Care Home: Casa Mia

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What the care home does well The atmosphere within the home is relaxed and friendly. People living at the home appeared to be `at home` and happy to engage in conversation with the staff. Staff were seen to be friendly caring and supportive to people. Conversations heard were open and positive between staff and residents. The computerised care planning has continued to develop. Any additions to the software are taken on board and actioned in order to provide additional guidance for staff in order that they are able to meet care needs. Staff were happy to be using the computer to record care plans and daily records and spoke about the training they had received. Health care needs are known to staff and early intervention takes place to ensure people`s health and well being. People serve themselves where possible at meal times and are happy with the quality and variety of food made available. The patio and garden area to the rear of the home is extensive and well planned. A decked area with a hot tub is available to people. Within the surveys returned to us we were told when we asked what the home does well: `Food is lovely, sitting outside in the summer, good choices, lots of activities.` `It feels like home. Relaxed and friendly. Nice open views from conservatory.` `The home is always clean and warm. Very homely. The food is home made with a very good choice. The staff are all so helpful.` `excellent overall care.` What has improved since the last inspection? Since our last inspection a draft Service User`s Guide has been prepared. This document may assist people decide whether Casa Mia is suitable to meet their care needs has not existed. What the care home could do better: In order to maintain the current stand of provision and develop further training needs to continue and extended to ensure that staff have the skills and knowledge they need to meet identified care needs. Procedures regarding staff recruitment need to be reviewed to ensure they are sufficiently robust to safeguard people from unsuitable people gaining employment. Improvements in the management of some health and safety checks will ensure that people are safeguarded from potential risks in the home`s environment. Key inspection report Care homes for adults (18-65 years) Name: Address: Casa Mia Cleobury Road Far Forest Near Kidderminster Worcestershire DY14 9EH     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: Andrew Spearing-Brown     Date: 0 8 0 2 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 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Casa Mia Cleobury Road Far Forest Near Kidderminster Worcestershire DY14 9EH 01299266317 01299266406 martin@casa-mia.org.uk www.casa-mia.org.uk Mr Martin James Winfield,Mrs Michelle Dawn Winfield Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Martin James Winfield Type of registration: Number of places registered: care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 15. The registered person may provide the following category of service only: Care Home Only (Code PC) the service users of the following gender: Either Whose Primary care needs on admission to the home are within the following categories: Mental Disorder (MD) 15 Learning Disability (LD) 15 Date of last inspection Brief description of the care home Casa Mia is a detached building situated in a rural area of Far Forest. The home has been extended and adapted in order to provide accommodation for a maximum of 15 people who may have either a Learning Disability or Mental Disorder as their primary Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 0 15 15 2 3 0 2 2 0 0 9 Brief description of the care home need upon admission. The minimum age for admission is 50 years. The home is set back from the road and provides car parking at the front of the premises and a patio and an attractive garden at the rear. Thirteen of the service users are accommodated on the ground floor and two service users are accommodated on the first floor. There is one shared bedroom. A portable ramp provides access at the front entrance for good access and a ramp provides access to the rear garden. There is no mechanical means of access to the two bedrooms on the first floor. For up to date information regarding the fees charged the reader should contact the service directly. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection at Casa Mia was carried out during February 2009. This inspection took place over a period of two days and was carried out by one inspector. Nobody within the service knew we were going to visit. The focus of our inspection is upon the outcomes for people who live in the care home. It includes, where possible, the views of people using the service. The process we use considers the care homes capacity to meet regulatory requirements, standards of practice and looks at aspects of the service that need further development. Prior to the visit we looked at the information that we have received since our last inspection. This information included the Annual Quality Assurance Assessment (AQAA). The AQAA is a document completed by the home and provides us with information about the home and how they believe they are meeting the needs of people living there. We also sent questionnaires to people living in the home and their Care Homes for Adults (18-65 years) Page 6 of 30 representatives. We also sent questionnaires to some members of staff and health and social care professionals. We looked around the home. We viewed records, many of which were held on computer, in relation to some people such as care records and risk assessments. We also looked at medication records, records relating to some members of staff and health and safety. 