Care Home: Cedarfoss House

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What the care home does well Care plans are a thorough record of a person`s capabilities and the support needed from staff and others to enable people to live their life to an optimum level. A new format is being introduced for care plans that will further improve the quality of the information held about individuals and record keeping. We observed that the health care needs of people are met and that this includes arranging specialist assessments for people when areas of concern are identified. We observed good rapport between the people living at the home and staff. Staff were encouraging and supportive with people, and decision making and responsible risk taking is supported. There is now an activities coordinator working at the home and we saw that people are spending more time taking part in social activities, both inside and outside of the home. People told us that they like the food provided by the home and we saw that there is a choice of meal at each mealtime. The home is maintained in a clean and hygienic condition and we observed that staff follow good hygiene practices. The home is well managed; this includes good systems to monitor the quality of the service being provided and health and safety systems that protect the well-being of the people living and working at the home. What has improved since the last inspection? Care plans are reviewed and updated on a regular basis and now include appropriate risk assessments that are based on the needs of the individual concerned. Medication is now stored safely and securely. Recording on medication administration records is accurate and there are sample signatures in place to enable records to be checked for authenticity and accuracy. Staff have had appropriate training on the administration of medication. The complaints log now includes the outcome of any investigation that has taken place. Some furniture has been replaced in living areas and there is a new carpet in the hall, stairs, landing and corridor areas. Some areas of the home have been redecorated; this has upgraded the premises and added to the homely feel of the home. People living at the home are now involved in the recruitment process and are able to express their views on whether the applicant is suitable for the post they have applied for. Staff now have induction training and on-going training that equips them to meet the needs of the people living at the home.People are protected from the risk of burning by the provision of covers that have been fitted over all radiators. A new manager has been appointed and she is in the process of applying to the Care Quality Commission for registration. What the care home could do better: New dining tables would add to the homely feel of the home. Any handwritten entries on medication administration records should be signed by two members of staff to ensure accuracy. The registered provider should record their unannounced visits to the home each month to evidence that the quality of the service provided is being monitored. The manager should continue with their plans for training in order to achieve qualifications at National Vocational Qualification (NVQ) Level 4. Protection of Vulnerable Adults (POVA) first checks should only be used to confirm a person`s suitability for the post they have applied for in exceptional circumstances, not routinely. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Cedarfoss House 55 Hull Road Withernsea East Riding Of Yorks HU19 2EE     The quality rating for this care home is:   two star good 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: Diane Wilkinson     Date: 0 5 0 6 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 28 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 28 Information about the care home Name of care home: Address: Cedarfoss House 55 Hull Road Withernsea East Riding Of Yorks HU19 2EE 01964614942 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : gaynor.saunders@willerfosshomes.co.uk Willerfoss Homes care home 16 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: Date of last inspection Brief description of the care home 16 Cedarfoss House is a privately owned care home that is situated in the seaside town of Withernsea, in East Yorkshire. The home is registered to provide care and accommodation for sixteen adults aged 18 - 65 years who have a learning disability. Accommodation is provided on two floors; private accommodation is situated on both floors and consists of six single bedrooms and five shared bedrooms. Communal accommodation is on the ground floor and consists of two lounges, a dining room and a conservatory. People using the service also have the benefit of a garden and patio area. The home does not have a passenger or stair lift to the first floor therefore people with a physical disability are accommodated on the ground floor. People have access to a range of local shops, services, transport and to the sea front. Details of the service provided by the home are available in the homes statement of purpose and service users guide; these are available from the manager. Care Homes for Adults (18-65 years) Page 4 of 28 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 inspection report is based on information received by the Care Quality Commission since the last Key Inspection of the home on the 9th June 2008, including information gathered during a site visit to the home. The unannounced site visit was undertaken by one inspector over one day. It began at 10.00 am and ended at 4.30 pm. On the day of the site visit the inspector spoke to people living at the home, to members of staff and to the manager. Inspection of the premises and close examination of a range of documentation, including two care plans, were also undertaken. The