Care Home: Cheam Road (101)

What the care home does well The home continues to provide a warm, comfortable and welcoming service to the six service users accommodated at the home. The service provided is very individual, recognising the uniqueness of each person - for instance, there are plans afoot for a holiday to Butlins Holiday camp in Bognor Regis and for a trip-of-a-lifetime visit to Australia. The home ensures that the diversity of needs are responded to, reflecting the more homely and gentle approach for the slightly older people using the service, to the more engaging and active outward-bound activities of the younger women residents. The staff team is closely involved with each service user, ensuring that life is as active and fulfilling as it can be - or as is required - by each person. The acknowledgment of the vulnerability - and consequent setting of honest limitations / adjustments - ensures the right balance of rights and risks for each individual. The provision of food - and involvement of those using the service continues to be commended, and staff recruitment is also noted for commendation again after the auditing of staff-focused paperwork, which evidenced a good and thorough recruitment, induction, training and support process throughout. The home should continue to be proud of the good service that it provides to this small community, which can certainly present its challenging ups and downs. What has improved since the last inspection? There were two requirements set at the last inspection visit, one relating to ensuring the passageway at the side of the house was accessible at all times, and the other relating to ensuring that extractor fans in toilets / bathrooms / ensuites were monitored and operative at all times. Although there was a slight obstruction in situ at the time of the visit, the side passageway was accessible - and all extractor fans encountered were in good operational order. The need for the passageway area to remain clear at all times was fully comprehended by the new manager. What the care home could do better: The home needs to continue to focus on establishing Person-Centred Care Plans for all those living there; there has been good progress, but this is still to be completed. This also applies to the active implementation of Health action plans. The recent maintenance of medication records - of a person who had many frequent changes to their prescription - could have been kept more accurately - in such circumstances, this is obviously absolutely essential. The decor of the house, internally, is generally to a high standard - but the external woodwork will require significant work in this next year or so to ensure it remains waterproof. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Cheam Road (101) 101 Cheam Road Sutton Surrey SM1 2BE     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: David Pennells     Date: 3 0 0 4 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 31 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 31 Information about the care home Name of care home: Address: Cheam Road (101) 101 Cheam Road Sutton Surrey SM1 2BE 02086420307 02086421134 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) : Care Management Group Ltd (trading as CMG Homes Ltd) care home 6 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 1 One (1) place for a service user over the age 65 years, with a learning disability, can be accommodated. Residents with challenging behaviour Date of last inspection Brief description of the care home 101, Cheam Road is maintained, managed and staffed by Care Management Group (CMG). The home, which opened in 1996, is registered with the Commission to provide residential care for up to six women with learning disabilities and associated challenging behaviours. The house is a large detached Victorian property situated in a residential area to the west of Sutton town centre - which is within roughly a half-mile walk of the home. A wide variety of shops, cafes, restaurants and numerous other social and sporting opportunities are available in Sutton, as are excellent transport links into London and into Surrey and beyond. Local busses stop close by, almost outside the house. Cheam Village - a small suburban shopping centre - is also not far away (a bus ride or strenuous walk), in the opposite (westerly) direction - again offering many community Care Homes for Adults (18-65 years) Page 4 of 31 Brief description of the care home resources. Accommodation in the home comprises of six single bedrooms (the top floor having an ensuite facility with shower), an open plan kitchen and dining area, and a separate lounge with a conservatory attached. There is also a small laundry area within a cupboard area and a small office. There are sufficient bathroom / shower and toilet facilities throughout the home to meet the needs of those on the ground and first floor. The large garden at the rear is generally well maintained, with a patio providing garden furniture and a barbecue for the use of everyone, alongside a drying area for clothes. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We visited the house on an unannounced basis - and conducted the inspection over a working day of about six-and-a-half hours, during which time the new manager, Sharon Todd, and staff members were able to assist us with the review of the requirements from the previous inspection report, and to examine current documentation. We also had good time to speak to the people using the service, and to explore any issues arising, including case-tracking and auditing paperwork. Feedback from those who use the service was taken both directly on the day. The general opinion expressed was one of a high level of satisfaction. Those who use the service indicated they are helped to make their own decisions, can Care Homes for Adults (18-65 years) Page 6 of 31 generally do what they want at all times of the day, know how to make a comment / complaint, and commented that staff treat them well, and do listen and act on what they say. We found, again, that the home was operating a good level of service, with an ongoing, consistent and reliable staff team, and with the people who use the service engaging generally well - with both the staff and the other people who lived there. As the service provides for just a small number of people, the culture is one of knowing each other really well - and the general feel of the place continues to feel as an extended family unit. In such close proximity, the home is not without its tensions at times, particularly between those who use the service, but staff members appear skilled to generally defuse any such identified problems and have training to handle challenging situations as they arise. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Adults (18-65 years) Page 8 of 31 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 31 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 31 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 users of the service can be confident that they will have the opportunity to find out about the home, to visit (including staying for short periods) and be assured that the home can meet their needs prior to making a firm decision to stay. Evidence: The service has a comprehensive Statement of Purpose together with a printed Service User Guide. These documents are well presented and include all the information required by the Care Homes Regulations 2001, including the aims of the home and the facilities / services provided. People using the service have all been given a copy. The Guide has symbols and photographs and clearly specifies the room sizes, staff qualifications and other required detail. The home admission policy is conditional to a three-month trial basis. In keeping with good practice, all the other service users are consulted about the possibility of a prospective new service user eventually moving in on a permanent basis - and the permanence is confirmed after a thorough multi-agency review. The organisation has a Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: dedicated Assessment Team that ensures that all necessary information is accrued prior to a trial period at the home, and the home staff (usually the Manager or Team Leader) are involved in assessment, this being followed by familiarisation visits by a prospective person to the home, prior to admission. The home - registered for people who also have challenging behaviour - inevitably has a number of users who present also with significant elements of mental health issues. It is clear, however, that those identified in this dual category are principally presenting with a learning disability diagnosis, secondarily augmented by some complex mental health needs / challenging behaviour. The age range of the majority of service users is between early 20 to mid-40s, with one service user recently reaching full retirement age, and the youngest being just 21. The average age of the people resident at Cheam Road is 40. The mixture of ages seems to blend very well - despite the age differential at either end. The length of stay at the home varies; from one person being at the home for more than the past ten years, whilst the others have arrived at the home in gaps of between one to two years from then on, up to the current day. People who use the service are in regular contact with both health- and social carebased professionals, including GPs, Care Managers, and community-based mental healthcare professionals, all of whom continue to assess that the ongoing needs of each individual is met. Such continuing support is vital for the home, especially if there becomes a need to fall back on the expertise of these particular professionals. Charges at the home vary dependent on identified need and staffing hours. Extras include such services as private chiropody - when required, and personal grooming such as hairdressing - with attendant charges for toiletries, cosmetics, and other small personal items such as individual activity material, magazines and papers. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home maintains care plans and assessment documents designed to ensure that the needs of people are met in a focused and individual way, though a greater focus on developing Person-Centered care planning and developing Health Action Planning is needed. People using the service can be assured that their rights to individuality and selfexpression are protected, with consultation and sharing of information taking into account the wishes and aspirations of each person. They can also be assured that risktaking will be an integral part of the support / protection plans put in place by the home. Evidence: Day-to-day notes for each individual person are kept in a hardback book, and monthly reports are also made by the Keyworkers, these highlighting areas of significance in these overviews, which then, in turn, contribute to the fuller annual formal review Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: process. The people who use the service, care managers, and relatives are all encouraged to participate in the creation of the care plan and the annual review process, and the home ensures people using the service sign, where possible, their own review documents. Care plans, though showing a recognition of the need of each individual person, could be better developed. Person-Centred Planning was developing slowly, but not being focused on to a great extent for all who were - and the manager also expressed the desire to see the Health Action Plans developed through more involvement of staff. The current plans are evidently based on assessments covering the broad aspects of personal, social, emotional and health care needs. Each plan referred to the likes and dislikes of the person, and identified how they would be supported to achieve their goals. Staff members encourage those - who are willing and able - to manage their own dayto-day financial affairs, as far as is reasonably practicable. The registered provider has a Finance Officer who acts with regard to benefit issues for some people using the service; most also have their own personal bank accounts in their own names, where they keep their personal allowance monies. The home, being a small community, runs - and relies on - on a cooperative spirit between those using the service to ensure the smooth running of the house. Shopping for the home - foodstuffs and other items - is also a shared responsibility between staff and those living there. People are encouraged to participate in organising the day-to-day routines at the house, and also to help each other - whilst staff also encourage the balance of individual activity (e.g. doing their own washing, including pegging it on the line, watching the weather, and the chore of ironing it afterwards). Risk assessments were again noted for each person using the service within the home. Risk assessment is clearly an important part of the ethos / underpinning of