Care Home: Carlton Avenue (64-66)

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What the care home does well `The home provides a loving and caring environment`. Comment from a relative. `They do well in respect of keeping me informed of any important matters regarding my relative. As far as I can tell they do take care of her well. As my relative cannot talk to me I trust that she is happy and I am sure she is happy`. Comment from a relative. `They take on board advice given regarding specific patients. They feedback relevant incidents regarding patients to me`. Comment from a health care professional. `We have an up to date training package. We are service user led. We take a person centred approach when working with service users. We create a homely environment for all who live here. This is a well managed home with great teamwork`. Comment from a staff survey. The home provides clear information for potential new residents and their families to help people make an informed choice to move into the home. Important information is provided in formats that make the information easier for people to understand. The home involves individuals in the planning of care which affects their lifestyle and quality of life. Staff understand the importance of residents being supported to take control of their own lives. Individuals are encouraged to make their own choices and decisions. Residents receive effective personal and healthcare support using a person centred approach with support based on the rights of dignity, equality, fairness, autonomy and respect. Staff ensure that care is person led, personal support is flexible, consistent and is able to meet the changing needs of the residents. Staff members are very alert to changes in mood, behaviour and general wellbeing and fully understand how they should respond and take action. What has improved since the last inspection? We made four requirements following our last inspection of the home to improve the recording of the care and support given to residents, the recording of residents` medication and the physical environment. During this visit we saw that all four of these requirements had been met. What the care home could do better: Following this inspection it is our judgement that the home provides excellent outcomes for people who live there. We have made no requirements or recommendations following this visit. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Carlton Avenue (64-66) 64-66 Carlton Avenue Kenton Harrow Middlesex HA3 8AY     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Tony Lawrence     Date: 0 1 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Carlton Avenue (64-66) 64-66 Carlton Avenue Kenton Harrow Middlesex HA3 8AY 02089074918 02089073370 donna.thompson7@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Care Management Group Ltd care home 9 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: 9 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection Brief description of the care home 64-66 Carlton Avenue is a care home registered to provide care for nine people with a learning disability. The registered provider is Care Management Group Ltd (CMG) and the home was first registered in November 2004. The home is situated in a quiet residential area of Kenton, Harrow, close to shops and other amenities. Public transport is located near by and the home has an adapted vehicle to transport passengers in wheelchairs. All bedrooms are single with ensuite Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 9 Brief description of the care home toilets and wash hand basins. Four rooms also have an ensuite shower, although these are little used. Four bedrooms are located on the ground floor and five bedrooms are on the first floor. There is a passenger lift. The dining room opens onto a large and accessible garden and patio area. The manager confirmed that the weekly fee for a residential placement in 64-66 Carlton Avenue ranges from £1,300 to £1,600. The actual fee is determined through an assessment of the potential residents needs. Care Homes for Adults (18-65 years) Page 5 of 29 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: three star excellent 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: This unannounced key inspection took place from 09:15 - 14:00 on Wednesday 1st July 2009. During this visit we reviewed outcomes for residents against the key National Minimum Standards for care homes. We did this by talking to residents, staff and the homes manager; we checked care records kept in the home and toured the building. We also received confidential surveys from residents, their relatives, staff working in the home and other professionals. We have used comments from these people in this report. We have also used information from the homes Annual Quality Assurance Assessment (AQAA). The AQAA is a self assessment that is completed by the provider. It was well completed and gave us a range of evidence that we have used in this report. Care Homes for Adults (18-65 years) Page 6 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Adults (18-65 years) Page 7 of 29 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 8 of 29 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 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides clear information for potential new residents and their families to help people make an informed choice to move into the home. Important information is provided in formats that make the information easier for people to understand. Evidence: We have a dedicated referral and assessment team who are responsible for screening, gathering information and assessing all new referrals. This gives service users and families an opportunity to consider what services are available and to ascertain if it is appropriate. Extract from the providers Annual Quality Assurance Assessment (AQAA). The home provides a loving and caring environment. Comment from a relative. Information from the providers AQAA was evidence that there had been no new admissions to the home since our last key inspection in September 2007. During this visit we checked the care plan files for two people who had lived together Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: in the home for a number of years. We saw that each of the files included and excellent, personalised Service User Guide that gave clear information about the services provided at Carlton Avenue. The Guides had been produced using photos, pictures and clip art to make the information easier for residents to understand. The Guides also included the homes complaints procedure and contact details for other agencies involved in the care of people living in the home. We also saw that each of the care plan files we reviewed included a copy of the providers Resident Agreement that outlined the rights and responsibilities of the resident and the providers and detailed the terms and conditions of residence. Eight people living in the home returned confidential questionnaires we sent to them as part of this inspection. All eight