manager submitted information about the service prior to the site visit by completing and returning an Annual Quality Assurance Assessment (AQAA) form. The AQAA is a selfassessment that focuses on how well outcomes are being met for people using the service. Care Homes for Adults (18-65 years) Page 6 of 28 As part of the inspecton process we sent survey forms to some of the people living at the home, members of staff and health and social care professionals; six were returned by people living at the home and one was returned by a health and social care professional. Responses in surveys and comments from discussions with people were mainly positive, for example, I like living at Cedarfoss House and the home has a very homely feel. Other anonymised comments are included throughout the report. The manager told us that the current accommodation fee is £375.00 per week. At the end of this site visit, feedback was given to the manager on our findings, including recommendations that would be made in the key inspection report. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? Care plans are reviewed and updated on a regular basis and now include appropriate risk assessments that are based on the needs of the individual concerned. Medication is now stored safely and securely. Recording on medication administration records is accurate and there are sample signatures in place to enable records to be checked for authenticity and accuracy. Staff have had appropriate training on the administration of medication. The complaints log now includes the outcome of any investigation that has taken place. Some furniture has been replaced in living areas and there is a new carpet in the hall, stairs, landing and corridor areas. Some areas of the home have been redecorated; this has upgraded the premises and added to the homely feel of the home. People living at the home are now involved in the recruitment process and are able to express their views on whether the applicant is suitable for the post they have applied for. Staff now have induction training and on-going training that equips them to meet the needs of the people living at the home. Care Homes for Adults (18-65 years) Page 8 of 28 People are protected from the risk of burning by the provision of covers that have been fitted over all radiators. A new manager has been appointed and she is in the process of applying to the Care Quality Commission for registration. 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. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 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 10 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. People have an up to date needs assessment in place that is used to develop an individual plan of care. Evidence: There have been no new admissions to the home since the last key inspection. However, we noted that all assessments and care plans for people currently living at the home have been updated; this includes risk assessments. Areas included in the assessment are mobility/manual dexterity, perception and sensory ability, communication skills, life skills aleady acquired, social interaction, community and leisure skills, work/social skills, medication and health. There is a community care assessment and care plan in place from the local authority that funds the placement at the home and we noted that some of these had also been updated. 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. People have an individual person centred plan in place that includes information about decision making and risk taking, as well as appropriate risk assessments. Evidence: Individual care plans have been developed that are based on the updated care needs assessment undertaken by the home and community care assessments and care plans received from care management. These care plans are agreed by the person concerned whenever this is possible and we noted that a photograph of the person is displayed at the front of each care plan. The home has arranged a formal review of care plans for everyone living at the home and in some instances the local authority has also undertaken a formal annual review. This means that people have a care needs review approximately every six months and this results in up to date information being available for staff. People have been invited to attend these reviews along with their key worker and relatives, where appropriate. We saw that care plans included information about any restrictions on choice or freedom and establishes Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: individual procedures for people that may display inappropriate behaviour. The manager told us that care staff have had training on person centred care and this is reflected in the new care plans under development. We noted that care plans include information about a persons ability to make decisions about their day to day lives and on the day of the site visit we saw that people are supported to make decisions and take responsible risks. The manager told us that everyone has a purse or wallet where they keep money for day to day spending, but most people have asked for this to be kept in safe keeping for them. However, we observed that people asked for their purse or wallet as needed. For example, on the day of the site visit one person asked for their money so that they could go out on their own to buy an ice-cream. One person living at the home belongs to a Speak Up group organised by Mencap where they are encouraged to express their views about their lifestyle, service provision etc. and the same person has been allocated an advocate from Mencap, who takes them out and assists them with decision making. There are general risk assessments in place but care plans also include more specific risk assessments individual to the person concerned, such as accessing the community, eating and drinking, epilepsy and baking in the kitchen. We noted that each area of the care needs assessment/care plan has an accompanying risk assessment - some of these record the level of risk i.e. low, medium or high and others record possible gains or losses associated with risk taking. 