 20 of 31 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 layout of the home enables residents to live in a safe, well maintained, and comfortable environment, which supports and encourages their independence. Evidence: The home is close to bus and train public transport facilities and community amenities of Harrow. With regard to the care home being a new service, the premises has been recently completed refurbished to be suitable for meeting the needs of people using the service. The environment and furnishings are of a high standard. There are hand rails in the bathrooms. The communal areas are homely and the kitchen has been furnished to ensure that people who use a wheelchair can access cooking facilities, including low level work tops. People using the service were observed to be relaxed and comfortable when using the communal sitting room facilities, when watching a DVD film. AQAA told us that the maintenance is ongoing and that the premises are secured electronically and by window fastenings that satisfy our insurers. There are two enclosed gardens which are well maintained, and each includes a gazebo, with seating. One garden has a barbeque facility. We were told that the garden is regularly used in the good weather by people using the service. There are three bedrooms each on the ground and on the first floor. Each bedroom has en-suite toilet and shower facilities, and television. Bedrooms also have their own Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: temperature control, which can be adjusted by people using the service so that they can have the temperature that they like in their bedroom. All the rooms have under floor heating. Staff told us that when permanent residents are admitted to the home they will have the opportunity to choose the decor of their bedroom, and to personalise their room as they wish. AQAA told us that the facilities are designed for easy of maintenance and good hygiene, with under-floor heated marble tiles (non-slip surfaced in critical areas), marble tiled lower walls where necessary, and wipe down surfaces. The home was very clean at the time of the inspection. Laundering facilities are located away from food storage and food preparation areas. Disposable gloves are accessible to staff. Hand washing facilities included soap and hot air hand driers. The home has been inspected by an Environmental Health officer, and met required standards, and quality rated good. Care Homes for Adults (18-65 years) Page 22 of 31 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. Staff in the home are trained, skilled and are in sufficient numbers to support the people using the service, and to support the smooth running of the service. People using the service are supported and protected by the care homes recruitment policy and procedure. A staff training plan should be developed and put in place. Evidence: The staff rota was available for inspection. It was evident from the this record and from talking to staff that the the numbers of staff on duty during the day and at night., were flexible to ensure that the needs of people receiving respite care are met by the home. Staff spoke of enjoying working in the home, and getting to know the people using the respite service. Staff follow a daily shift planner with regard to their duties. Feedback from visitors and relatives of people using the service was positive about the staff. We were told by relatives of people using the service that staff were approachable, listened to them and kept them informed of the progress of their family member. AQAA told us that the staff structure would be fully developed following recruitment of a manager and a deputy manager who are due to take up their posts in September 2009. Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: The home has a recruitment and selection policy. AQAA told us that the care care home makes every effort to ensure we employ staff members who have the right experience, attitudes and qualifications to do their job, and to grow into their role and the future of Care Assist. All the staff employed in the home have been recently recruited. Three staff personnel records were looked at. These confirmed that appropriate required checks including an enhanced Criminal Record Bureau check (a check to gain information as to whether a person has a criminal record) was carried out. One staff members records had a record of a CRB check that was carried out during the persons previous employment. We were told by the staff member and the senior staff member that Care Assist had carried out a CRB check, and following the inspection we were supplied with appropriate evidence that this check had been completed. The home has a staff supervision policy/procedure. At the time of the inspection, there were no records of staff one to one supervision. Following the inspection a senior staff member told us that she had carried out staff supervision with one staff member and that she was planning to supervise another staff member on the day that she contacted us. We were told that staff supervision meetings would be taking place regularly to ensure that staff are supported in their role, and have the opportunity to develop and achieve goals in regard to carrying out their duties in caring and supporting people using the service. A staff member told us that she had received a staff induction when they started working in the home. She told us that the induction programme was comprehensive and covered information that she needed to know to be able to carry out her role and responsibilities in meeting the needs of people using the service. We looked at a record of a staff induction. This record had only been partly completed. The senior staff member told us that she would ensure that all the staff induction records would be fully completed. This should take place. AQAA told us that the staff induction meets National Minimum Standards for the service, and that new staff members have a two week induction to their role at Care Assist, and complete a six-month probationary