people told us that they had enough information before moving into the home and all said that they, or their representatives, were asked if they wanted to live at Carlton Avenue. One persons relative also returned a questionnaire. This person also told us that they had received enough information about the home before their relative moved in. Care Homes for Adults (18-65 years) Page 11 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home involves individuals in the planning of care which affects their lifestyle and quality of life. Staff understand the importance of residents being supported to take control of their own lives. Individuals are encouraged to make their own choices and decisions. Evidence: Care plans are conveyed to service users and families in a variety of methods for example using communication cards or making documentation available in different languages. Care plans always identify any cultural or religious needs of any service user. Extract from the providers Annual Quality Assurance Assessment (AQAA). During this inspection we checked the care plan files for two people living in the home. The manager told us that the home was moving towards a system of person centred planning (PCP) and each resident would have a new PCP by the end of July 2009. The first plan we checked had not been transferred to the new PCP format. It had been reviewed and updated in March 2009 and covered all aspects of the residents Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: personal and health care needs, activities, cultural and spiritual needs. We saw that a strength of the plan was the assessment of the persons cultural needs and how these would be met in the home. Following this assessment, staff supported this person to go to the local temple each week and had provided CDs of religious music and prayers. The plan also included good goals to maximise this persons community participation, independence, choices and relationships. We also saw that the care plan file included risk assessments that had been reviewed each month. These covered a wide range of areas, including same gender personal care, managing finances, use of the bathroom and use of the persons wheelchair. The assessments all included clear guidance for staff on how risks should be minimised. The second care plan we checked had been written in March 2009 using the homes new person centred planning system. The manager and the residents key worker told us that the key worker had worked with the resident and their relatives to complete a Listen To Me workbook. This made sure that the persons views on all aspects of the care they received were recorded and considered. The workbook was then used by the homes PCP co-ordinator and the key worker to develop the care plan. We saw that the plan was very person centred and used photographs and pictures to make the information easier for the resident to understand. We saw that the resident and staff had agreed good goals concerning health care, community participation and holidays. The plan also covered all aspects of care and included details of the persons daily routines and the ways they communicated with staff. We saw that a separate epilepsy support plan had also been completed in March 2009. This care plan file also included a lot of risk assessments that had been reviewed each month. These identified potential risks involving the persons medication, use of a wheelchair, use of the hoist and swimming. Eight people living in the home returned confidential questionnaires we sent to them as part of this inspection. All eight people told us they could always make decisions about what they wanted to do during the day and in the evenings and at weekends. Care Homes for Adults (18-65 years) Page 13 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has a strong commitment to enabling residents to develop or maintain their skills, including social, emotional, communication and independent living skills. The staff team help with communication skills, both within the service and the local community, to enable residents to fully participate in daily living activities. Evidence: It has continued to be important to identify educational or leisure opportunities which are of interest to the service user prior to their move. We have accessed a day service which offers a range of therapeutic groups for example, sensory groups, drama therapy, dance movement, body awareness or food tasting. Extract from the providers Annual Quality Assurance Assessment (AQAA). They do well in respect of keeping me informed of any important matters regarding my relative. As far as I can tell they do take care of her well. As my relative cannot Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: talk to me I trust that she is happy and I am sure she is happy. Comment from a relative. The staff look after my relative and give him a happy and stable environment to live in. Comment from a relative. The home assists and enables people to participate in activities and provides a stable and nurturing environment. Comment from a social care professional. During this visit we saw that residents key workers had worked with individuals to record their interests and activities they preferred. Person centred plans included a weekly programme of activities for each person. The activities included use of local day services, community based activities and activities in the home. The home also had an excellent pictorial activities board that used photos to illustrate activities that residents had taken part in. The homes manager told us that one of the homes support workers had been designated as Total Communication Champion. This person attended workshops organised by the provider to improve the ways staff and residents communicated with each other. This person also had access to a resource library of materials and communication equipment that could be used in the home with individual residents. The care plans we saw also included information about individuals relatives, friends and other significant people. Each plan included information for staff on how each person should be supported to keep in touch with these people. Daily care notes showed us that residents spent time with and were visited by relatives and friends. Staff also made sure that one person spent time talking with relatives on the phone. We saw that the rights and responsibilities of people living in the home were clearly outlined in the Service User Guide, in formats that made the information easier for people to understand. We also saw that residents were registered to vote in local and general elections. The manager told us that since our last inspection, staff had worked with residents, their relatives and local banks to make sure that each person had an individual bank account. We saw the homes menus and these showed that residents were offered a variety of nutritious meals. We also saw that staff had been given clear guidance on supporting people who needed help to eat. The home had a large, comfortable dining room and we saw residents