Care Home: Cherry Tree House

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What the care home does well The service is able to demonstrate its commitment to equality and diversity issues and is user focused. As part of a bigger organisation the service benefits from a good recruitment process which ensures that care workers are suitable to work with vulnerable people. There is a good training program to ensure that staff are competent and well trained. People are supported by a stable staff team that know them well and that work together to provide a good service. They are supported to be as independent as possible, to develop their skills and, if appropriate, to move on to more independent living. People living at Cherry Tree House said: "it is very nice here, I have no complaints and the staff are always respectful. They help and support me and I can talk to them if I have any problems." "I like it here, staff are nice and talk to me and reassure me when I`m anxious." "Staff always knock before coming into my room." Feedback from relatives was that they were very satisfied with the service provided. That they are always made welcome and that the house is neat, clean and peaceful. What has improved since the last inspection? One person was able to move to more independent supported living accommodation. The organisation has introduced easy read policies to help people to understand these and to be more involved in what is happening in their home and in their lives. With the help of people who use their services the organisation has developed a DVD about making complaints. This will help people to understand that they can make a complaint and how to do this. The organisation has developed its own agency staff bank to cover shifts when needed. This means that people who cover shifts have knowledge of working to the organisation`s policies and procedures and are aware of what is expected of them. Users of the service have been involved in the recruitment of staff. What the care home could do better: The service continues to grow and develop and staff support people to be as independent as possible. Staff are committed to this and continue to look at different ways of improving and developing the service further. The service is part of bigger organisation. The organisation takes on board advice given and keeps up to date with good practice and other changes. The administration of medication is very good and is monitored closely. The development of more detailed guidelines for the administration of PRN (as required) medication will ensure that staff are clear as to how and when to administer this as safely as possible. Key inspection report Care homes for adults (18-65 years) Name: Address: Cherry Tree House 49 Hainault Road Romford Essex RM5 3AA     The quality rating for this care home is:   three star excellent 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: Jackie Date     Date: 2 3 0 3 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: Cherry Tree House 49 Hainault Road Romford Essex RM5 3AA 01708735387 01708735387 rita@outlookcare.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Outlook Care Name of registered manager (if applicable) Mrs Rita Evelyn Hall Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 5 The registered person may provide the following category of service only: Care Home only Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Cherry Tree House is a care home that provides accommodation and support for up to five people who have in the past experienced mental health problems. Opened in 1991, it is run by Outlook Care Limited, a not for profit organisation that operate a range of accommodation and support services in North East London and Essex. The house is a detached property on a corner plot close on the outskirts of Romford in the London Borough of Havering. The house has a lounge/dining area, a kitchen, utility Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 5 Brief description of the care home room and a walk in shower on the ground floor. There are a further four bedrooms, a bathroom and an office/sleep in room upstairs. There is a well kept garden and people use this. The house is close to good bus and train links and also to shops and leisure facilities. The fees range from 1,025.26 to 1,554.38 pounds per week. Information about the service provided is contained in the service user guide. 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection of this service was on 23 April 2007. This inspection was unannounced and took place over six hours. This was a key inspection and all of the key inspection standards were tested. Staff were asked about the care that people using this service receive and were also observed carrying out their duties. People using the service were asked to give their views on the service and their experience of living in the home. All of the shared areas and two of the bedrooms were seen. Staff, care and other records were checked. Feedback questionnaires were sent to staff and people using the service. Completed questionnaires were received from one member of staff and three people living at Cherry tree house. Services are now required to complete an AQAA (Annual Quality Assurance Care Homes for Adults (18-65 years) Page 6 of 30 Assessment) and the completed form was received in March 2010. Information provided in this document also formed part of the overall inspection. The inspector would like to thank the people living at Cherry Tree House and the staff for their input during the inspection. 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: The service continues to grow and develop and staff support people to be as independent as possible. Staff are committed to this and continue to look at different ways of improving and developing the service further. The service is part of bigger organisation. The organisation takes on board advice given and keeps up to date with good practice and other changes. The administration of medication is very good and is monitored closely. The development of more detailed guidelines for the administration of PRN (as required) medication will ensure that staff are clear as to how and when to administer this as Care Homes for Adults (18-65 years) Page 8 of 30 safely as possible. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good easy to understand information is available to help people to decide if they want to move into this home. Assessments completed by the home and information and reports received from health and social care professionals mean that staff have the necessary information to enable them to determine whether or not the home can meet a persons needs. People and their representatives have a written contract/tenancy agreement and therefore will be clear about what they are entitled to. Evidence: Standards 1, 2, 3, 4 & 5 were tested. There is a Statement of Purpose and Service User Guide and these are updated when needed and are available at the home. The Service User Guide is in an easy read Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: format to help people to understand it. The service has also developed an information pack for people that are new to the home. This includes information about services, the tenancy agreement, the complaints procedure, the local Community Mental Health Team, the Service Users Guide and other relevant information. Therefore people have good information that helps them to decide if they want to move into Cherry Tree House. The organisation has an admission procedure that includes the gathering of information and carrying out assessments. The AQAA (Annual Quality Assurance Assessment) states that when the service receives a referral they carry out a needs assessment to ensure that the person has been referred to the right environment, or to see if the environment can be adapted to meet their needs. Prospective users of the service are given the opportunity to visit and to meet other people who live there before they make a decision about moving into the home. Their relatives are also encouraged to visit. One person is due to move into the home in April and paperwork relating to this was examined. An individual file had been started and this contained referral and assessment information from professionals involved with this person and also a copy of the detailed assessment carried out by the home. The file also contained details of introductory visits and notes on how these had gone and feedback from the individual and his relative. Each person has their own tenancy agreement which gives clear information about fees and about the service. The tenancy agreement is also in a user-friendly format to help people to understand it. This means that there is clear information about the service that will be provided to each individual. The files seen contained copies of the tenancy agreement and had been signed by each individual. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Cherry Tree House are involved in developing and reviewing their personal plans and these provide staff with the information that they need to appropriately support people. People are supported to take risks and they have the opportunity to try things and to develop their skills as safely as possible. People are encouraged and supported to be involved in decisions about what they do and what happens in the home. Their opinions are valued and listened to. Evidence: Standards 6, 7, 8, 9 & 10 were tested. Each person has their own individual person centred plan covering all of the necessary areas and focusing on how to support individuals to maintain their independence/skills and also to develop new skills. Areas covered included, important things we are Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: working on, important things in my life and things I need a hand with. Each person has a named key worker and people spoken to were clear as to who their key worker was. Two care plans were checked and were up to date and had been reviewed regularly. The plans seen had been signed by the individual and people spoken to confirmed that they were involved in drawing up their plans. They contained information about what had been negotiated with the individual and what they had agreed to work on. There was sufficient information available for staff to work with each person and show that staff know people well and that they are working to meet individual needs and to provide a person centred service. Daily observation recordings are made about what each person has done, how they have been and the support that they have had. Notes are kept of discussions with individuals and also when they choose not to do things. The information is used as part of the review process and to identify ongoing and changing needs. Also to identify if anyone is experiencing deterioration in their mental health. This information can then be used to assist other professionals working with the individual. Regular residents meetings are held and a record is kept of these. All of the people living at Cherry Tree House are able to express their views about what they want to do and what they like. They are able to make their own choices and these are respected by the staff team. They choose where to go on holiday, activities to do and also decoration and furnishings. They are actively involved in the day-to-day running of the home and each person has their own front door key and the key to their room. People can participate in staff work based interviews if they choose. They are encouraged to manage their own finances, with support if necessary. A local advocacy service is invited to the home once every three months and therefore people have access to an advocate regularly. The advocate can support them on a one-to-one basis or jointly with making decisions in their lives. There were up-to-date risk assessments covering the necessary areas. These were relative to each individual, the activities that they do and their own specific behaviours or needs. This means that risk can be reduced and that peoples needs can be met as safely as possible while still encouraging and supporting them to be independent. Personal information and records are stored in a lockable cupboard in the office and staff are aware of issues of confidentiality. When not in use the office is locked. 