Care Home: Carricks Brook

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What the care home does well The home provides prospective residents with information about the home in both written and pictorial format which in the future will also be produced in audio and DVD form. Thorough pre-admission assessments are carried out and information gained from other professionals and relatives who know the resident. Prospective residents are expected to visit the home and meet with present residents and the staff before they make an informed choice about moving into the home. The staff in the home ensure that residents have one to one time spent with them using the communication methods best suited and preferred by the resident. From the information and preadmission assessment the initial care plan is formed, but through one to one with the resident, this is produced with a person centred approach ensuring that residents personal, health and social care needs are taken into consideration as well as their preferences, aspirations, likes and dislikes. There is good evidence within the home and through the residents weekly plan that supported by staff they are able to pursue education, hobbies and interests they have. Residents have good access to the community by taking part in both food and personal shopping trips, outings to places of interest, local pubs, cinemas, theatres, swimming pools and the bowling alley. The home as recently employed an activities co-ordinator, who is in the process of setting up the activities room in the home, so residents are able to follow activities and interests of their choice and participate in and learn about other activities that might interest them. Care plans show that resident`s select certain goals they would like to achieve to enable them to become more independent these are then followed up through monthly reviews. Evidence was available that residents personal hygiene care needs are met, with staff supporting residents to be independent and respecting residents privacy and dignity. Residents have support from staff to access external health care professionals as and when required. Residents are encourage to maintain contact with their families and friends. Evidence showed that some residents are able to visit their family, while other maintain contact via the telephone or computer. Meals in the home are good and meet the nutritional needs of the residents. Residents are able to choose food they like and are given choice at each meal. The open plan communal living area enables resident to choose where they sit to eat their meals. The complaints policy and procedure is freely available in the home. Staff understand the importance of supporting residents if they wish to make a complaint. Staff have received induction and training to help prevent residents being put at risk of abuse. The environment of the home provides residents with a warm, comfortable, well maintained home in which to live. All residents have their own bedrooms, with sitting area and en suite facilities. Communal space is of open plan design, with comfortable furniture that is simple in design. All rooms are decorated in neutral colours. On the day of the inspection the home was found to be clean and tidy throughout, with attention paid to infection control. The home has extensive grounds to the rear which will be further developed to fit in with residents interests and outdoor activities. Staffing levels at the present time meet the assessed needs of the residents and the registered manager is aware of the need to regularly monitor rotas to ensure that sufficient staff are on duty to meet the residents personal, health and social care needs. The registered manager has many years experience of working with Autism, she has the qualifications to manage the home effectively and understands the need to keep her skills and knowledge updated. The directors of the company support the manager in her role and ensure that they spend some time in the home on a weekly basis. The home has a good quality assurance system in place, that ensures all systems used in the home are monitored regularly. The registered manager is in the process of sending out questionnaires to relatives to obtain their views of the care provided. Key workers will work one to one with residents to obtain their views of the home. It is envisaged that at some time during this coming year a summary of findings from questionnaires and monitoring of systems will be published and will identify what the home does well and plans for improvements that will be made. Attention to fire, health and safety issues are robust ensuring the residents and staff are not placed at risk. What has improved since the last inspection? This is a new home that was opened in August 2009 and this is the first unannounced key inspection. What the care home could do better: When recruiting new staff the registered manager must ensure that the appropriate checks are carried out prior to employment taking place to help ensure that residents are not placed at risk of abuse. Further work needs to be done in ensuring that staff have the appropriate mandatory training, so that they can work safely with the residents and not place the residents or themselves at risk. Key inspection report Care homes for adults (18-65 years) Name: Address: Carricks Brook Carricks Brook Carricks Hill Dallington East Sussex TN21 9JL     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: June Davies     Date: 1 9 0 1 2 0 1 0 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 28 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 28 Information about the care home Name of care home: Address: Carricks Brook Carricks Brook Carricks Hill Dallington East Sussex TN21 9JL 01435883492 01435883369 carricksbrook@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Oakdown House Ltd Name of registered manager (if applicable) Mrs Tina Lorraine OCallaghan Type of registration: Number of places registered: care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: 1. The registered person may provide the following category/ies of service only : Care home only (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) 2. The maximum number of service users to be accommodated is: 10 Date of last inspection Brief description of the care home Carricks Brook is registered to provide care for 10 people with Autism. The home has been designed to ensure it meets the needs of many different individuals, with a large dining room spread out to ensure