Care Home: Chilmington House

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What the care home does well Prospective service users or their representatives are provided with the information they need to enable an informed decision about the suitability of the home. The needs and wishes of the prospective resident are thoroughly assessed to ensure they can be met by the home. Detailed and individual care plans are maintained for each resident, which identify their needs and any known wishes or preferences about how they are supported. Residents are supported to make day-to-day decisions about their lives and risk assessments positively support participation and involvement. An appropriate range of activities and opportunities are made available to residents within the home and the local community, and the home supports contact with residents` families. Residents are also encouraged to be involved in the daily household routines, and are treated with respect. They are provided with a varied and appropriate diet, based on their needs and known preferences. The physical and emotional healthcare needs of residents are also met effectively. The home has an appropriate procedure in place to respond to complaints and has systems to safeguard residents from abuse. The home provides residents with a homely, safe and comfortable environment which is adapted to meet their needs, and standards of hygiene are well maintained. Residents are supported by a well qualified staff team, who are supported in their role through regular supervision. The recruitment system helps to safeguard residents and appropriate records of the process are maintained for inspection. An appropriate quality assurance system is in place to enable ongoing monitoring and review of performance and outcomes for residents. The health, safety and welfare of residents is promoted by the home. What has improved since the last inspection? The home has begun to re-recruit staff to replace those lost when resident numbers were reduced and the levels of NVQ attainment remain high. Improvements to supervision systems have also been made. Resident involvement in daily living tasks and the range of menu choice and diversity have improved. Premises improvements have been made including the new wet-room shower facility and additional toilet Hospital information profiles have been devised for each resident. The manager has become an accredited manual handling trainer to enable training input to be provided when required. The managing director has sought external professional supervision to enhance the input on national developments in care. What the care home could do better: Staff need to be reminded of the importance of fully maintaining the medication records, and the records of, as required, medication could be improved. The manager should ensure that all staff have received the necessary training and that this is updated appropriately. Key inspection report Care homes for adults (18-65 years) Name: Address: Chilmington House Armadale Court, Westcote Road Reading Berkshire RG30 2ES     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: Stephen Webb     Date: 1 4 0 4 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 27 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 27 Information about the care home Name of care home: Address: Chilmington House Armadale Court, Westcote Road Reading Berkshire RG30 2ES 01189567877 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): manager_chilmington@yahoo.co.uk Chilmington Homes Ltd Name of registered manager (if applicable) Ms Martine Patricia Lesley Dell Type of registration: Number of places registered: care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users to be accommodated is 7 The registered person may provide the following category 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 category : Physical disability (PD) Learning disability (LD) Date of last inspection Brief description of the care home Chilmington House is a purpose built building which provides seven bedrooms for people with a learning disability and with associated physical disabilities. The home has a lounge, dining room kitchen and laundry room. There is also a garden area with seating and a barbecue. All seven bedrooms have been decorated to reflect the individual tastes of the service users. Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 0 7 7 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 quality rating for this service is three stars. This means the people who use this service experience excellent quality outcomes. This inspection included an unannounced site visit from 09.45 until 19.00 on the 14th of April 2010. This report also includes reference to documents completed and supplied by the home, and those examined during the course of the site visit. The report also draws from conversation with the manager and other staff. The inspector also observed the interactions between residents and staff at various points during the inspection. The interactions observed were positive and staff were seen to respond promptly to the needs of individual residents. The inspector also examined the premises. The fees, at the time of this inspection range between twelve hundred and fifty pounds per week and two thousand one hundred pounds per week based on the assessed needs of individual residents. Care Homes for Adults (18-65 years) Page 5 of 27 What the care home does well: What has improved since the last inspection? The home has begun to re-recruit staff to replace those lost when resident numbers were reduced and the levels of NVQ attainment remain high. Improvements to supervision systems have also been made. Resident involvement in daily living tasks and the range of menu choice and diversity have improved. Premises improvements have been made including the new wet-room shower facility and additional toilet Hospital information profiles have been devised for each resident. The manager has become an accredited manual handling trainer to enable training input to be provided when required. The managing director has sought external professional supervision to enhance the input on national developments in care. Care Homes for Adults (18-65 years) Page 6 of 27 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. 