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 have opportunities for personal development and are encouraged and supported to be as independent as possible. They are encouraged to engage in appropriate leisure activities within the community. They go out when they want to and keep in contact with their friends and families. They choose their own food and help to cook their own meals. Evidence: Standards 11, 12, 13, 14, 15, 16 & 17 were tested. People are encouraged and supported to develop their skills and each have individual daily routines and social activities. This includes household tasks such as preparing meals and snacks, shopping, cleaning and laundry. In addition they are encouraged and supported to manage their own finances as far as they are able. Individual plans focus on ways in which people can be supported to maintain their independence/skills Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: and to develop new skills. One person was successfully supported to develop their independence skills and was able to move on to less supported living accommodation last year. People choose where they want to go on holiday and they sometimes have additional short breaks. They are encouraged to use community facilities such as the local shops and post office as well as leisure activities such as tenpin bowling, pub lunches or going to the cinema. In addition in-house activities and events are organised. This includes board games. However motivating people can be difficult at times due to the nature of their illnesses. On the day of the visit one person had gone to visit her mother, another went to Romford on their own and the other two people remained at home. One said that it was their day for doing their chores and the other had wanted to wash and curl her hair. People have different amounts of contact with their families. One person visits her family very regularly and staff support this by organising transport and also by arranging for medication to be available for her to take with her. Other people have visits from their families or contact them by telephone or letter. Families are invited to events at the home. For example just after Easter they are going to have a cream tea afternoon. Feedback from relatives was that they are always made to feel welcome. As stated previously people are encouraged to take an active part and to be involved in the day-to-day running of the home. Last year some people helped to plant vegetables in the garden and these were used in the home. People can and do say what they would like to eat and are involved in menu planning and food preparation. Feedback from one person was that they liked the meals and that they were involved in planning the menus. Although there are regular meal times these are often adjusted and times can be flexible to suit individuals. However some people have chosen to keep to this routine. On the day of the visit the two people at home had lunch together and the person that had gone shopping came back later and was then supported to prepare her lunch. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service are supported with their personal care in a way that meets their needs and preferences. They are actively supported to receive the medical and health care that they need and to remain as healthy as possible. People are supported to receive their prescribed medication safely and to participate in this as far as they are able. Evidence: Standards 18, 19 & 20 were tested. All of the people living at Cherry tree house are independent in terms of personal care. At times some just need reminders or prompting. Guidelines on how to support each person are in their individual support plan. The plans also contain information on how people have been supported to be more independent in this area. Each person is registered with a local GP practice and receives specialist input as and when required. This includes community psychiatric nurses and the psychiatrist. They also have annual health checks. People have a healthcare file which contains Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: information about health care needs. These show that people have checks from the optician, dentist and when needed the chiropodist. The files also contain information about medical appointments and their outcomes. Staff support people with their medical appointments unless the person has indicated that they do not want this. Last year one person needed to have an operation and was supported by their key worker and the manager to attend appointments. An independent advocate was also involved to support the person in giving consent to the operation. This person spoke about her stay in hospital and said that staff had gone to appointments with her and had reassured her and also that they had helped her when she came home. In addition staff also support people with their mental health needs and each person has a mental health behaviour management plan included in their individual information. One person has recently returned to the home after a period in hospital due to mental health issues. While she was in hospital staff maintained contact and it was evident from observations on the day and discussions with staff that they are monitoring her closely, providing the support that she needs and liaising with other professionals. None of the people currently living at Cherry Tree House self medicate but people are encouraged and supported to be as independent as possible in this area. The person that moved out to independent living was self-medicating and systems and procedures are in place to enable this if it is appropriate for the person. A medication safe has been fitted into the room for the person that is due to move into enable them to continue self medicating. Medication is administered by staff that have been trained and deemed capable to do this. This process is thorough and in addition to the training course includes a written test, observations and monitoring. Staff then have annual drug assessments to ensure that they are administering medication correctly and