the home, and such issues are generally well covered in associated documents. Care Homes for Adults (18-65 years) Page 14 of 31 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 can be assured that Cheam Road provides opportunities for them to engage in activities both within and outside the home, and to adopt a lifestyle suited to their individual needs and wishes. Relatives and friends can expect a positive welcome from the service, within the context of respect the choice and decision-making of the individual. People using the service can expect to be provided with a good standard of nutritious and wholesome food - meeting dietary needs and ensuring that mealtimes are a pleasant, involving, and enjoyable time. Evidence: All six people using the service were met during the unannounced visit; they all Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: confirmed that they enjoyed living at the home, that they were well cared for, and that their individuality in decision-making was respected. Staff members are clearly supportive of individuals seeking the best opportunity to develop and maintain their social and independent living skills. Some go out independently; others stay in more of the time and enjoy their very pleasant home environment. Staff seek to ensure that as much of a 1:1 focus can be provided, but sometimes the programme of appointments and routine activities can obstruct this. Staffing is provided at a higher level for identified planned appointments - but cannot, clearly, be provided on a 1:1 basis at all times. Staff members encourage and accompany people using the service - when required to social, shopping and activity-based locations. The service has access to its own vehicle for outings and shopping trips. Many people have London Transport Freedom Passes, but a number continue to really enjoy walking into the different town centres / engaging with the local community. Social activities enjoyed include going bowling, to the cinema, swimming and using pubs / cafes and restaurants - and going out to nightclubs. One person is currently working as a volunteer in a local Drop-In centre. Some people attend local day centres - and SCOLA College has recently provided classes in Pottery, Cookery, Reading & Writing and Computer skills. The manager confirmed that the home remains well accepted locally, and has a good rapport with their neighbours - sharing neighbourly activities such as an occasional summer barbecue. Family and friends are clearly always welcome to visit - as and when they wish. The visiting policy is expressed in symbols as well as words. Individuals can see visitors in the privacy of their own bedroom, but this is based on appropriate risk assessments; agreements can be brokered with the home in respect of such visiting situations, to ensure appropriate support and, where appropriate, protection. Staff members positively support people who use the service to establish and maintain personal relationships - and to hold onto previous friends from before moving into Cheam Road. The home offers a high standard in regard to food. Choice of a wide range of menu options is available most evenings. The inspector continues to be impressed by the variety of food available - both at mealtimes and readily available in the home in general - including fresh fruit and vegetables. Those using the service confirmed again that staff members encourage them to take it in turns to prepare the evening meal for the entire group. Some cook for themselves. Individual care plans identify food preferences and specific dietary needs / requirements. Food is freshly purchased from the shops on a regular, almost daily, basis - as well as people assisting with the more Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: substantial shopping to replenish the freezer, etc. Alternative meals are always offered, and a record of this is maintained. Food is also readily made available to relatives or visitors (some travel quite a distance) - either eating with the others at the regular mealtimes, or having the table separately to share with their friends / relatives before / afterwards. Care Homes for Adults (18-65 years) Page 17 of 31 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. People using the service can be assured that their personal, health care and emotional needs will be recognised, and addressed by the assessment and care planning programme of the home. The systems adopted by the home regarding medication generally ensure the safety and consistent treatment and support for each service user, though care must be taken to ensure a proper audit trail for changing / flexible medication regimes. Evidence: There is little in the routine of the house that is not flexible - though of course, some people rely on a domestic routine or rely on positive encouragement to enable them to undertake their activities. The idiosyncrasies of each individual are certainly acknowledged and respected. Each user of the service is respected and supported in a positive way to be themselves, as much as possible - this extending to personal and health care issues. Most people can undertake their own personal care and are encouraged to undertake Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: this. Some of those resident at the home use a professional hairdresser who visits the home and undertakes styling on the premises. This provision is suited to individual needs, and charges are reasonable - and more than competitive with outside services. A professional chiropodist is also available through visits to the home. A single GP practice cares for all at the home - because all are out-of-area from their placing authority / original health care practitioner, and so have had to sign up with a locally convenient GP. This and other medical / health professional contacts are made as needed; records of appointments and visits are appropriately maintained. Specialist practitioners also monitor mental health - as required, and visit on a regular basis. The formal Accident Book was being appropriately maintained. Records of medication administration were checked and found to be well maintained, with all medicines received, administered and disposed of (via the Chemist) being generally in order. Assessments of an individual being willing to, and having the capacity to, self-administer their medication are actively undertaken, but none currently do so. Those using the service sign their agreement to their medication being managed by the