people can chose to sit with others or on their own, it has a main lounge and a lounge area in the dining room and a quiet room on the ground floor. Some of the bedrooms have a lounge attahed while other bedrooms are large and have a lounge area within them, one bedroom is a small flat comprising of a lounge, bedroom, bathroom and potential kitchen each bedroom has its own en suite Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 10 Brief description of the care home facility. There home is a main kitchen, seperate laundry and one communal bathroom. The large grounds are secure and are in the process of being developed to provide outside activities for the residents. The home is situated on the main Battle to Heathfield road, public transport is rather limited but buses will drop people outside the home, there are several railway stations only a few miles away. The home does have its own transport so that residents are able to get out into the community and have access to local towns, colleges and village activities. For the range of fees can be obtained from applicatin to the registered manager. Care Homes for Adults (18-65 years) Page 5 of 28 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: This key unannounced inspection was carried out on Tuesday 19th January 2010 over a period of six and half hours. Some information contained in this report was provided by the Annual Quality Assurance Assessment. Other evidence was gained on the day of the inspection by discussion with the manager, registered provider, observation and looking at documentation relating to the key standards inspected. One service user and to members of staff were spoken to. Care Homes for Adults (18-65 years) Page 6 of 28 What the care home does well: The home provides prospective residents with information about the home in both written and pictorial format which in the future will also be produced in audio and DVD form. Thorough pre-admission assessments are carried out and information gained from other professionals and relatives who know the resident. Prospective residents are expected to visit the home and meet with present residents and the staff before they make an informed choice about moving into the home. The staff in the home ensure that residents have one to one time spent with them using the communication methods best suited and preferred by the resident. From the information and preadmission assessment the initial care plan is formed, but through one to one with the resident, this is produced with a person centred approach ensuring that residents personal, health and social care needs are taken into consideration as well as their preferences, aspirations, likes and dislikes. There is good evidence within the home and through the residents weekly plan that supported by staff they are able to pursue education, hobbies and interests they have. Residents have good access to the community by taking part in both food and personal shopping trips, outings to places of interest, local pubs, cinemas, theatres, swimming pools and the bowling alley. The home as recently employed an activities co-ordinator, who is in the process of setting up the activities room in the home, so residents are able to follow activities and interests of their choice and participate in and learn about other activities that might interest them. Care plans show that residents select certain goals they would like to achieve to enable them to become more independent these are then followed up through monthly reviews. Evidence was available that residents personal hygiene care needs are met, with staff supporting residents to be independent and respecting residents privacy and dignity. Residents have support from staff to access external health care professionals as and when required. Residents are encourage to maintain contact with their families and friends. Evidence showed that some residents are able to visit their family, while other maintain contact via the telephone or computer. Meals in the home are good and meet the nutritional needs of the residents. Residents are able to choose food they like and are given choice at each meal. The open plan communal living area enables resident to choose where they sit to eat their meals. The complaints policy and procedure is freely available in the home. Staff understand the importance of supporting residents if they wish to make a complaint. Staff have received induction and training to help prevent residents being put at risk of abuse. The environment of the home provides residents with a warm, comfortable, well maintained home in which to live. All residents have their own bedrooms, with sitting area and en suite facilities. Communal space is of open plan design, with comfortable furniture that is simple in design. All rooms are decorated in neutral colours. On the day of the inspection the home was found to be clean and tidy throughout, with attention paid to infection control. The home has extensive grounds to the rear which will be further developed to fit in with residents interests and outdoor activities. Care Homes for Adults (18-65 years) Page 7 of 28 Staffing levels at the present time meet the assessed needs of the residents and the registered manager is aware of the need to regularly monitor rotas to ensure that sufficient staff are on duty to meet the residents personal, health and social care needs. The registered manager has many years experience of working with Autism, she has the qualifications to manage the home effectively and understands the need to keep her skills and knowledge updated. The directors of the company support the manager in her role and ensure that they spend some time in the home on a weekly basis. The home has a good quality assurance system in place, that ensures all systems used in the home are monitored regularly. The registered manager is in the process of sending out questionnaires to relatives to obtain their views of the care provided. Key workers will work one to one with residents to obtain their views of the home. It is envisaged that at some time during this coming year a summary of findings from questionnaires and monitoring of systems will be published and will identify what the home does well and plans for improvements that will be made. Attention to fire, health and safety issues are robust ensuring the residents and staff are not placed at risk. 