Care Home: Careview Services

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What the care home does well The service continues to provide people with a good environment in which to live. Maintenance issues are addressed in a timely manner and aids and adaptations are provided as required. People are cared for by a dedicated manager and staff team who encourage people to participate in the day-to-day running of the home. Their best interests are protected by the service`s recruitment and induction procedures. All staff members are supported to achieve recognised qualifications and are provided with the training they need to meet the needs of the people living in the home. Care plans are produced and regularly reviewed to ensure people`s needs and personal preferences are met. Risk assessments are undertaken and strategies identified to keep people safe from harm. They are supported to make their own decisions, maintain contact with family and friends and are provided with opportunities to participate in a range of activities. What has improved since the last inspection? The service has reviewed its procedures and practice for assessing the needs of people who wish to live in the home. They are provided with excellent opportunities for visits and overnight stays. An individual programme of introduction is agreed that enables the person to meet the people who live here, the staff team and familiarise themselves with the environment. Arrangements for how finances will be managed for individual`s and by whom have been fully included in people`s care plans. The staff team have attended training in the adult abuse and safeguarding issues to ensure people`s best interests are promoted and they are fully protected from abuse. The medication policy and procedures have been reviewed. A procedure for administering `over the counter` remedies has been included and additional recording systems, where necessary, have been implemented to ensure effective monitoring and auditing can take place. Staff members with responsibility for the handling of medication have been trained to do so. These actions ensure people`s health and wellbeing is more fully protected. Health and safety training has been provided for all staff. This includes basic food hygiene, first aid and the prevention and control of infection. The service has made suitable arrangements to ensure gas appliances are serviced at least once a year. It continues to have systems in place for all other appliances and equipment to be regularly checked and serviced. What the care home could do better: A system for monitoring arrangements for people to receive routine health care checks should be implemented to ensure appointments are made on a regular basis. Detailed records, where applicable, should be kept for people who have shown signs of distress when receiving treatment or declined to attend. This is to ensure person`s wishes and best interests are given due consideration, fully discussed and advice sought from relevant professionals. Some relatives and health and social care professionals who responded to our survey commented that they felt communication was an area that could be improved. The manager is aware of this and has begun to look how this can be addressed. Consideration should be given to providing staff with guidance and/or training to develop their confidence when discussing a person`s care with relatives and relevant professionals. A comprehensive quality assurance system has yet to be fully implemented to assess the service`s own performance in meeting its stated aims and objectives. An annual develop plan should be produced based on the service`s findings and made available to all interested parties for them to be fully confident their views underpin the service`s self-monitoring, review and plans for development. Key inspection report Care homes for adults (18-65 years) Name: Address: Careview Services Ashley House 81 Birmingham Road West Bromwich B70 6PX     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: Linda Elsaleh     Date: 0 9 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Careview Services Ashley House 81 Birmingham Road West Bromwich B70 6PX 01215326790 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Care View Services Limited care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Learning Disability (LD) 6 Date of last inspection Brief description of the care home Careview is an older terraced property, which has been completely refurbished to a high standard. The home offers care to six adults between the ages of 18 to 65 who have a learning disability. The accommodation is provided over 3 floors. There is a large lounge and dining room on the ground floor, with a domestic style kitchen and small laundry. All bedrooms are single and provided with an en suite toilet and shower or bath. There is one bedroom on the ground floor, which meets the needs of a person with a physical disability. There are 3 bedrooms on the first floor and 2 on the second floor. A stair lift has been installed for use, where required, to access the first floor. The stairs to the second floor are fitted with grab rails. To the rear of the property is a small, very attractive and private garden. Transport is provided to assist service users Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 6 Brief description of the care home to attend Day Centres during the week. The homes aims are: To provide high quality individualised care and encourage and support independent living as far as possible. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We looked at information we have received about the service since our last visit and sent surveys to people who live in the home, their relatives and health and social care professionals asking them to tell us what they think about the service. We received responses from 40 per cent of people we surveyed. Comments were positive about the service and have been included in this report. The service is required to complete an Annual Quality Assurance Assessment (AQAA). This provides us with information about what has happened in the home during the last 12 months. This was returned to us when requested and contained the information we asked for. This unannounced visit was carried out by one inspector on 9th September 2009. We spoke to the manager, staff and some people who live here. We looked at the care files for two people and the files for two staff in detail as well as other records and Care Homes for Adults (18-65 years) Page 6 of 30 documents kept by the service. This was to help us to assess the quality of life for people who live in the home and the services performance against the national minimum standards. The atmosphere in the home was relaxed and friendly. We looked round the building and found it to be suitably furnished, clean and tidy. People we met appeared healthy and well looked after. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: A system for monitoring arrangements for people to receive routine health care checks should be implemented to ensure appointments are made on a regular basis. Detailed records, where applicable, should be kept for people who have shown signs of distress when receiving treatment or declined to attend. This is to ensure persons wishes and best interests are given due consideration, fully discussed and advice sought from Care Homes for Adults (18-65 years) Page 8 of 30 relevant professionals. Some relatives and health and social care professionals who responded to our survey commented that they felt communication was an area that could be improved. The manager is aware of this and has begun to look how this can be addressed. Consideration should be given to providing staff with guidance and/or training to develop their confidence when discussing a persons care with relatives and relevant professionals. A comprehensive quality assurance system has yet to be fully implemented to assess the services own performance in meeting its stated aims and objectives. An annual develop plan should be produced based on the services findings and made available to all interested parties for them to be fully confident their views underpin the services self-monitoring, review and plans for development. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with the information they need to make an informed choice about where to live. This is provided in suitable formats and explained to them by staff. The service carries out a comprehensive assessment of the needs and aspirations of people who wish to move in. People are confident their needs can be met by the service because they fully involved in the assessment process. People who wish to move in are provided with excellent opportunities to make visits to the home and have overnight stays before they move in. Evidence: Information provided to us by the manager shows details about the service was last reviewed in May 2009. There has been one person admitted to the home since our last visit. We looked at this persons file in detail. It contained assessments obtained from health and social care agencies, the services own assessment, minutes of the meetings held to discuss the individuals care needs, personal preferences and how these will be met by the service. A plan for introductory visits and overnight stays was Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: agreed, together with interim care plans and risk assessments for staff to follow during this period. The records show the person being care for and her/his relatives were involved in this process. Staff we spoke to told us they had been provided with good information about the persons care needs during her/his period of introduction. The rota was arranged to ensure one member of the staff team, known to the individual, was always on duty during visits. Staff told us the person had settled in very well and they felt the manager prepared us well for dealing with any issues/behaviours that may arise. We spoke to the person who had recently come to live in the home. S/he told us they were given information about the service by the manager and staff discussed this with them during their visits. The persons file contains a copy of the letter sent by the service confirming it is able to meet this persons needs. The interim care plan, risk assessments and contract are produced in easy to read formats to enable the person to understand the contents. This shows us the service is committed to reviewing and improving its assessment process to ensure peoples needs can be fully met and they are provided with good opportunities to get to know the staff, other people living at the home and familiarise themselves with the premises before they move in. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are involved in the planning of their own care and are supported to make their own decisions. The service undertake risk assessments to keep people safe from harm and supports them to take risks, where possible, to follow an independent lifestyle. Evidence: We looked at the care plans for two people living in the home. These are produced in easy read formats with detailed information about their individual needs, how these are to be met, and their likes and dislikes. The plans show individuals are involved in their care planning and encouraged to maintain and develop their independent skills. Discussions held with staff demonstrated that they are familiar with both peoples care plans. Since our last visit the service has included more information about arrangements agreed of how peoples finances will be managed and by whom. The manager told us the service is working towards more actively involving all people in planning their own care and are making further improvements to how care plans are Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: produced. Health and social care professionals who responded to our survey tell us they feel the diverse needs of people living in the home are being met by the service. Weekly meetings are held with people to discuss their care and what they would like to do the following week. A record of the meeting is kept on their daily notes. These are regularly reviewed by the manager and/or deputy. During this visit we saw staff encouraging people to make choices about how they