staff. Other records available clearly identified current and discontinued medication regimes. The home procedures for administering as required (PRN) medication are detailed to minimise any risks associated with their misuse. The Medication profile examined in regard to one person - who had a sequence of revised treatments and approaches over a time of challenging behaviours - did not show up the adjustments clearly enough to enable a newcomer to understand the current regime. As explained to the manager at the time, it is vital that a clear record of changes be maintained clearly showing the current medication regime, as particularly with regard to treating challenging behaviour - such a consistent approach is vital to monitor effectiveness. Care Homes for Adults (18-65 years) Page 19 of 31 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 using the service can be confident that their comments and complaints will be responded to, with appropriate action taken. The home provides support to people to ensure that they are protected from harm and any form of abuse within the service. Evidence: The CMG Complaints Procedure is available in symbols format to enable an alternative communication method other than the written word - and it is clearly displayed in the home. The complaints procedure is also included in the Service User Guide, which is also available to all those living at the home in a suitable language / format (e.g. symbols). The home has a complaints book in which people can write any complaint they have, the management then responding within this record. Complaints are investigated internally at first level, with a formal process being available for those who wish to further their concerns. From records, the majority of complaints are of varying subject matters - and the majority are not upheld on further investigation. Two small safes are fitted in the home to ensure that valuables and monies are kept on site by the home are securely in safekeeping. Finances are managed by the home in respect of all service users; suitable records are maintained for all transactions, including the keeping of monies in bank or building society accounts. Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: The procedures for responding to suspicion or evidence of abuse, including the Whistleblowing policy, are openly available. The Sutton Council Safeguarding / Vulnerable Adult Procedures are also openly available within the office. Staff members attend Safeguarding training, and training especially focused on supporting people in crisis; which prepares the staff members to appropriately deal with challenging behaviour. The home policy is to only use physical intervention as a last resort, in extreme circumstances. Care Homes for Adults (18-65 years) Page 21 of 31 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 who use the service can expect to live in a clean, warm and comfortable environment designed to meet their individual needs, and providing generally a high standard of furnishings, services and domestic facilities. People who use the service can be assured that they live in a safe environment in which they may live their lives without unnecessary risk. Evidence: The home is conveniently located in West Sutton, in a pleasant residential area. The location is ideal to enable access to many community resources, using local transport busses stop close by and trains are available from Sutton station into London and into Surrey and beyond. The home is pleasantly ordinary in its general external appearance, though the external paintwork will require attention within the next year or so to ensure that the waterproof integrity of the building is maintained. The home is very much in keeping with the local ambience; those living at 101, Cheam Road can certainly feel as if they are living at home - and not in an institution. Internally, furnishings are of good quality and care is taken with the decor throughout. The communal space is more than adequate for the six service users and also the staff Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: who provide the service alongside them. There is clearly a corporate sense of pride in the house and its surrounds - and in maintaining their general living standards. All bedrooms are single occupancy, of which all are over 12 sq metres in dimension. As this is an older building, not all rooms have an ensuite; two have personal facilities one with just a toilet, and one with a toilet and shower cubicle. The advantage of the premises being of an age, is that each room is quite different in its shape and feel; lending a very individualised feel to the private space. All service users again stated that they were very happy with their facilities and furnishings. All bedrooms seen were decorated to a high standard; they are well furnished, and personalised to reflect individual tastes. The downstairs bathroom now houses a shower - this enhancing the facilities available to service users. The radiator in the shower room has now been protected to avoid the risk of burns from the hot surfaces. Inside the home, there is a spacious hallway, a large dining room with open-plan kitchen attached, and a pleasant lounge with TV and music centre etc, leading out into a comfortable conservatory, which is often used for meetings / reviews. The house is generally well maintained and kept clean and tidy. The home was clean and free from any malodour at the time of the visit. The laundry facilities are located in a small room with a door off the kitchen area. The registered provider, CMG, provides a comprehensive list of policies and procedures for the prevention and control of infection within the home. All maintenance and servicing of equipment at the home was up-to-date and certificates were readily available to evidence such provision. Regular in-house checks are undertaken by staff members and these records are regularly checked during the Regulation 26 visits of representatives of the person-in-control of the home. Care Homes for Adults (18-65 years) Page 23 of 31 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 excellent 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 can be assured that they will be supported at all times by staff who are experienced and competent in their work, staff being provided in sufficient numbers to meet their identified needs. People can expect to be provided with a service that ensures their safety and protection from abuse, through thorough recruitment