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 order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 28 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 28 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. Prospective residents and their relatives are given detailed information about the home prior to moving in. Detailed evidence is obtained prior to a resident moving into the home so that the manager is able to assess if the home can meet the prospective residents needs. Evidence: The homes statement of purpose and service user guide are produced in written and picture format. The registered manager hopes that in the future these documents will also be produced in audio and on DVD, so that prospective residents are able to choose which format will enable them to make an informed choice about the home. The inspector viewed the pre-admission assessments for two residents, both gave very detailed information regarding all aspects of the residents health, personal and social care. It was also noted that the registered manager had obtained plans of care from the funding local authorities. These assessments are used to ensure that the staff team have the knowledge and skills to meet the prospective residents needs and Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: that the environment is suitable for their needs. The pre-admission assessment is also used to set up an initial plan of care. Prospective residents are able to visit the home prior to making the decision to move in, this can take the form of visiting for a few hours, a day or over a weekend. These visits enable the prospective resident to meet with other residents in the home and to meet with the staff. Care Homes for Adults (18-65 years) Page 11 of 28 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. Care plans are person centred and reflect the residents preferred choices and aspirations. Residents are supported by staff to make decisions in regard to their daily lives and care as well as general daily running of the home. Any risk to residents is recognised and clear guidelines recorded for staff to follow to ensure that the risk to residents is kept to a minimum. Evidence: Two care plans were viewed and there was sufficient evidence that residents are very involved in the drawing up of their care plans which showed a person centred approach to all aspects of the residents care. Care plans showed residents likes and dislikes, preferences, aspirations and goals. Each care plan is reviewed on a monthly basis in the presence of the resident and other interested parties who the resident wishes to be present, any changes in personal, health or social care are recorded. Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: Each residents is allocated a key worker, who spends one to one time interacting with the resident using the residents preferred method of communication. This enables residents to make choices in regard to their daily living, personal, health and social care, and the general running of the home. For important decisions an advocate would be used. In the main residents have asked the home to keep their personal money safe for them, but have access to this money when going out into the community for shopping trips, outings, visiting placed of interest. The manager prefers to look at risk assessments as keeping safe which is a more positive outlook for the residents. Keeping safe is individual to each resident and depends on their capabilities, lifestyle and care needs. Keeping safe needs are identified, and clear guidelines written up for staff to that the element of risk is kept to a minimum. For example one to one support when going out into the community and crossing busy roads. Care Homes for Adults (18-65 years) Page 13 of 28 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. Residents are able to choose their own activities and education this helps them to lead a meaningful social life. Meals in the home are prepared in accordance with residents choices while at the same time ensuring that they receive a nutritious and varied diet. Evidence: Evidence was available via the residents weekly planners that staff support residents to follow activities of their choice. For instance one resident attends college for a social skills course another resident works at a local stables and earns riding in return for the help. The registered manager has developed a good working relationship with a nearby college. As a result of this residents will be able to access a variety of college courses in the next year. Weekly planners showed that residents have regular access to the local community, by helping with weekly shopping, visiting local towns for Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: personal shopping, visiting local pubs, cinemas, theatres, swimming pool and attending local church services. The home has its own transport but residents can have access to the local bus service and there are nearby train stations. Three residents are supported by staff on one to one basis when going out into the community. The home has just appointed an activity co-ordinator, who is in the process of setting up the activities room in the home, so that residents can follow activities of their choice and try new activities if they wish to. The activities room has a computer and residents have access to the internet. Residents are supported by staff to maintain links with family and friends. Residents are supported by staff to spend occassional weekends away with their family, maintain close telephone contact with their family or access their friends via the internet. Each residents care plan identifies the residents choice of lifestyle going to bed and getting up in the morning. Residents have access to the external grounds of the home at all times and in accordance with their keeping safe assessment this would depend on if this is on a staff support basis or on their own. Staff were observed during the inspection to be respecting the privacy and dignity of the residents and ensuring that they knocked on residents doors before entering and ensuring that while personal hygiene tasks were carried out residents bedroom doors were shut. The menus in the home have been developed in consultation with the residents and take into account the residents food likes and dislikes. One resident has developed their own menu due to their food preferences. All residents are offered three meals a day, with choices at each meal. The residents are able to choose where they eat and provision has been made for those residents who do not wish to sit in the main dining area with other residents. The home