would like spent their time and providing them with the relevant support they needed to participate in their chosen activity. Staff we spoke to, and those who responded to our questionnaire, stated they are always provided with good information to meet peoples individual needs. Care plans are reviewed on a regularly basis with the individual, their relative/representative and relevant agencies. One persons care plan we looked at was last reviewed in January 2009. The care plan of the most recent person to move in has been reviewed more frequently to ensure it meets her/his needs. The last review was held in August 2009. Risk assessments are carried out to protect people from harm and/or injury when in the home or out in the community. One persons risk assessment shows there is an increase risk of falls during periods when s/he is less mobile. Therefore, a stair lift is available for them to use when using the stairs. The risk assessment for the most recent person to move in shows there has been times when her/his behaviour could result in harm to themselves or others. Details of how these risks can be minimised have been produced. Risk assessments are also undertaken to identify strategies to support people to safely carry out tasks by themselves, such as preparing a drink or snack or doing their own shopping. The records show all risk assessments are regularly reviewed. 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 able to follow their own routines and have opportunities to participate in a range of activities. The service provides people with support in maintaining and developing relationships with relatives and friends. People are offered a choice of meals that meet their dietary needs and personal preferences. Suitable arrangements are made for them to enjoy mealtimes. Evidence: The two people whose care we followed showed they do not attend local day centres or colleges. The staff told us the older person is becoming frail, has limited social skills and does not respond positively when with large groups of people. S/he prefers to participate in brief activities with staff and spends much of her/his time relaxing Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: watching television. The other person is spending time settling in and getting to know the staff and the people they live with. The manager told us plans are being made to discuss what, if any, learning, development and social opportunities the person would like to access. We looked at the care plan and daily records for another person living in the home. It shows they still enjoy going to their local day centre twice a week. Staff told us other people living in the home also continue to attend various centres/clubs. Individual communication books continue to be used between the service and the persons day centre to ensure all relevant information is passed between workers. A range of activities is provided during the evenings and weekends, such as visits to local places of interest and various social clubs and pubs in and around the West Bromwich area. The interests of one person include listening to music, going to discos and bowling. These are identified in her/his care plan. As well as recording peoples participation in activities on their individual notes, the service also takes photographs. These are displayed in the annex next to the lounge/dining room for everyone to enjoy with photographs of days out and holidays. Information provided to us by the service prior to our visit shows the policy for Contact with/visits by Family & Friends was reviewed in May 2009. Care plans include details of contact arrangements. Records are kept of the support people have received to facilitate telephone calls and visits. Surveys returned to us by relatives tell us they feel the service supports people to keep in touch. Some relatives and health and social care professionals commented communication could be improved. The manager told us she had identified this and has been working to improve systems within the home. Consideration should be given to providing staff with training in information sharing and maintaining confidentiality to improve their confidence in discussing care issues with relatives and relevant professionals. People are supported to follow their preferred routines. One person goes to their bedroom during the day for a short nap and another likes to go into the garden when they come home. People are able to choose the clothes they want to wear, but will often consult staff on the suitability of their choice in respect of the weather. There is unrestricted access to communal areas, however, people are supervised and/or supported in high risk areas, such as the kitchen, in accordance with their individual plans and risk assessments. Relatives told us they feel people are supported to live the life they choose. A pictorial menu is available for people to use when discussing meal choices. Mealtimes are regarded as social occasions where the days events and activities are discussed. At our previous visit staff identified one person who usually preferred to eat Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: alone. The records show s/he is choosing to dine with the group more often and sometimes enjoys a meal out. Care staff are responsible for carrying out all duties associated with catering and have attended training in Basic Food Hygiene. Records are kept of all meals taken by individuals for monitoring purposes. The service works closely with relevant health care agencies, for example dieticians, to ensure peoples dietary needs are being met. Visits have been made to the home by speech and language therapists to discuss concerns raised by staff about the difficulties two people experience when eating. People are encouraged to take part in weekly shopping trips and be involved in the choice of purchases made. They are also supported to participate in the preparation of meals and snacks, if they wish. Care Homes for Adults (18-65 years) Page 17 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service meets the personal, emotional and healthcare needs of people living in the home. Improved