processes and ongoing staff support arrangements. Evidence: Nine care staff members provide the ongoing service to the house. No staff have moved on in the past twelve months, save one person moving to bank work, rather than full-time. The staff team consists of women only, providing the service to this women-only service. Staffing is provided at an absolute minimum of two care staff being available at all times during the day. Some people who use the service are also identified as requiring a certain number of hours of 1:1 attention, and appointments or sessions needing escorts brings more staff into the house. Staffing at nighttimes is based on a risk-assessed agreement of one staff member only with an on-call arrangement. The manager / senior staff are additionally on call, on a rota basis, when not in the building. Vacant shifts are covered by the bank worker or are covered inCare Homes for Adults (18-65 years) Page 24 of 31 Evidence: house - thus ensuring the all-important continuity for the people who use the service. Staff job descriptions are comprehensive and linked to achieving goals as identified in the home plan. Staff members are familiar with the Codes of Practice set by the General Social Care Council (GSCC); they have been issued with a copy of the Code, which they have signed for. CMG do not permit new members of staff to start work until the company has obtained two satisfactory references from third parties, including their previous employer, and a Criminal Records Bureau / PoVA check is undertaken. Staff files hold signed acknowledgment letters from CMG Human Resources section confirming that staff members CRB checks have been carried out and these full declarations, due to data protection, are held at CMG Head Office. All new members of staff receive a structured induction within the first six weeks of their appointment and signed and dated records are kept to evidence they have read / understood the wide variety of policy and practice contents. Checking files of relatively new staff evidenced that full documentation concerning the application and subsequent referencing / CRB checking and interview of the applicant was available. Initial staff records were also found to be complete, with contract letters and details and other documents showing a fully followed-through process of induction and employment. This again evidences the care taken in recruiting staff for the service. We saw a full matrix record of training - as proof of staff members competency; training in the statutory elements (Basic Food Hygiene, First Aid and working with people with mental health issues) were up to date, with adequate staff currently holding a First Aid certificate. The records relating to NVQ training in care showed all staff save one have completed their training at level 2 - the remaining single staff member due to commence in May 2009. Five staff members have NVQ at level 3, whilst another staff member is due to commence this level of training. Care Homes for Adults (18-65 years) Page 25 of 31 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 operates management systems that ensure that people using the service benefit from a well-run and well-lead service. People using the service can be assured that their rights and interests are well served and protected through the approach to record keeping, policies, procedures and the day-to-day administrative conduct of the home. People using the service can be assured that their welfare, health and safety is safeguarded through the adherence to appropriate guidance and regulations concerning best safety practice. Evidence: The Manager - Sharon Todd - has eleven years experience working with people with learning disabilities, she has a certificate in management studies, currently NVQ in care at level 3 and is completing her NVQ at level 4 to attain the Registered Manager Award. The Team Leader and three senior support workers provide the supervisory Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: level of the home, holding delegated areas of responsibility, with another four support workers completing the team. The home has a Quality Assurance folder which focuses the service on the many aspects of this aspect - by gathering together all the varying audit documents, including focusing on the experience of the home through an auditing exercise looking through the eyes of a service user. The home also actively participates in the CMG Company quality audits each year - with people who use the service acting as representatives to assist in evaluating the quality of input at the homes. The registered provider regularly surveys people using the service and also seeks the opinions of relatives / advocates on paper - to gain feedback about the quality of the service provision. Reports compiled by the home Regional Director or other representatives of the Company - are produced following the monthly, unannounced visits to the home, in line with Regulation 26 of the Care Homes Regulations 2001. CMG has a comprehensive set of policy and procedure manuals which cover the broad spectrum of needs identified under the headings of: Mission Statement / Staff Policies / Service Management / Service & Care Delivery / Health & Safety / Residents Welfare, and Emergency Procedures. Health & Safety issues were dealt with at the home in a well-organised and audited way; maintenance and service documentation was readily available, and evidenced that all routine safety checks were up-to-date in their execution. The CMG Company has a team of maintenance staff who undertake many of the principal checks and audits as a matter of course, year-on-year. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 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 6 15 The home must continue to focus on establishing Person-Centred Care Plans and to the active implementation of Health Action Plans. To ensure the best individually-focused attention is given to each person using the service. 31/07/2009 2 20 17 Clear records of changes to medication must be maintained, clearly showing the current medication regime. As - particulalry with regard to treating challenging behaviour - such a consistent approach is vital to monitor effectiveness and subsequent treatment. 05/06/2009 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 Care Homes for Adults (18-65 years) Page 29 of 31 improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 31 of 31 - 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!