would be able to cater for specialised diets if and when required. Care Homes for Adults (18-65 years) Page 15 of 28 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. Staff support resident to maintain their personal hygiene and health care needs. Medication in the home is generally well managed and this helps to ensure that residents are not placed at risk from medication errors. Evidence: Care plans showed that staff are given clear guidelines as to individual residents needs required in maintaining their personal hygiene in relation to bathing/showering, oral care, shaving, hair care. Daily routines are shown to be flexible while at the same time fitting in with individual residents weekly planner. There is good evidence that residents have access to a range of external health care professionals, to ensure that all aspects of health care are met. In most cases residents are supported by staff to visit external health care professionals. There is also evidence that when required health care professionals will visit the home. Staff ensure that residents have access to health care professionals as and when required. There are clear pain guidelines for staff so they can be aware of a resident who is experiencing pain and how they will manifest this into their behaviour. Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: Medication in the home is generally well managed by staff who have received medication training. Both medication and staff administering medication are regularly monitored. Monthly administration records had been completed appropriately when medication has been administered. There were some gaps of when medication was received, the amount and who had checked the medication into the home and this was discussed with the registered manager. Controlled drugs are stored appropriately in the home and the controlled drugs register was in order. The registered manager is also aware of keeping records of medication leaving the home when residents are visiting their families, and she will insure that in future medication leaving and being brought back into the home is recorded. There are good clear policies and procedures in place for the receipt, storage, administration and return of unused medication as well as the management of controlled drugs. A separate policy and procedure has been written for the use of homely remedies. Regular recorded temperatures are taken of the medication fridge. Discussion took place with the registered manager in respect of external and internal medications being stored together and the risk of contamination, this will be looked into and a remedy put in place to ensure that topical medicines are kept separate from oral medication. Care Homes for Adults (18-65 years) Page 17 of 28 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. Residents are made aware of the complaints procedure and will be supported by staff to make a complaint should they feel the need to. The home has good policies/procedures and staff training in place to help protect residents from abuse. Evidence: The home has a simple but explicit complaint policy and procedure that is included in the statement of purpose and service user guide and displayed in the home. It is produced in written and picture format. The home considers that complaints made will only help them to improve the service that they offer to their residents. Staff are made aware of the complaints policy and procedure on induction. A complaints, concerns, comments form has been drawn up for staff to use. The registered manager has a complaints file in her office, this showed that one complaint has been received in the last six months. This complaint was appropriately recorded, investigated and appropriate feedback given to the complainant within the timescales set out on the policy and procedure. The home places zero tolerance on any form of abuse it has detailed but clear guidelines for staff in the form of policies and procedures. Staff are expected to read these policies and procedures with the manager during their induction into the home. Nine staff have received safeguarding vulnerable adults training with a further five Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: staff to attend training booked in February 2010. All staff have received NAPPA training and instances of restraint are kept to a minimum through good behavioural guidelines charts. At the present time there is one safeguarding referral that has been made to the Community Learning Disability Team, which is in the process of being investigated. Care Homes for Adults (18-65 years) Page 19 of 28 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. Carricks Brook provides its residents with a comfortable, safe and secure home in which to live. Infection control procedures are adhered to, but further improvements could be made to the training of staff to ensure that residents are not placed at risk. Evidence: Prior to opening this home had been completely refurbished and redecorated. Decorations are neutral in colour to fit in with the residents. All communal areas offer residents a warm and homely place to relax. Residents bedrooms all have en-suite facilities which include walk in showers or wet room, the majority of bedrooms are spacious and allow for integral sitting areas. There is one flat attached to the home that provides a bedroom, sitting room, bathroom and toilet and the possibility of using another area as a small kitchen. At the rear of the home there is a very large outdoor space for residents to enjoy and which in the future will be developed in accordance with the residents outdoor activities and interests. Throughout the home provides a well maintained and comfortable home for the residents live in. The home has its own seperate laundry situated on the first floor in the older part of the building. The laundry has an industrial washing machine and tumble drier, there is Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: also a small domestic washing machine for one resident who prefers to do their own washing, with washing powder of their choice. The laundry room, communal bathroom and staff toilet are all provided with liquid soap and paper handtowels. Cleaning materials are kept locked in a COSHH cupboard. Staff are supplied with disposable aprons and gloves that they use for clearing spillages and clinical waste. Infection control policies and procedures are adhered to. Three staff have received infection control training and further training in this area is planned