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. People are encouraged and supported to take part in leisure activities within the home and the local community, and to keep in contact with family and friends; key workers support this process. Meal provision at the home is good and is based on the health care needs of people and their preferred choices. Evidence: Most of the people living at the home are now over retirement age so their social time is spend undertaking leisure pursuits rather than educational pursuits. One person attends an Adult Education Centre to take part in craft activities and two people attend a local day centre, where they take part in social activities. One person told us in a survey, I like living at Cedarfoss House. One person uses public transport when they go to stay with their mum on alternate weekends and the home has a mini bus that is used to take people on trips out. We Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: saw the minutes of an activities meeting held with the people living at the home and they were asked to make suggestions about where they would like to visit - we noted that people had recently visited The Deep. On the day of the site visit one person went out with their key worker to shop for new clothes, and another person went out on their own to buy an ice cream. Some people took part in a kareoke session with staff; this took place in the dining room so that people that did not want to take part could remain in one of the lounges either watching TV or listening to music. Two people are going to have a holiday in a caravan over a long weekend accompanied by staff; they were very keen to tell us about their planned holiday and were looking forward to going away. Any trips out are undertaken in small groups to places chosen by people living at the home, such at The Deep, Hornsea Freeport and Hull. Care plans evidence that people are supported to remain in contact with family and friends and people told us that staff help them with reading letters from family and making telephone calls to family. Care plans also include information about a persons responsibility for house keeping tasks, such as keeping their bedroom tidy and setting tables. Some people like to help with gardening and one person had assisted the handyman to fill planters in the garden. People told us that they like the meals at the home. There is a weekly menu in operation and this is based on the weather, any outings planned for the week and peoples likes and suggestions. The menu is displayed and we heard several people ask staff about the meals to be provided that day. Everyone told us that there is a choice of meal at every mealtime and we saw that there were two choices on offer on the day of the site visit. We noted that staff made efforts to tempt people with different foods when they did not eat what they had been given. The manager told us that two people are on low fat diets due to high cholesterol levels; we saw that this was recorded in their care plans. In addition to this, four people are on liquidised diets due to eating/swallowing concerns. Two people have already been assessed by a health professional and it has been agreed that two people should be on liquidised diets pending assessment. The manager told us that each component of the meal is liquidised separately so that individual tastes are retained. The manager told us that they are in the process of recruiting another cook so that they can have a cook on duty every day; this will give care staff more time to spend with people living at the home. 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. The health care needs of people are met; this includes the safe administration of medication by well trained staff. Evidence: Care plans record a persons capabilities and need for assistance with personal care and personal hygiene in some detail. There is now a male carer employed at the home as well as two male ancillary staff so there is an improved gender balance - this gives males the opportunity to be assisted by a male carer if this is their choice. We observed on the day of the site visit that people are able to choose their own clothes and hairstyle and that their appearance reflects their personality. We saw evidence in care plan records that people receive support from other professionals, such as physiotherapists, dieticians, speech and language therapists and the epilepsy nurse; these contacts are clearly recorded in care plans, including any advice that should be followed. Records evidence that people have an annual health check with their own GP and attend for required screening, such as breast screening. One person has been having a course of treatment at hospital and records evidenced that as much information as possible has been obtained from the hospital and shared Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: with staff to help them assist this person appropriately. The manager told us that liaison with hospital staff has been very helpful and that they have been told to contact them at any time for assistance or advice. There is a key worker system in operation and care plan records evidence that key workers spend one to one time with people - this includes taking them shopping, spending one to one social time with them and attending their care reviews. The storage and administration of medication at the home has improved. Only senior or acting senior staff administer medication and training records show that they have had appropriate training. There are sample signatures in place for this group of staff to enable medication records to be checked. Medication administration records were checked on the day of the site visit - we noted that they include a photograph of the person concerned and that there were no gaps in recording. We advised that any hand written entries made on medication administration records should be signed by two members of staff to ensure accuracy. The controlled drugs held and associated records were also checked and these were found to be accurate. Medication is now stored in a locked trolley and a locked cabinet; the cabinet contains a further locked cabinet where controlled drugs are stored. The trolley and the cabinet are stored under a wide shelf and covered with a curtain in an area that cannot be easily seen by visitors to the home. 