Care Home: Chestnuts

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What the care home does well Residents are involved in decisions about their lives, and play an active role in planning the care and support they receive. Residents are able to make choices about their life style, and supported to develop their life skills. Social, educational, cultural and recreational activities meet individuals` expectations. Residents are encouraged and supported to maintain family links and staff support them to visit their parents if they wish to do so. The principles of respect, dignity and privacy are put into practice. The home has a clear and accessible complaints procedure. This is in an accessible format for residents and contains all of the required information with regard to raising concerns and investigations. The physical design and layout of the home enables residents to live in a safe, well maintained and comfortable environment, which encourages independence. Residents and the staff are able to discuss all aspects of the running of the home generally or on a personal level. This opportunity is offered in resident and staff meetings, residents reviews and surveys. What has improved since the last inspection? Since our last inspection staffing levels have increased. This has resulted in residents having greater flexibility with regards to participating in activities and meets a previous requirement. Residents now have individual bank accounts, with all benefits paid directly into these. Records in the home include details of all transactions such as amounts withdrawn, reasons and balances. Residents informed us that everyone has recently had a new television for their personal use and also that a new television has been provided for the lounge. What the care home could do better: Either all recruitment and training records must be maintained in the home for inspection or if the organisation that owns the home wishes to centralise its recruitment and training records a proforma must be put in place that contains all the required information. If the company wishes to proceed with this option it must obtain agreement from the CQC. This must happen to ensure thehome can evidence its recruitment and training systems offer safeguards to residents. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Chestnuts Yapton Road Barnham Bognor Regis West Sussex PO20 0AZ 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: Lesley Webb Date: 1 5 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. They reflect the things that people have said are important to them: 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. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 30 Care Homes for Adults (18-65 years) Audience Further copies from Copyright 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 30 Information about the care home Name of care home: Address: Chestnuts Yapton Road Barnham Bognor Regis West Sussex PO20 0AZ 01243554679 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) : Self Unlimited care home 6 Number of places (if applicable): Under 65 Over 65 6 0 learning disability Additional conditions: The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD The maximum number of service users who can be accommodated is: 6 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 30 A bit about the care home Chestnuts is registered to accommodate up to six service users in the category LD (Learning Disability) aged 18 to 65 years. The establishment is situated in the village of Barnham, close to train and bus services and local shops. All rooms are for single occupancy. The service is a voluntary charity. The registered providers are Self Unlimited. The Responsible Individual is Mr Peter Williams and the registered manager is Ms Joanne Targett. Up to date information regarding fees charged for living at the home was not availible at our visit. Interested parties should contact the registered provider directly for this information. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 30 How we did our inspection: This is what the inspector did when they were at the care home The purpose of this inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. We also looked for evidence that the home has met Requirements made at our last key inspection undertaken April 2008. The Registered Manager was not present during the first half of our visit. The assistant manager assisted us throughout this time. During our visit to the home we talked to two residents and all staff. We also case tracked two residents, examined staff records, policies and procedures and other documentation. In addition to this we looked around the home and indirectly observed interactions between residents and staff. Before we carried out our visit the home sent us its Annual Quality Assurance Assessment (AQAA). Information from this was also used when forming judgements on the quality of service people receive living at the home. At the time of writing this report we have received two residents surveys. Information from these is also included in this report. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well Residents are involved in decisions about their lives, and play an active role in planning the care and support they receive. Residents are able to make choices about their life style, and supported to develop their life skills. Social, educational, cultural and recreational activities meet individuals expectations. Residents are encouraged and supported to maintain family links and staff support them to visit their parents if they wish to do so. The principles of respect, dignity and privacy are put into practice. The home has a clear and accessible complaints procedure. This is in an accessible format for residents and contains all of the required information with regard to raising concerns and investigations. The physical design and layout of the home enables residents to live in a safe, well maintained and comfortable environment, which encourages independence. Residents and the staff are able to discuss all aspects of the running of the home generally or on a personal level. This opportunity is offered in resident and staff meetings, residents reviews and surveys. Care Homes for Adults (18-65 years) Page 8 of 30 What has got better from the last inspection What the care home could do better Either all recruitment and training records must be maintained in the home for inspection or if the organisation that owns the home wishes to centralise its recruitment and training records a proforma must be put in place that contains all the required information. If the company wishes to proceed with this option it must obtain agreement from the CQC. This must happen to ensure the Care Homes for Adults (18-65 years) Page 9 of 30 home can evidence its recruitment and training systems offer safeguards to residents. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Lesley Webb 33 Greycoat Street London SW1P 2QF 02079792000 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 10 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 11 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Procedures are in place, that if followed will ensure prospective residents needs are assessed before they move into the home. Evidence: As at our previous inspection there have been no new admissions to the home. The home has a policy and procedure in place with regard to pre admission assessments that includes inviting prospective residents to visit the home before moving in so that they can meet people already living there. Two residents completed questionnaires and returned them to us before our inspection. Both state they were asked if they wanted to move into the home and received enough information about it before they moved in so they could decide if it was the right place for them. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents are involved in decisions about their lives, and play an active role in planning the care and support they receive. Evidence: We looked at the care and support plans for two residents. Both of these were clear and easy to follow, giving detailed information for staff on what support was needed and how and when this support should be given. Both care plans seen were essential life plans. This is a form of care planning that is centred around the individual, that details their preferences with regard to daily routines around the home, personal hygiene, socialisation, behaviour, care at night, likes and dislikes, leisure activities, work and education. Both residents that we spoke to confirmed they have key workers who offer support. One explained, They ask what we want to do, take us out for days. Records that we looked at also confirm key workers review care plans monthly with residents. The records of these reviews are detailed and informative. In addition to this Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: an annual review is undertaken with social services; families are invited to attend reviews, as are any other interested parties. The home sent us its Annual Quality Assurance Assessment (AQAA) prior to our inspection. With regard to supporting residents it states Chestnuts encourages all residents to choose and follow their own path supported by Key Workers. Key Workers help residents in researching new clubs activities and these are always depicted by the customer. Communication is paramount and we have several formats for this within the house and the organisation. Methods of communication are stated as house meetings, Service User Forums, PCP, Reviews, Advocates, in house comments book and surveys and involvement with processes via external agencies i.e. Partnership Board Voice. When visiting the home we spoke with two residents, staff and examined records, all of which confirm the contents of the AQAA as accurate. Two residents completed questionnaires and returned them to us before our inspection. Both state they always make decisions about what they do each day. We spoke to one resident regarding rules within the home. He stated, We all independent, do what we like, can go out when we want. X and myself have home alone so can look after selves, get own lunch. Staff here if need them, we have key to back door. Home alone that the resident referred to is an assessment process that has been undertaken for individuals that identifies the amount of supervision they require, skills for independence and any risk factors. Both residents who were case tracked had risk assessments in place and these gave details of the assumed risk, the support required and the action to be taken to minimize the risk. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents are able to make choices about their life style, and supported to develop their life skills. Social, educational, cultural and recreational activities meet individuals expectations. Evidence: With regard to lifestyle choices the homes AQAA states We support our customers in every aspect of their life requirements. We help in promoting independence through risk assessments, activities, socialising events, education. We facilitate and support in all aspects of Health needs. We promote independence and individual choices, expression, lifestyle and sexual awareness. Chestnut residents maintain full involvement within their local Community. Many of our Service Users are adpt at using Public Services e.g. voting, going to church, using public transport, library and telecommunications. At our visit to the home we spoke to two residents, observe practices and looked at Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: records, all of which confirm the