to ensure that all staff have received this training so that residents are not placed at risk of cross infection. Care Homes for Adults (18-65 years) Page 21 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At the present time staffing levels within the home meet the assessed personal, health and social care needs of the residents. Further work needs to be done to ensure that staff have the qualifications, skills and knowledge to meet the residents needs in a safe and professional manner. Recruitment processes are robust, but further improvements can be made to ensure that all new staff are appropriately vetted prior to being deployed to work in the home so that residents are not placed at risk of abuse. Evidence: From viewing staff rotas, information given in the AQAA and discussion with the registered manager, there is good evidence that at the present time care and ancillary staff are employed in sufficient numbers to meet the resident personal, health and social care needs. The registered manager is very aware of arranging staff rotas to meet residents needs. Two bank staff are retained to cover for emergencies. Since receiving the AQAA staffing levels have increased in the home but this has brought the percentage of staff with NVQ level 2 in Social Care down so at the present time only 46 percent of the staff have achieved this qualification. The registered manager is actively seeking a training agency so that more staff can gain this qualification. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: The inspector viewed three staff files and found that generally the home operates a robust employment procedure, but it was noted that ISA Adult First checks had been received after the new employee had started work in the home. This matter was discussed with the registered provider and registered manager, who will ensure in future that prospective employees have the appropriate checks carried out prior to taking up employment in the home. All new staff complete an initial induction, as well as Skills for Care induction and are also expected to complete a two day training course in Autism Focus and a two day NAPPI (Non-abusive psychological and physical intervention) course. Throughout the first weeks of employment new staff are mentored and supervised and work alongside experience members of staff. From information contained withing the AQAA, from the training matrix within the home and discussion with the registered manager, the inspector found that some areas of mandatory training were lacking. The registered manager recognises that while she has booked some mandatory training courses to ensure staff do receive this training, she will be using the services of staff from Oakdown House the sister home, who have obtained train the trainer qualifications in some mandatory areas to ensure that all staff have obtained this training. Care Homes for Adults (18-65 years) Page 23 of 28 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 registered manager has the skills, experience and qualifications to manage the home and ensure that residents experience a good quality of life. The quality assurance system in the home is very good, with regular monitoring of systems used in the home, seeking the views of residents and relatives, listening to staff suggestions and ideas to ensure that residents receive a high quality of care. Health and safety procedures in the home are good and help to ensure that residents live and staff work in an environment that does not place them at risk. Evidence: The registered manager has many years experience of working in care homes and has spent the last 8 years working with Autism and Challenging Behaviour. She has obtained her NVQ level 4 in Social Care and Leadership and Management as well as being a qualified trainer in Infection Control, Safeguarding Vulnerable Adults, Health and Safety,Autism Awareness and Person Centred Awareness. A Deputy Manager has recently been appointed from one of the senior team within the home and will be Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: taking up this position in February 2010, he will be doing his Leadership and Management qualification. The registered manager is well supported by the Directors of Oakdown House Limited. She has an open door approach to management where residents and staff know they can speak to her at any time she is on duty. The home operates a good quality assurance system, residents are regularly surveyed in regard to outings they have participated in. The registered manager is about to send out quality assurance surveys to residents (in picture format) and relatives. She is going to produce a stakeholder survey to seek the views of professionals who visit the home. All systems used in the home are regularly monitored - this includes medications, daily records, care plans, fire drills etc. Weekly meetings are held with the staff team and takes on board their ideas and suggestions that will help to improve the quality of care provided in the home. The whole ethos of the home is to provide equality, diversity and person centred planning. The preferred provider carries out recorded Regulation 26 visits. From evidence supplied the Regulation 26 visit forms, reports are very detailed and outline where areas of improvement are to be made. Regular fire, health and safety assessments are carried out. Staff are tested for competency after receiving training. Within the next year, the registered manager intends to produce a summary of the findings from quality assurance surveys and monitoring outlining improvements that needs to be made and what the home does well. Health and safety within the home is of high importance and regular recorded checks are carried out of the fire call bell system, emergency lighting and hot water delivery temperatures. Where bedrooms have not been used, water systems are regularly flushed through to help prevent Legionella. All appliances used in the home have up to date maintenance certificates. Incidences of residents accidents are appropriately recorded, and the registered manager monitors each form to ensure that safety assessments do not need changing, and to alert her to residents needing further assessments from health care professionals. Care Homes for Adults (18-65 years) Page 25 of 28 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 26 of 28 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 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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