systems for monitoring arrangements for routine health checks will ensure these are always met in a timely manner. Medication is managed on peoples behalf by staff trained to do so. Procedures are in place for the safe handling and administering of medication. Evidence: Information provided to us by the service shows the different levels of support people need in respect of their personal care. Details of the assistance and/or prompts required are included in the care plans we looked at. Discussions held with staff confirm they are aware these and the importance of supporting people to maintain and develop areas of independence. Comments from relatives tell us they feel a satisfactory level of care and support is provided by staff. A health care profile is available on the peoples files. Individual record sheets are kept of peoples appointments with their GP, health care specialists and for routine checks, such as with the optician and chiropodist. However, some records show gaps between Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: routine appointments. For example, the last dental appointment for one person is recorded as August 2007. This was discussed with the manager. She agreed a more efficient system for monitoring appointments and the quality of recordings needed to be improved. Detailed records should be kept for instances where people choose not to attend or show signs of distress towards receiving treatment to show these are being managed appropriately. Surveys returned to us by health and social care professionals tell us they feel the diverse needs of people are being met and their right to dignity and privacy is respected. The service continues to manage medication on behalf of people living in the home. Training, which includes medication specifically prescribed for people with learning disabilities, has been attended by all staff with responsibility for handling medication and periodic refresher courses are arranged. Sample signatures and initials of staff authorised to handle medication are kept for identification and auditing purposes. The medication administration record (MAR) sheets are completed to a satisfactory standard and the relevant codes are used, where applicable. The service has suitable facilities for the safe storage of all medication. Policy and procedures were reviewed in May 2009. These now include procedures for over the counter remedies. Since our last visit the service has implemented a more robust system for recording the adding of prescribed thickening agents to food/drinks. Information provided to us by the service states it plans to provide people with more easy to read information about their medicines with a view to them being more involved, where applicable, in the administering their medication. Care Homes for Adults (18-65 years) Page 19 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are regularly consulted about their care and the day-to-day running of the service and feel their views are listened to and acted upon. Suitable procedures in place to promote peoples well being and are protected from abuse by a trained staff team. Evidence: The service has a complaint procedure. This is available in a pictorial format. One person we spoke to told us they knew who to speak to if they were unhappy or concerned about anything. People are also encouraged to raise any issues they may have at group meetings and individual meetings with their key worker. The records of both meetings include details of any action taken to meet peoples requests and address any concerns raised. The service periodically invites comments from relatives about the service. The comments we looked at were positive about the care being provided. Comments we received from relatives were also positive about the care being provided. No complaints about the service have been reported to us, the Care Quality Commission (CQC). Adult protection policies and procedures are available in the home. No safeguarding concerns have been reported to us and none were raised during this visit. Staff we Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: spoke to told us they had received training in adult protection and were confident any issues raised would be appropriately dealt with by the manager and provider. We looked at the training records and these show periodic refresher training in safeguarding adults is arranged for all staff. The service has a policy for responding to behaviour that may challenge the service and this was last reviewed in May 2009. The records show their have been no such incidents. This was confirmed by the manager and staff and no behavioural concerns had been identified. There are suitable procedures are in place to ensure people are supported, wherever possible, to manage their personal allowances in accordance with their care plans. Records are kept of all purchases made by staff on behalf of people living in the home. Care Homes for Adults (18-65 years) Page 21 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent 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 homely, comfortable and safe environment. It is well-maintained and good procedures are in place to ensure it is clean and hygienic. Evidence: Communal areas in the home include a large lounge and dining area. People have unrestricted access to these communal areas, their bedrooms and the pleasantly landscaped garden. The manager told us the annual renewal programme for the premises will include replacing the carpet in the lounge. Supervision, where appropriate, is provided in high-risk areas such as the kitchen. People are encouraged to participate in light household duties and are supported by staff to keep their own rooms clean and tidy. Bedrooms are decorated and furnished to meet the individuals taste. One person we spoke to told us they chose their own colour scheme and showed us their new home entertainment equipment. The manager closely monitors the environment to ensure peoples individual needs are being met. Since our last visit the service has fitted additional grab rails on the stairs. Procedures are in place to ensure good hygiene practices are followed