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. People told us that they know how to make a complaint and efforts are made to ensure that people have the opportunity to express concerns. The manager and staff have undertaken training on safeguarding adults from abuse and this offers people living at the home some protection from harm. Evidence: We noted that the complaints procedure is displayed in the entrance hall of the home. The minutes of residents meetings evidences that people are asked if they have any complaints and told that they can ask to speak to someone in private at any time. We examined the complaints and suggestions book and noted that details of complaints made are recorded, along with the outcome of the investigation and any action taken, and that all entries have been signed by the manager. The manager told us that she attended Managers awareness training on safeguarding adults from abuse and that most staff have also attended this training. The manager has also attended training on Deprivation of Liberty. The manager has produced an Abuse board for people living at the home and staff - this displays information about the Mental Capacity Act, Deprivation of Liberty and safeguarding adults from abuse. There have been no recorded allegations or incidents of abuse at the home since the last key inspection. We observed that any money held on behalf of people living at the home is kept securely and that associated records are accurate. Care Homes for Adults (18-65 years) Page 18 of 28 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. The home is well maintained, well decorated, clean, bright and free from unpleasant odours. Laundry facilities are satisfactory and staff follow good hygiene practices. Evidence: On the day of the site visit we saw that the home was clean, bright and well maintained and we noted that there were no unpleasant odours. There is a programme in place for the continual upgrading of the premises and the homes environment is much improved - the lounges and some of the bedrooms have been redecorated and a new carpet has been fitted to the hall, stairs, landing and corridors. The conservatory has been tidied up and is now used by the people that live at the home to undertake activities and as a meeting room to see visitors. One of the bathrooms has been converted into a wet room/shower room and the manager told us that some of the people living at the home prefer using the shower to having a bath. All of these upgrades make the home more comfortable for the people who live there. A health/social care professional told us in a survey, The home has a very homely feel. We advised the manager that new dining tables would add to the homely feel in the dining room. Covers have been fitted on all radiators in the home; this protects people from the risk of burning themselves. New double glazed windows have been fitted to the front of the Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: property and these include lockable window opening restrictors. There are window opening restrictors on other first floor windows and there is a risk assessment in place for one of the people living at the home around this aspect of health and safety. One person at the home uses a wheelchair and all ground floor areas are accessible to them. Some people still share bedrooms and the manager told us that this is is their choice - they have been offered single rooms but have declined. On the day of the site visit the washing machine and tumble dryer were faulty. A contractor came to the home in the morning and repaired the washing machine. A new tumble dryer was ordered, as the existing machine was going to be expensive to repair. Staff were planning to hang washing outside to dry until the new tumble dryer was delivered and fitted; this was only expected to be a few days. We noted that the wash basins in the laundry room were labelled to identify the one to be used for washing clothes and the one to be used by staff to wash their hands. Staff were seen to use good hygiene practices on the day of the site visit and we noted that disinfecting fluid was freely available. The manager told us that most staff had undertaken training on infection control and we saw a notice advertising further training to be held on the 29th May 2009. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Only people who are considered safe to work with vulnerable people are employed at the home. Staff receive induction training and on-going training to equip them with the skills and knowledge to support the people living at the home; this includes NVQ training. Evidence: On the day of the site visit we observed that rapport between the people living at the home and staff was good; people were happy to approach staff and seemed to be comfortable with them. One member of staff was able to engage people in an activity during the afternoon and another took someone out to the shops. 