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: 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. Care Homes for Adults (18-65 years) Page 8 of 30 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Revised information is available to help people make a choice as to whether they would like to live at Casa Mia. The service is aware that an assessment needs to be carried out prior to a new resident moving into the home to ensure that identified care needs can be met. Evidence: Our report following the inspection in February 2009 stated that the home had a Statement of Purpose and a Service Users Guide. We concluded,within that earlier report, that the guide needed to be revisited and made more user-friendly. Furthermore, we suggested that the guide could possibly be pictorial to allow people considering admission an easy but informative document to read. Having this information can help in assessing the suitability of the home regarding the meeting of care needs. As part of this inspection we were given a copy of a draft Service Users Guide. This was completed in advance of current work taking place to increase the number of registered places. At the time of this inspection the changes to the building were not Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: complete. The previous inspection took place shortly after two people were admitted to Casa Mia. We reported on that occasion upon the process and found that the homes pre admission assessment was carried out. No further admissions have taken place over the last 12 months. The registered manager assured us that a contract or statement of terms and conditions is in place for everybody using the service. We did not view any of these documents as part of this inspection. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service have care plans which are up to date reflecting current care needs. People are supported to make choices about their day to day lives. Evidence: Within our last report we wrote about a newly introduced computerised care planning system. We concluded at that time that staff had received training on an extremely user-friendly and easy to operate system. It is evident that a considerable amount of time was spent setting up the new system. Any shortfalls identified by staff are addressed by the provider of the software. During this visit we were told that ways of improving the system further are on going. We looked over a number of care plans and found them to be detailed and to provided good information within a number of sections to guide staff regarding how to meet individual care needs. During this inspection we found that the system is currently not able to search for complaints or concerns. The manager stated that he would ensure that such a facility was made available. Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: A new office is now available for staff to use the computer.We found the system to be secure with each member of staff having an individual password. Paper documents were also found to be secure. The AQAA states The service users are involved in making decisions in the environment in which they live It also stated that within the service users plan people are encouraged in decision making and that risk assessments allow for risk taking. We saw greater empowerment and decision making in place during this inspection than we have reported previously. People are encouraged to serve themselves at meal times and we saw people taking part in daily living routines. 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 using the service are able to participate in community and in house activities which are appropriate to each individual. People enjoy a choice of food provided for them. Evidence: The service has a key worker system in place which assists in developing close relationships with people and an opportunity to gain knowledge of individual needs. This can also therefore include looking at peoples aspirations and goals. One person had just commenced a work placement on the day we visited the home. Within the AQAA the manager stated that the service would like to promote and support more outside community participation and activities. People told us on the surveys that they are usually able to make decisions about what they do each day. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: A range of in house activities are available. These activities include dominoes, crafts such as painting and making things like cakes for wild birds. People are also encouraged to participate in daily living tasks such as setting the tables, getting logs for the fire and collecting eggs from chickens in the garden. External activities are also provided. The village has a local shop which is nearby and some people visit independently while others join staff when they pop out to get something. Visits take place to the cinema. People have in the past had a holiday or a short break and some of the residents told us about these. Within the AQAA we were told that the service respects everybodys individuality and any spiritual /cultural needs. We did not see any visitors during this inspection. The AQAA states that visitors are allowed at any time. People using the service are very satisfied with the meals provided. Since our last inspection the home has introduced a self service system whereby people are invited to come and help themselves from hot plates. The menu was on display. The main meal was honey and mustard roast gammon served with new potatoes, rosemary roast potatoes with cauliflower and leek cheese or seafood spaghetti or salad. Drinks and snacks including fresh fruit are available throughout the day. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health care needs are known and met. There is a safe system in place regarding peoples medication to ensure well-being and protection of people using the service. Evidence: Records regarding health care needs are held on the computerised system. It was possible to filter notes in order that we could read them in chronological order. Health care needs are being met by a range of health care professionals including visiting district nurses. People using the service also receives services from other professionals such as dentists, opticians, community psychiatric nurses and GPs. The AQAA stated that the service assists people to attain their health care checks by providing transport to and from local surgeries and hospitals. The service has recently changed its registration status and now supports more younger people with mental health needs. We were told that staff have received training regarding a certain diagnosed condition. Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: Throughout our inspection we saw staff caring for people with dignity. People were able to confirm that staff are kind to them. People were observed to be well cared for by the staff on duty. Within the AQAA we were assured that people using the service are able to choose when they get up and go to bed. The AQAA stated that the service maintains same gender care when dealing with intimate care and where appropriate make sure client is happy with the care assistants dealing with them and record in their care plan if they specifically do not want opposite gender care. During the inspection we discussed, with the manager, our observation that at times both the wakeful and sleeping in person are male. We were informed that this arrangement had not brought about any concerns to date. As part of this inspection we assessed the management of medication. We were informed that nobody was self administering medication therefore staff are administering medicines to people. We viewed the current months MAR (Medication Administration Record) sheets. We found the vast majority of them to be completed satisfactorily. We carried out some audits of some medication held outside of the monitored dosage system. The vast majority of these audits balanced although on a couple of occasions we found a small deficit in the number of tablets remaining. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are aware of how to make a complaint and they are confident that their concerns would be listened to. Staff have received training on safeguarding procedures and are aware of their responsibilities. Evidence: Within the AQAA we were told that the service had received 6 complaints during the last year. We requested the records regarding these complaints. The manager told us that he had filled in the AQAA incorrectly and that the service had not received any complaints during the last 12 months. The last recorded complaint was dated prior to our last inspection, although this information does not appear to have been available at that time. We have not received any complaints or concerns about the service provided at Casa Mia since our last inspection.The computerised records were not able to be filtered to find any reference to complaints. The registered manager undertook to discuss this matter with the software provider in order to get this facility added. A detailed complaints procedure was seen displayed around the home. The procedure states that the service sees complaints as an opportunity to identify anything that is going wrong in our organization and to make it right. You can help us by keeping a look out for any problems and letting us know about them as soon as possible. Your comments and suggestions for improvements are always welcome. The procedure informs people that they are able to contact the Care Quality Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: Commission directly and gives our address. This should be revised to show our address in Newcastle rather than Birmingham. The procedure also gives the managers mobile telephone number so that people are able to contact him directly. On our survey the vast majority of people told us that they are aware of how to make a complaint. This was confirmed during our visit. People were confident that any concerns they may have would be listened to and actioned. Information was also available within the home regarding safeguarding and the action people should take in the event of them having concerns about adult protection. We previously reported that the home did not have a copy of the Worcestershire safeguarding procedures available for staff to refer to. This guidance is now available to everybody on the homes computer. During this inspection staff confirmed that they had received training on safeguarding and they were able to tell us what constitutes abuse. Staff could also tell us about the action they would take in the event of them becoming aware of actual or potential abuse taking place within the home. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable and generally well maintained environment. Evidence: Within our previous report we highlighted a range of improvements which have taken place within the home. We reported that planning permission was being sought to link Casa Mia with the adjoining property. Since that inspection, work has commenced and was well underway at the time of this inspection. The home will, once registered, increase the number of places available as well as increase communal space and facilities provided. Some of these planned changes were highlighted within the AQAA such as having no double bedrooms, additional lounge and dining areas and having a gym. Some parts of the home remain in need of improvement. Improvement to the standard of bedrooms and the bathroom on the first floor and one of the bathrooms on the ground floor are included within phase two of the current plans. These areas of the home appeared particularly tired. These improvements are due to be actioned after above changes in registration are approved. We were informed that some new windows had been fitted to some rooms, including a bedroom on the first floor. This window could be fully opened as it had no means of restriction to prevent accidental or deliberate falling to the ground. The registered manager took immediate action to Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: address this potential health and safety concern. Casa Mia has a lounge area where people were seen to be relaxing watching television. The room has an open fire which added to the homely feel. We were told that the light fittings in this area were recently removed therefore accounting for why bulbs were hanging without any shades. People are able to dine either within a dining area or the conservatory. Both of these areas are off the main lounge area. A double bedroom at the front of the house was prior to our previous inspection converted into 2 single bedrooms. We saw one of these rooms, the occupant of which told us that he was happy with his room. The home was clean and free from any odours throughout. The rear garden at Casa Mia is spacious, well planned and private. It provides a large area where people can sit or walk around. Despite the time of year and the exceptionally bad weather, the garden appeared well maintained. A large hot tub is available on a decked patio area. Some residents told us that they had used this facility and we saw a number of photographs showing people using it. Garden furniture is provided on the decked patio should people wish to use it. Signage is on display to warn people that the decking may be slippery at times. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Training is provided to ensure that staff have the necessary skills and knowledge to enable them to fulfill their duties. Some improvement is needed in the recruitment process to ensure that staff appointed are suitable. Evidence: Throughout our inspection the staff on duty were observed to give support to people with warmth, friendliness and patience. People living in the home were treated with respect. During the waking day at least two carers are on duty. The rota showed that at peak times the home often has three carers in order to provide additional support for people. The night shift is covered by one member of staff awake with a senior member of staff sleeping in and on call. We noticed that at times both members of staff are male. We were informed that nobody had raised any concern regarding the lack of a female member of staff within the home. This should however be monitored to ensure that people remain comfortable with this arrangement. Staff training has taken place since our last inspection. Details of training were included within the AQAA as well as upon a training matrix within the office. The majority of staff, other than those most recently recruited, have received training in Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: the Mental Capacity Act, safeguarding, and schizophrenia. The manager is aware that during the current year training is needed in areas such as manual handling, infection control, coping with aggression and dementia. We were told that training is already planned in relation to first aid and recording skills. Out of 14 carers a total of 11 hold a NVQ (National Vocational Qualification). This number of qualified staff exceeds the National Minimum Standard. We were told that only the most recently appointed members of staff have not completed this training. We were also informed that the vast majority of staff have attended the Learning Disability Qualification (LDQ). The most recently appointed staff are currently undertaking their LDQ. We were informed that once they have completed the LDQ they will commence their NVQ. One member of staff wrote on a survey returned to us Since starting here been extremely well trained in all aspects of my job. Having a well trained staff team ensures they have the knowledge available to them in order to meet the needs of people living in the home. We looked at the records of two recently appointed members of staff. These records showed that a Criminal Records Bureau (CRB) check was carried out to ensure that people are suitable to work with people using the service. One member of staff confirmed that she did not commence duties at the home until her CRB check had arrived and that she then had shadowed staff for a while. On one of these files we saw one written reference, this however was not dated by the person who wrote it and there was no indication as to when it was received back at the home. A second written reference was not obtained although a verbal one was sought by the manager. The notes from the discussion were not dated. Recruitment procedures do therefore need to be improved to ensure that they are robust enough to prevent unsuitable people gaining employment within the care home. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is actively involved in the day to day running of the home and is keen to make further improvements. Some areas around health and safety need to be better recorded to ensure any shortfalls are picked up and addressed. Evidence: The qualifications held by the registered manager are included within the draft Service Users Guide. These are an NVQ (National Vocational Qualification) level 4 in Health and Social Care, the RMA (Registered Managers Award) and a level 3 LDQ (Learning Disability Qualification. A training matrix was on display within the office. Although the registered manager was included upon the matrix it did not show details of other training he had undertaken. We were told that this would be addressed and up dated. We previously reported that the manager has a hands on role in the daily running of the home giving direct support and care to people who live there. During this visit it was noted that this finding continues to be the case. When we arrived for the second part of this inspection the manager was out with a resident. Throughout the inspection residents spoke highly of the manager. Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: Our previous report highlighted that the manager planned to resume feedback forms to obtain the views of people using the service. We wrote within our last report that these views should be included within the Service Users Guide. As mentioned earlier within this report we saw a draft copy of a revised guide which included comments and views of current residents. We saw some surveys completed by residents relatives. Comments seen included food really good and first class home. Although the findings were not collated there was evidence of action taken regarding any comments made such as making information about social events more available. Within the AQAA the manager wrote Client meetings include agendas to promote open and transparent discussion. During this inspection minutes of these meetings were available. We viewed the fire records held on the computer. These were not always clear and need to be improved to ensure that they are accurate and up to date. The records showed that for a while the alarm was not tested on a weekly basis as needed due to the lack of a key. We were unable to find records regarding any monthly visual checking of fire fighting equipment. Records regarding water temperatures did not exist. We were informed that thermostatic valves are fitted to hot water supplies however, as these are not fail safe, routine checks should take place. We saw some pipe work feeding radiators in a corridor. The pipes were very hot to touch and therefore could pose a risk in the event of somebody falling against them. We asked whether they were risk assessed. As a result we briefly viewed risk assessments regarding the environment. Although these assessments were reviewed during December 2009. We did not find any assessment regarding the pipework. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 34 19 Regulation 19 (1) (b) All relevant information and documents as required by Regulation 19 (1) (b) and paragraphs 1-9 inclusive of Schedule 2 of The Care Homes Regulations 2001 must be obtained prior to staff commencing employment. This is so that people can be confident that only suitable staff are employed at the home. 01/05/2010 2 41 13 Regulation 13 (4) Systems must be in place to ensure that all parts of the home are free from hazards. To ensure the health and safety of people using the service. 03/05/2010 Care Homes for Adults (18-65 years) Page 28 of 30 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 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. Care Homes for Adults (18-65 years) Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!