enjoying their breakfast when we arrived for this visit. Care Homes for Adults (18-65 years) Page 15 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive effective personal and healthcare support using a person centred approach with support based on the rights of dignity, equality, fairness, autonomy and respect. Staff ensure that care is person led, personal support is flexible, consistent and is able to meet the changing needs of the residents. Staff members are very alert to changes in mood, behaviour and general wellbeing and fully understand how they should respond and take action. Evidence: Service users preferences around clothing, culture and beliefs are also identified in individual care plans and these are adhered to at all times. We have positive working relationships with our local GP practice, continence nurse, optician, dentist and pharmacy. Extract from the providers Annual Quality Assurance Assessment (AQAA). We give people a high standard of care, working with them according to their rights and needs. Comment from a staff survey. They take on board advice given regarding specific patients. They feedback relevant incidents regarding patients to me. Comment from a health care professional. Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: During this inspection we reviewed the ways the personal and health care needs of 2 residents were met in the home. We saw that peoples personal and health care needs were recorded well in their person centred care plans. Peoples preferences about how they were supported with their personal care were well recorded and each care plan included details of the persons daily routines. We saw that some people living in the home had significant health care needs and that the manager and staff had worked well since our last inspection in September 2007 to meet these needs. Since our last visit, the manager had arranged with the Primary Care Trust (PCT) for a physiotherapist to visit the home twice each week to work with all eight residents. The manager and staff told us that this had resulted in a significant reduction in the number of residents chest infections. The manager also told us that one person was now able to walk upstairs unaided and this persons relatives had also reported that she was able to get in and out of their car much more easily. The manager also told us that she had arranged with the PCT for a speech and language therapist to complete assessments for all eight people living in the home. We were told that one aim of the assessments was to provide equipment for individuals to enable them to have more control over their environment. One example of this was that one person would be able to control their own music system, instead of relying on staff to do this for them. One of the people whose care we reviewed during this visit had a health action plan that had been reviewed in November 2008. We saw that this was very detailed and included good evidence of excellent joint work with health care professionals. The plan included good guidance for staff on managing the persons epilepsy and peg feed and the manager told us that all staff had completed training to enable them to provide this support. As a result of an annual health check up and medication review by the persons GP in June 2009, a referral had been made to the local hospital for the supply of special footwear. We saw that all of the health information kept in the home had been produced in formats that were easier for residents to understand, using photographs, pictures and Plain English. We saw that all staff had been assessed as competent to manage residents medication. The manager also told us in the AQAA that the pharmacist carried out three monthly checks of the homes medication management, to make sure that procedures were followed correctly. Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: We also saw that staff had worked with residents, their families and other people to record residents wishes regarding illness and end of life care. Care Homes for Adults (18-65 years) Page 18 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an open culture that allows residents and other people to express their views and concerns in a safe and understanding environment. The service has a complaints procedure that is clearly written and easy to understand. The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. Evidence: We have a clear complaints procedure which is accessible to all staff, service users, external professionals and family members. Complaints or the raising of concerns is welcomed by the staff team and constructive feedback is accepted as a positive means of further improving our service. Extract from the providers Annual Quality Assurance Assessment (AQAA). If I was worried about any of the people living here I would talk to the manager. Comment from a member of staff. The most important part of our job is keeping people safe. Comment from a member of staff. During this visit we saw that the home had a clear complaints procedure that had been produced in accessible formats to make the information easier for residents to follow. The procedure made good use of photos to show residents and other people Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: who they could talk to about any concerns. The manager told us that staff would deal with any informal complaints and there had been no need to use the providers formal complaints procedure in the past 12 months. We saw that staff had access to a copy of the local authoritys safeguarding adults policy and procedures. The manager confirmed that there had been no safeguarding adults referrals or investigations since our last inspection in September 2007. Eight people living in the home returned confidential questionnaires we sent to them as part of this inspection. All eight people told us that they knew who to talk to if they were not happy and they knew how to make a complaint. Care Homes for Adults (18-65 years) Page 20 of 29 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 home provides a physical environment that is appropriate to the specific needs of the people who live there. The well maintained environment provides specialist aids and equipment to meet residents needs. The home is a pleasant, safe place to live. Evidence: Our home offers a home to eight service users, six of whom are wheelchair users. The home is kept clean, comfortable and airy and we provide good heating and ventilation. Extract from the providers Annual Quality Assurance Assessment (AQAA). Sometimes minor maintenance takes a long time to get corrected. Comment from a relative. The home is situated in a quiet residential area of Kenton, Harrow, close to shops and other amenities. Public transport is located near by and the home has an adapted vehicle to transport passengers in wheelchairs. All bedrooms are single with ensuite toilets and wash hand basins. Four rooms also have an ensuite shower. Four bedrooms are located on the ground floor and five bedrooms are on the first floor. There is a passenger lift. The dining room opens onto a large and accessible garden and patio area. Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: During this visit we saw all communal parts of the home and the garden. We saw that the home was well decorated and comfortable furnished. New flooring had been laid in one lounge and the manager told us that this was being extended throughout the ground floor. This would make it easier for people using wheelchairs to move themselves around the home. There was a ramp leading to the large, attractive garden. This visit took place on a very hot day and we saw residents enjoying activities and relaxing in the garden with staff. We saw that the home had a sufficient number of accessible toilets and bathrooms for residents use. Eight people living in the home returned confidential questionnaires we sent to them as part of this inspection. All eight people told us that the home was fresh and clean. All parts of the home we saw during this visit were clean and hygienic. Care Homes for Adults (18-65 years) Page 22 of 29 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. There are consistently enough staff to meet the care needs of people living in the home. All staff receive relevant training that is focused on delivering improved outcomes for residents. There is a good recruitment procedure that recognises the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. Evidence: Our staff group are committed and approachable and understand they are employed to fully meet the needs of our service users. They understand the importance of gaining an understanding of the communication methods used by our service users. Extract from the providers Annual Quality Assurance Assessment (AQAA). The service users are very well cared for. I believe we provide the best service we can. Comment from a staff survey. The home is doing very well. I enjoy my work and I am happy here. I understand all of the policies and procedures. Comment from a staff survey. We have an up to date training package. We are service user led. We take a person centred approach when working with service users. We create a homely environment Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: for all who live here. This is a well managed home with great teamwork. Comment from a staff survey. During this visit we spent time talking with staff on duty and we also checked the personnel files for two people working in the home. We found that the staff were very positive about their roles and each person demonstrated an excellent knowledge of each residents care and support needs. During this visit we saw that all staff worked well together to make sure that residents care needs were met promptly and appropriately. The manager told us that there was a minimum of 5 staff on duty in the home each morning and a minimum of four staff during the afternoon and evening. At night there were two waking night staff in the home to support residents. We checked the homes rotas and these showed that these levels of staffing were provided consistently. Information from the providers AQAA was evidence that over 95 of staff working in the home had completed their National Vocational Qualification (NVQ) Level 2 training. We also saw from the staff files we checked that staff had access to a range of appropriate training. The staff files we checked included all of the checks needed to make sure that staff were suitable to work with vulnerable adults, including Criminal Records Bureau (CRB) checks and references. The files also included evidence that staff had regular supervision with the homes manager and an annual appraisal. We received 12 confidential surveys from staff who worked in the home. Staff were generally very positive about their work. They told us that they had enough information about the people they cared for and they were given training that helped them meet peoples care needs. They said that they had enough support from the homes manager and there were always enough staff to meet the care needs of people living in the home. When asked what the home could do better, 8 staff told us that their pay should be reviewed. One person commented all the service users are in wheelchairs and the work is physically very hard. Care Homes for Adults (18-65 years) Page 24 of 29 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 manager has the required qualifications and experience and is competent to run the home. The manager has a clear understanding of the key principles and focus of the service. The AQAA contains clear, relevant information that is supported by a wide range of evidence. The AQAA lets us know about changes the provider has made and where they still need to make improvements. Evidence: Care Management Group distribute annual satisfaction questionnaires to all parties involved with our service.Through support from the quality assurance questionnaires, feedback from Regulation 26 meetings and six monthly reviews, we are able to review our year on year service user development. Extract from the providers Annual Quality Assurance Assessment (AQAA). The manager is very supportive. Shes been there every time to supervise me or advise me how to handle situations and explain to me those things I dont understand. Comment from a staff survey. Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: The manager is very good, she does all she can to support the staff. Comment from a member of staff. The homes manager told us that she had 12 years experience of working in social care services with young people and adults with a mental illness or learning disability. She had been the manager of the home for almost 5 years and had completed the Registered Managers Award. Staff who spoke with us during this visit were very positive about the managers leadership and support. The manager returned the Annual Quality Assurance Assessment (AQAA)when we asked for it in May 2009. The AQAA was well completed and gave us useful information about the home that we have used to inform this report. During this visit we saw that the provider had developed all of the policies and procedures needed to meet these Standards. The polices and procedures were up to date and regularly reviewed. Copies were available in the office for staff reference. We also checked a selection of care records kept in the home, including residents care plans, risk assessments and medication records. Standards of record keeping in the home were good. The manager told us that health and safety checks were carried out regularly by staff. We saw no health and safety issues during this visit. The manager told us that a manager from one of the companys other homes visited the home each month to review the day to day running of the service. The visits were unannounced and a written report with action points was sent to the home after each visit. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 29 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 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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