safely. Medication is stored in a wooden cabinet secured to the wall in the lounge and is administered via a Monitored Dosage System. In addition to this there is an appropriate controlled drugs cupboard in the office. Medication is appropriately stored and there are opening dates on liquid medication and creams. This is in line with good practice. One person visits her mother very regularly and the service was arranged for the pharmacy to dispense medication separately for those visits. This is good practice and gives the person some independence with regard to medication and also flexibility in the time she spends at her mothers. Examination of the MAR (Medication Administration Records) found that these had been appropriately completed. There were photographs of each person and details of what medication they take and why and there was also a list available with the signatures of staff that have been deemed competent to administer medication. Again these are good practice. One person is prescribed a PRN (as required) medication and there were some guidelines for the administration of this. They had been reviewed and kept up-to-date. However this guidance did not contain sufficient detail. For example it did not confirm the required Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: gap between doses or how many doses could be administered in a 24-hour period. Protocols for any PRN (as required) medication must be updated to indicate frequency/minimum period before repeating a dose, the maximum number of doses in the time span, and the action to be taken in the event of the person symptoms inadequately responding to the medication. This will ensure that staff are clear about when, how and why to administer this medication. Overall the administration and monitoring of medication is robust and ensures that people receive their prescribed medication as safely as possible and in line with good practice guidance. Care Homes for Adults (18-65 years) Page 19 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are safeguarded by the working practices and support of the staff team. In addition their rights are actively promoted People living at Cherry Tree House can be confident that they will be listened to if they are not happy about anything. Evidence: Standards 22 and 23 were tested. There is an appropriate user-friendly complaints procedure and this is available in an easy read format and also as a DVD. A copy of the complaints procedure is displayed at the home. When staff are out in the community with users of the service they carry a complaint card that they can give to members of the general public if necessary. Staff are aware of what to do and how to facilitate a complaint and people spoken to said that if they were not happy about anything they could talk to any of the staff or the manager. In addition they have regular access to advocates who could support them if they needed to complain. Feedback from relatives and from a care manager was that they were very satisfied with the quality of service provided. The Commission has not received any complaints about the service since the last inspection. The organisation has produced a detailed safeguarding policy which tells staff the actions to be taken in the event of abuse/suspected abuse being discovered. Staff Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: have received safeguarding vulnerable adults training. Staff were aware of issues of safeguarding and of their responsibility to people using this service. Shortly after the inspection one person did not return at the expected time. Staff were alert to this immediately and followed the correct procedures, including alerting the police. The person did safely return a few hours later. People need different amounts of support with their personal finances and some people manage their own affairs. Others are supported by staff. When cash amounts are held for people these are checked at every shift handover and staff sign to say that they are correct. Cash was being held for two people and these amounts were checked during the inspection and found to be correct. In addition to having keys to their rooms people have lockable facilities in which they can store any cash or other valuables. The section on staffing later in this report gives information that confirms that there is an appropriate recruitment procedure and this also helps to safeguard people living at the home. Care Homes for Adults (18-65 years) Page 21 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 clean and comfortable home that is suitable for their needs. Evidence: Standards 24, 25, 26, 27, 28, 29 & 30 were tested. The house is a detached property on a corner plot on the outskirts of Romford in the London Borough of Havering. It is close to good bus and train links and also to shops and leisure facilities. There is a bedroom, a lounge/dining area, kitchen, utility room and a walk in shower on the ground floor. There are a further four bedrooms, a bathroom and an office/sleep in room upstairs. Grab rails and a shower seat have been fitted in the downstairs shower room to provide extra support for anybody that needs this. There is a well kept garden with a patio and garden furniture. Hand rails have been fitted to help those who require extra support to access the garden independently. Facilities are suitable for the needs of the people living there and have been adapted over the years as peoples needs have changed. All communal areas are comfortable, homely and well decorated. The home has an annual development plan which includes plans for decoration or replacement of furnishings and fittings. Feedback from a relative was that the house is always neat and clean and this was the case at the time of the visit. Each person has a single room and two people were happy to show us their rooms. The rooms were well decorated and appropriately Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: furnished and in one case had been personalised. This person said that when the room was decorated she chose the colours and the carpets. She said she liked her room. The other person chose not to