period of employment before confirmation in post. Staff training records, and certificates of training from previous employment were available for inspection. Staff training included health and safety, 1st Aid, moving and handling, safeguarding adults, mental health awareness, medication awareness and safe food handling training. Specialist training areas included challenging behaviour training, and National Vocational Qualification (NVQ) level 2 and/or 3 in health and care. A senior staff member told us that a variety of appropriate training was planned for staff, and that Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: she was in the process of completing a training plan for staff. We were informed by the provider that mental health training was planned for staff. Care Homes for Adults (18-65 years) Page 25 of 31 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 management and administration of the home is based on openness and respect, has effective quality assurance systems, which ensures that a quality service is provided to people using the service. So far as reasonably practicable the health, safety and welfare of people using the service is promoted and protected. Evidence: At present there is not a manager running the home, but we were told that a manager had been recruited and would be in post on the 1st September 2009, and would be registering with us. At the time of the inspection the respite service was being managed by a senior staff member, with support from the provider. She told us of her experience, which included working in the care sector for sometime and in another of Care Assists homes. Records and feedback from relatives and visitors were positive about the service managed by her. From talking to the senior staff member, and from looking at records it was evident that she is motivated and competent in ensuring that people using the service are provided with a quality service. Where there are areas for improvement that emerge, she works hard to put systems in place to manage and Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: develop them. Talking to staff, and looking at records, confirmed that the home has systems in place to improve, and to monitor the quality of the service provided to people. AQAA told us that the home receives feedback from people using the service and their relatives, comments in the AQAA told us the happy responses of the respite users, and the positive feedback from their families, suggest we are getting it right. We saw completed feedback satisfaction surveys, which included very positive comments about the service. We also spoke to relatives and visitors who were all positive about the care home; comments included I couldnt fault the service, its very flexible, my (relative) is happy using the service, we are kept well informed, about the service. There are policies, and procedures in place to ensure that people using the service are safe. Staff sign when they have read them. Staff meetings take place. The home has a fire risk assessment. Records and the senior staff member told us that appropriate fire checks are carried out. Fire drills take place, and fire awareness is included in the staff induction programme. AQAA told us that the premises have been inspected and certificated by the Fire Services. A senior staff member told us that the home had received an inspection from the Fire Service during the week prior the inspection and that the Fire Service had confirmed that the the home has satisfactory fire safety systems in place. AQAA and records told us that fire safety appliances have been checked, and that the premises are secured electronically and by window fastenings that satisfy the care homes insurers. There was displayed fire guidance. We were also told in the AQAA that the home could ensure that the staff team have in-house training in the right responses to fire and other possible emergencies. Following the inspection we were informed by the provider that fire training was planned for all staff. This should take place promptly. The home has health and safety risk assessments. The senior staff member and records told us that equipment in the home is regularly serviced/checked by appropriate persons. Records told us that hot water temperatures were monitored everyday. The home has up to date employers liability insurance. Care Homes for Adults (18-65 years) Page 27 of 31 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 31 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 20 13 The home needs to ensure that it is evident that all staff have received up to date medication training including evidence of in house training. To ensure that it is evident that staff administering medication have a basic knowledge of how medicines are used and how to recognise and deal with problems in their use, and know and understand the principles behind all aspects of the homes policy on medicines handling and records. 30/10/2009 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 1 Information about the service (statement of purpose and Care Homes for Adults (18-65 years) Page 29 of 31 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 service user guide) provided should be available in the home at all times. So that this information is accessible to people using the service and to others. 2 23 It should be evident that each staff member has received up to date safeguarding adults training since being employed in the care home. It should be evident that all staff complete a comprehensive induction programme that is recorded. There should be a training and development plan for each staff member. An manager should be in post running the home and be registered with the Care Quality Commission. It should be evident that all staff receive certified fire safety training, to ensure that they have the skills and comprehensive knowledge of fire safety. 3 35 4 5 37 42 Care Homes for Adults (18-65 years) Page 30 of 31 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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