and training in infection control is provided for all staff. There continues to be good systems in place for carrying out regular environmental risk assessments and maintenance checks. Any Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: repairs needed are reported by staff and entered in the maintenance book. The book includes the date the request was made and when the job was completed. It is monitored by the manager to ensure these are completed in a timely manner. People who responded to our survey tell us the atmosphere in the home is friendly and it is always clean and tidy. The service employs a person to undertaken some of the domestic duties to ensure a high standard of cleanliness is maintained. Care Homes for Adults (18-65 years) Page 23 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported by a stable, competent and trained staff team. The services recruitment procedures ensure they are safeguarded from harm or abuse. Evidence: The staff team is made up of individuals (male & female) who have different life experiences. The discussions held with staff show us they are familiar with peoples needs, routines and preferences and how these are to be met. Information provided to us by the service show all staff hold the National Vocational Qualification (NVQ) Level 2, four have completed Level 3 and three staff are working towards this. Copies of these certificates are kept on by the home. The training records show dates of other training courses that have been and arrangements made for future training. The manager has identified communication as an area which the service needs to improve. Work has recently been carried out to improve communication systems. Policies and procedures for recruiting staff were reviewed in May 2009. We looked at the files for two staff. The information kept includes a completed application form, with full employment history, two references and a Criminal Record Bureau (CRB) Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: check. The service also keeps a written record of interviews with candidates. Once appointed arrangements are made for the new staff member to shadow a senior member of staff as part of their initial induction to the service. The manager is currently reviewing its recording systems for this part of a persons induction. They are also required to complete the Skills for Care Induction and Foundation workbook. The manager monitors their progress and discusses practice issues with them during supervision. Staff we spoke to confirmed they receive regular supervision and found these sessions useful. We looked at the supervision records for two staff. These were signed and dated by both parties. Care Homes for Adults (18-65 years) Page 25 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home benefit from a service that is run by a qualified and competent manager. Good opportunities are provided for people to express their views. A comprehensive quality assurance system and annual development plan should be produced so people living in the home, their relatives and other interested parties can be fully confident their views underpin the services self-monitoring, review and plans to development. Policies and procedures are in place to promote and protect peoples health and safety. Evidence: The service is run by a suitably qualified and competent manager. Regular meetings to discuss the service are held with the provider. The service is to be commended on the work undertaken to ensure a comprehensive assessment and admission process is in place. The manager told us she had reduced some of the time she would usually spend providing direct care to people living in the home to enable her to plan, Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: organise and monitor each stage of the process. The manager is advised to make similar arrangements for monitoring, reviewing and developing other aspects of the service. The manager has attended training in the Deprivation of Liberties Safeguards and refresher courses for the Protection of Vulnerable Adults and the safe handling and administration of medication since our last visit. Arrangements should be made for the manager to attend periodic training to update her knowledge on regulations and good practice guidance and for developing her management skills. As well as the systems in place for obtaining the views of people who use the service, it also periodically seeks the views of their relatives. However, the service has yet to implement a comprehensive quality assurance system for assessing its own performance. An annual development plan, based on the services findings, should be produced and made available to all interested parties to ensure they can be fully confident their views underpin the services self-monitoring, review and plans for development. Health and safety policies and procedures are periodically reviewed and practice is monitored to ensure these are being implemented. We looked at the services records for routine checks carried out on the premises and servicing of appliances and equipment. These show suitable arrangements are in place to ensure people in the home are kept safe. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 15 Training in information sharing and maintaining confidentiality should be provided for staff to improve their confidence in responding to requests for information by relatives of people living in the home and health and social care professionals. The service should improve its systems for monitoring routine health care checks including discussions held where a person has refused treatment or showed signs of distress. Suitable arrangements should be made for the manager to attend periodic training to update her knowledge of regulations, good practice guidances and develop her managerial skills. A comprehensive quality assurance system should be implemented and an annual develop plan produced so people can be fully confident their views underpin the services monitoring and review of its own practice. 2 19 3 37 4 39 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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