personalise their room. As previously stated people have keys to their own rooms and also to the front door so that they can gain access whenever they wish. Care Homes for Adults (18-65 years) Page 23 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported and protected by the recruitment practices of the service. People are supported by staff team that receive the necessary training, supervision and support to meet their needs. People are supported by a competent and qualified staff team who know them well and who are committed to providing a person centred service. Evidence: Standards 31, 32, 33, 34, 35 & 36 were tested. From the rota and from discussions with staff and people who use this service it was evident that people are supported by a regular staff team that know them well. The organisation has their own agency bank staff and this is used if any shifts need to be covered. Therefore people are supported by staff that have a working knowledge of the organisations policies and procedures and in most cases experience of this client group. There are usually two staff on duty during the daytime shifts and one member of staff sleeps in at night. The manager is usually supernumerary and at the time of the visit Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: to the service the staffing levels were sufficient to meet peoples needs. Feedback from relatives that they were very satisfied with the service provided. One person using this service said that staff always try to sort things out for her and support her when she has to make decisions. She also said that they always knock before coming into her room. Another person said that staff are always respectful and provide help and support. Staff spoken to said that there was a lot of flexibility for the people that live there and that staff do have the time to sit and talk to them and to work through any problems and difficulties. All staff have job descriptions and contracts and were clear about their roles, responsibilities and duties. They said that they have access to a lot of training both mandatory and specific to the people they work with. This includes working with people with mental health problems. In addition all of the support staff team have obtained NVQ level 3 and the manager and deputy NVQ level 4. Records are kept of staff training and confirm that staff receive the training needed to meet the needs of the people using the service. The organisation operates an appropriate recruitment procedure. Jobs are advertised, application forms completed and interviews held. Two staff files, including the newest person were checked. The files contained evidence that the necessary checks had been carried out. Therefore the recruitment procedure offers safeguards to the people using this service. Records show and staff confirm that they receive regular supervision and also that staff meetings are held regularly. They therefore have an opportunity individually and collectively to discuss issues, concerns and the development of the service. Care Homes for Adults (18-65 years) Page 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Cherry Tree House benefit from a service that is very well managed and where their opinions are sought, valued and acted upon as far as possible. They live in a safe home. Evidence: Standards 37, 38, 39 & 42 were tested. The manager has a lot of experience of working with people with mental health problems and managing services. She has completed NVQ level 4 in care and the RMA (Registered Managers Award). In addition the deputy also has the same qualifications. Therefore the management team are both appropriately qualified and experienced. Staff are aware of lines of accountability within the home and were clear about their roles and responsibilities. Staff said, this is a well run home, the manager is firm but willing to listen and can be approached when needed. The manager is always thorough and on the ball. She is very supportive. Feedback from a care manager was that everything runs well and is user friendly and helpful. Feedback from a relative was that the manager was helpful and supportive. The manager provides an Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: excellent role model to staff and is aware of issues of equality and diversity, human rights and person centred thinking. The manager is also aware of her responsibilities under the Mental Capacity Act and Deprivation of Liberty safeguards and Independent Mental Capacity Advocates have been contacted when needed on behalf of people living at Cherry Tree House. A representative of the organisation carries out monthly unannounced monitoring visits to the home and a report on this visit is left at the home. The reports cover the necessary areas and indicate any action that is needed. The service has an annual development plan and as part of the development of this questionnaires had been sent out to stakeholders. In addition the service has a continuous improvement plan which is an ongoing working document throughout the year. Therefore the quality of the service provided is monitored by the organisation and the manager and the aims, objectives and future plans for the service are clear. The necessary health and safety checks are carried out and records are kept of these. Records seen were up to date and accurate. In addition the organisation carries out comprehensive annual health and safety checks. Overall a safe environment is provided for the people living, visiting or working here. Care Homes for Adults (18-65 years) Page 27 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 28 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 20 13 Protocols for PRN (as required) medication must be updated to indicate the frequency/minimum period before repeating a dose, the maximum number of doses in a time span, and the action to be taken in the event of the persons symptoms inadequately responding to the medication. To ensure that staff are clear about when, how and why to administer this medication. 31/05/2010 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. 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