50 of care staff have now achieved National Vocational Qualification (NVQ) Level 2 in Care and four staff are working towards the Level 3 award. Training is being provided for staff in an effort to update their knowledge and skills training on various topics has been provided over the last year, including infection control, moving and handling, medication, safeguarding adults from abuse, learning disability, fire safety, food hygiene, first aid and health and safety. In addition to this, staff attended some training sessions with a Community Psychiatric nurse on challenging behaviour and diabetes. New staff now undertake Induction training that meets Skills for Care requirements. A health care professional that completed a survey Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: told us, most staff are very good but there are a couple of staff who could benefit from further training. The training programme that is in place at the home should ensure that all care staff have received or will receive appropriate training, and the manager is enforcing good practice via staff meetings, staff appraisals and staff supervision. Appraisals record each persons training achievements and the need for further training. We examined the recruitment records for two members of staff. There were appropriate application forms in place that recorded the persons previous employment history, the names of two referees and a criminal conviction declaration. Two written references and a Protection of Vulnerable Adults (POVA) first check were in place prior to people commencing work at the home. The manager told us that there are two residents who have been involved in the interview process and all parties have found this to be a positive experience. 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 home is well managed; this includes arrangements for monitoring the quality of the service provided and the health and safety arrangements that are in place to protect people from the risk of harm. Evidence: The home is being well managed by the new manager. We are aware that one of the local authorities that commission a service from the home have offered ongoing support to the provider and manager in an attempt to raise standards, and the manager told us that she has received a lot of support from the manager of their sister home. This has resulted in a much improved service for the people living at the home. A health care professional recorded in a survey, the home has improved since the new manager has taken over. The manager has achieved NVQ Level 3 in Care and has enrolled on management training at Level 4 - this is due to start on the 22nd June 2009. The manager has recently attended training on safeguarding adults from abuse (managers awareness), deprivation of liberty and infection control in an effort to keep her practice up to date; in addition to this she uses the Care Quality Commission Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: (CQC) website in order to access up to date information. The manager has started the process needed to apply to the CQC for registration. The home has good systems in place to monitor the quality of their service. This includes surveys being distributed to people living at the home plus visitors to the home, including health and social care professionals. The information in returned surveys is collated and any necessary action is taken; people are informed of the outcome of surveys. In addition to this, audits are conducted on various topics. Regular staff meetings and resident meetings are held; on the day of the site visit we examined minutes for recent meetings and noted that people are encouraged to express their views at these meetings and that action is taken as a result of suggestions made and any concerns raised. All of this information is recorded in an end of year report and is used to develop a plan for the forthcoming year. There is a maintenance plan in place from August 2008 to September 2009. This records the weekly, monthly and 3-monthly tasks undertaken by the handyman, including weekly tests of the fire alarm system, monthly fire drills (we noted that people living at the home are always included in these) and testing of water temperatures at outlets in peoples bedrooms. All tasks to be undertaken by the handyman were found to be up to date. There are risk assessments in place for some health and safety topics such as such as use of the toolbox and use of the lawn mower. Service certificates for the fire alarm system, gas equipment and systems, hoists and slings and electrical equipment were all up to date. Staff now undertake training at the time of their induction on health and safety topics, and then refresher training is arranged. We examined the accident book in use at the home and noted that the CQC are notified appropriately of any accidents or incidents that take place at the home; we also noted that people are always accompanied to hospital by a member of staff for both emergency admissions and planned admissions. 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 1 20 To ensure accuracy, two members of staff should sign medication administration records when any handwritten entries are made. POVA first checks should only be used in exceptional circumstances, not routinely. Staff should work under supervision until a satisfactory Criminal Records Bureau (CRB) check is received. The manager should continue with plans to achieve qualifications at NVQ Level 4 and to apply for registration with the Care Quality Commission The registered provider should complete reports to record their unannounced visits to the home to evidence that the quality of the service is being monitored. 2 34 3 37 4 39 Care Homes for Adults (18-65 years) Page 27 of 28 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. 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