contents of the AQAA as accurate. For example one resident informed us, I am going on the Orient Express for a champagne lunch, four course meal on the 16th October. I am semi retired, go the centre two days a week. Train spotting is one of my hobbies; I go to Eastly sometimes as I get to see all the freight trains from Southampton. Also I do gardening and have cleaning duties. The second resident that we spoke to informed us that they like to look after the goldfish and rabbit (two of the three pets owned by the home) and that they go shopping in Barnham by themselves. Since our last inspection staffing levels have increased. This has resulted in residents having greater flexibility with regards to participating in activities and meets a previous requirement. Three of the five residents were not present during our visit to the home. They were attending various day placements. Two residents completed questionnaires and returned them to us prior to our inspection. Both state they can do what they want during the day, evening and at weekends. As at the previous inspection the home has a visiting policy that states family and friends are welcome at any time. Residents are encouraged and supported to maintain family links and staff support them to visit their parents if they wish to do so. Both residents that we spoke to informed us they have contact with relatives either visiting them, by telephone or in writing. We observed staff interacting with residents, noting that preferred forms of address were used. As at previous inspections residents who we spoke to made it clear that they were very happy at the home and it was clear that the residents and staff get on well together. All residents in the home have weekly tasks to encourage them to be involved in the day to day running of the home. Routines in the home respect residents rights to be involved as much or as little as they want. The likes and dislikes of residents are taken into account and recorded in their individual care files. The homes AQAA informs us that nutritional needs are not assessed. We discussed this with the registered manager during our visit who agreed this should take place to promote holistic management of care and health needs. Records that we looked at demonstrate residents are offered a choice of cereals and toast at breakfast, with the main meal being of an evening. The lunch time meal is normally a snack type meal and residents are able to make their own drinks and snacks at anytime and staff will provide support if needed. The menu is flexible and allows for change at short notice and this gives residents the opportunity to choose a take away if they wish. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The health and personal care that residents receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: Both of the care files that we looked at included care plans that give clear information to staff on how the individual residents would like their personal support to be given. These evidence that support is normally verbal prompts but staff will give extra support if needed. As at the previous inspection there is a mix of both male and female staff and each resident has a key worker, with residents having been involved as much as possible in their selection. On the day of our inspection when we arrived at the home one resident informed us they were going to have their hair cut later that day at the local barbers. They appeared to be looking forward to this event. All of the residents at the home are registered with the same GP surgery; however they have different GPs. Residents visit a local community dentist and optician as required and a visiting chiropodist calls every 6 - 8 weeks. Residents are able to access other health care professionals such as district nurses, occupational and speech Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: therapists, a continence adviser and physiotherapists through GP referrals as required. One resident confirmed their satisfaction with the support they receive to manage their health, explaining We have own doctors, dentist and staff can come with us if needed, like if we go hospital. Examination of records and discussions with staff confirm one of the five residents are able to self medicate. Secure storage is provided for their medication to be kept in their rooms. The home has a medication policy and all staff have received training in the administration of medication. We found two medication policies in place, one dated 2004 and another dated June 2006. Both contain the same information with some of this not being in line with current good practice guidance and legislation. We informed the registered manager priority should be given to reviewing of the medication policies to ensure staff have access to current and safe information. The registered manager agreed. The home uses a monitored dose system for medication. Records were inspected and in the main found to be accurate and up to date. We did inform the registered manager that any handwritten entries on medication administration records should contain the same information as that on the pharmacy dispensing labels. She agreed. At the previous inspection the home was informed that the law concerning the storage of controlled drugs has changed and the home was reminded that should there be a need for any controlled drugs to be held at the home, they must be stored in a proper Controlled Drugs Cupboard. A proper Controlled Drugs cupboard is one, which meets the standard set in the Misuse of Drugs (Safe Custody) Regulations 1973. Suppliers of CD cabinets can confirm that a cupboard meets the legal requirements. This has still to be addressed by the home. Currently there are no residents that are prescribed controlled drugs, however this could change and the home should have the appropriate storage facilities available for such an event. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents are able to express their concerns and have access to a robust, effective complaints procedure, are protected from harm and have their rights protected. Evidence: Both residents that we spoke to confirmed they were aware of the homes complaints procedure and that they would talk to staff or the manager if unhappy. When asked who they would talk to if they were unhappy with the staff or manager both replied they did not know. We talked to the registered manager about this who agreed to explore this further with residents at the next residents meeting due on Friday. The home has a clear and accessible complaints procedure. This is in an accessible format for residents and contains all of the required information with regard to raising concerns and investigations. The homes completed AQAA and states that there have been no complaints made to the home since our last inspection. The home has a copy of the West Sussex Multi Agency Guidelines and also has a whistle blowing policy. The homes training matrix gives details of all staff having received safeguarding training. It was noted that for the registered manager and assistant manager this was in 2006 and 2005. At our last inspection a requirement was made that the registered person must ensure Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: that there is a clear record of all monies held by the organisation on behalf of residents and these records must be kept at the home, they must also ensure that any money held for individuals is kept in an account in the name of the service user to which it belongs. Evidence gained at this inspection demonstrates this requirement is now met. Residents now have individual bank accounts, with all benefits paid directly into these. Records in the home include details of all transactions such as amounts withdrawn, reasons and balances. One resident expressed satisfaction with their financial arrangements, explaining, I draw money out of bank, have own bank account with Lloyds, I have a card and draw money with pin, have to keep this secret, to keep safe. Got locks on door to my bedroom to keep money safe. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The physical design and layout of the home enables residents to live in a safe, well maintained and comfortable environment, which encourages independence. Evidence: With regard to the environment the homes AQAA states Chestnuts is situated in the heart of the Community and is part of the Parish of Five Villages and Community Scheme. The home has large grounds enabling Service Users to have pets of their choice and a separate vegetable garden where Service Users grow their own produce. Every Service User has their own bedroom decorated to their own choice, with their own keys. The home is well lit and decorated to the Service Users choice. The building complies with all relevant care standards. Within the local community we have various outlets for transport. The two residents who were at home during our inspection escorted around the home and invited us to view their bedrooms. All areas of the home were clean and generally furniture and fittings were of good quality and homely in appearance. Both resident bedrooms contained an abundance of personal effects including photographs and pictures. The residents informed us that everyone has recently had a new television for their personal use and also that a new television has been provided for the lounge. Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: The home was clean and hygienic and there were no offensive odours. There is a separate laundry, which has washable floors and walls. There is a domestic washing machine that can wash clothing at appropriate temperatures. Residents do their own laundry and each resident has a set day, however they are able to use the laundry at any time if they need to. The home currently has no clothes dryer with residents informing us this had broken and not been replaced. One expressed dissatisfaction with this, informing us that its fine when sun shinning, we hang it outside but when raining we have to put on radiators. We talked to the registered manager about this who told us a new one would be purchased. The home has an infection control policy. The training matrix states that two of the four staff currently working at the home have received training in this area. Two residents completed questionnaires and returned them to us prior to our inspection. Both state the home is always fresh and clean. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Generally staff in the home are trained, skilled and in sufficient numbers to support residents. Systems for monitoring that all recruitment records are in place must improve to reduce potential risks to residents. Evidence: The staffing structure at the home consists of: registered manager, assistant manager and two support workers. The home does not employ separate ancillary workers. At our last inspection the registered manager did not have any supernumerary hours and was included in the staffing ratio of one member of staff to six residents. Due to comments made in two residents surveys we issued a requirement that the registered person must ensure there are sufficient numbers of staff on duty at all times to meet the needs of residents. At this inspection we found that staffing levels have improved. Rotas and discussions with residents and staff confirm that the registered manager is allocated three shifts each week for administration duties and that there are now six shifts per week when two staff are on duty. We spoke with the assistant manager and a new member of staff who was in the process of completing their induction. Both demonstrated understanding of their roles appropriate for their position and length of employment. Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: Two residents completed questionnaires and returned them to us prior to our inspection. Both state staff always treat them well and listen and act on what they say. The training matrix for the home gives details of two staff having undertaken moving and handling training within the last twelve months. It states the registered manager and assistant manager undertook this in 2007. Three staff have undertaken first aid training (appointed persons) and one a four day qualified first aider course. All have received food hygiene and fire. The training matrix does not include information regarding National Vocational Qualifications (NVQ). The homes AQAA states that all staff hold this qualification. We looked at the recruitment and training records for each staff member. There was only evidence of the registered manager and assistant manager holding this qualification. Other courses detailed on the training matrix that staff have undertaken include mental capacity (1 person), person centred planning (1 person), disability awareness (2 people), epilepsy (1 person), dementia awareness (2 people) and hearing impaired communication (1 person). We could not validate the information recorded on the training matrix as copies of certificates were only available for the registered manager and assistant manager. We examined the recruitment records for all of the four people employed at the home. They included two references, application forms and forms of identification. None contained evidence of a POVAfirst and one did not contain evidence that an enhanced criminal records bureau (CRB) disclosure had been obtained prior to them commencing shifts at the home. The registered manager contacted the organisations head office who supplied a reference number and date. The registered manager said this was for the full CRB. She agreed to forward confirmation of this to us within five days. There were no recruitment or training records in the home for the member of staff on induction (who was present during our inspection). We discussed the current system for maintaining recruitment records with the registered manager informing that either all recruitment records as detailed in the Care Home Regulations 2001 must be maintained in the home for inspection or if the organisation that owns the home wishes to centralise its recruitment a proforma must be put in place that contains required information. If the company wishes to proceed with this option it must obtain agreement from the CQC. We spoke to the member of staff who was undertaking their induction. They confirmed this has included spending time at the homes head office, reading policies and procedures and shadowing staff working at the home. They also informed us that they have completed some mandatory training with their previous employer but that they have not been asked to produce copies of these for this employer. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Management of the home in the main is meeting residents needs safely. Evidence: The registered manger has been in post for over three years. She is supported by an assistant manager. Evidence sited in other sections of this report indicates that there have been improvements with regard to management of the service and outcomes for residents (e.g. residents finances, staffing levels and management hours). Priority must now be given to improving systems for monitoring employee recruitment records. We found that residents and the staff are able to discuss all aspects of the running of the home generally or on a personal level. This opportunity is offered in resident and staff meetings, residents reviews and surveys. Since our last inspection the organisation that owns this home has changed its name. A resident that we spoke to told us they were involved and informed of the changes before they occurred. As they explained, not called CARE anymore, its Self Unlimited, I went to a meeting in London where it was discussed, the company have sites all over Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: the country, we all went. Monthly reports in line with Regulation 26 of the Care Home Regulations 2001 are undertaken by a representative of the Responsible Individual. Reports that we viewed gave accounts of discussions with residents and staff and examination of records. We sampled a number of health and safety records, finding in the main all to be in good order and up to date. For example the homes fire risk assessment was reviewed July 2008 and residents and staff undertook a fire drill and evacuation February 2009. The form used for recording the checks to smoke detectors and lighting states this should take place weekly. Records that we were shown do not demonstrate this occurring at this frequency. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 30 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description 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 Description Timescale for action 1 34 19 08/06/2009 In line with Regulation 19 and Schedule 2 either all recruitment and training records must be maintained in the home for inspection or if the organisation that owns the home wishes to centralise its recruitment and training records a proforma must be put in place that contains all the required information. If the company wishes to proceed with this option it must obtain agreement from the CQC. This must happen to ensure the home can evidence its recruitment and training systems offer safeguards to residents. Recommendations Care Homes for Adults (18-65 years) Page 28 of 30 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 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. 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