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 7 of 27 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 8 of 27 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. Prospective service users or their representatives are provided with the information to enable an informed decision about the suitability of the home for their needs. The needs and wishes of the prospective resident are thoroughly assessed to ensure the individuals needs can be met by the home. Evidence: The home has a Statement of purpose and Service User Guide. The Statement of Purpose had been reviewed in February 2010. A copy of the Service user guide is on each residents care file. These are signed by the residents next of kin or advocate on behalf of the resident. The home has an appropriate preadmission assessment process which leads to the preparation of an initial care plan. The completed assessment forms seen indicate that information has been sought from a range of appropriate sources, and reflects a positive approach, supportive of the individuals existing abilities and wishes. Care Homes for Adults (18-65 years) Page 9 of 27 Evidence: Under normal circumstances a prospective resident is invited to a series of visits to the home, leading up to one or more overnight stays, though one resident was admitted without prior visits, as agreed with the care manager, because this was felt to be in their best interests. The homes manager visited the prospective resident in her previous home, prior to admission in this case. Care Homes for Adults (18-65 years) Page 10 of 27 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. Each resident has a care plan which identifies their needs and also their likes, dislikes and preferences about how they are supported to enable staff to deliver individual, person-centred support. Residents are encouraged and supported to make decisions about their day-to-day lives to encourage a fulfilling lifestyle. The risk assessment process supports residents in this, by identifying how identified risks can be addressed or minimised. Evidence: Each resident had a care plan in place, which had a positive focus on supporting the abilities of the individual, and referred to their known preferences or wishes about how any necessary support is provided. The care plans examined included guidelines for staff on aspects of physical and healthcare and also on supporting metal wellbeing. Mental Capacity Act judgement forms were on file indicating that appropriate capacity assessments had been made, for example with regard to the receipt of flu jabs. Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: However, unlike other records, which had dates of review recorded, the review dates of these assessments were not recorded on the forms. The manager agreed that this would be an appropriate development. Where necessary specific guidelines were included for staff on how to support aspects of the care of individuals, which indicated that the known views and preferences of the resident were taken account of. Where an individual responds better to specific staff when being supported, this is identified and where possible, is facilitated. Specific behaviour support plans were also present where necessary, and each file contained information about the preferred communication repertoire of the resident. Care plans had been reviewed periodically and copies of reviews were on file. The care plans also indicated that residents are encouraged to make decision about their daily lives, and the support of independent advocates had been arranged where necessary. Staff were also observed to encourage and support individual decision making by residents during the inspection. Though none of the residents is able to manage their own personal allowance they have access to these funds, which are managed on their behalf by family or independent advocates and administered by the senior staff at the home. Residents funds are stored and accounted separately and detailed records of, and receipts for any expenditure, are retained. Examination of a sample of these records indicated appropriate expenditure of these funds to enhance the daily lives of residents. The files examined also contained a range of individual risk assessment in relevant areas for the resident, which included details of how to address identified risks where possible. These documents had an enabling focus, and had been subject to regular review. The feedback received from two residents advocates and from family members on behalf of four residents supported the above observations. Care Homes for Adults (18-65 years) Page 12 of 27 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 have appropriate opportunities to take part in rewarding activities and to access the local community, and contact with family is supported where possible. Residents are also encouraged to be involved in the daily household routines, and are treated with respect. They are provided with a varied and appropriate diet, based on their needs and known preferences. Evidence: Residents have access to a good range of activities, within day-services, in the home and within the local community. Two residents also attend sessions at college. Programmes are tailored to individual needs and reflect the preferences of each resident. Activities in the community include walks, meals out, watching football, personal shopping trips, cinema and pub outings; and both massage and Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: aromatherapy are also provided by visiting professionals. The home has various sensory equipment for use where appropriate. None of the residents currently choose to attend places of worship though some have done so previously. Residents have been on various holidays including ones overseas, and appropriate consultation, risk assessment and preparation has taken place for holidays containing an element of potential risk. One resident has a range of day outings instead of a holiday as this better meets their needs. Contact with relatives is encouraged where possible and staff have supported visits to family as well as arranged holidays close to family homes, on occasion, to support this. Independent advocates have been found where appropriate to safeguard the best interests of some residents who do not have relatives able to do this. Residents are encouraged to take part in household tasks like shopping cleaning and meal preparation, though their level of involvement is variable. Those attending day services are also encouraged to help prepare their packed lunch and all residents are encouraged to help with their personal laundry. Residents each have a weeks menu compiled from their known likes and dislikes and these rotate in turn. An alternative is always made available if anyone doesnt like the meal provided. One resident is provided with a low calorie diet to meet their needs. Meals are generally eaten communally though individuals can eat separately if they wish. One resident who tended to be excluded and eat alone in a previous placement, has been successfully supported to eat with the group since moving to Chilmington House. Staff were observed to encourage and prompt individuals appropriately during the lunchtime meal on the day of inspection, and one resident was supported to eat their lunch, by one staff member who sat with them throughout. Meals are provided in an appropriate form to meet the needs of individuals and may be liquidised or thickened as required. The advice of external specialists is sought where required. One resident is going to be fed via peg tube in the future and all staff have received training in managing this. Care Homes for Adults (18-65 years) Page 14 of 27 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. Residents are supported in accordance with their needs and any known preferences. Their physical and emotional healthcare needs are also met effectively, and their medication is managed on their behalf by the staff. Evidence: Staff offer support to residents according to the detailed care plans and other available information, which is based upon their needs and also any known preferences, likes and dislikes. There is evidence of consultation with individual residents about changes in their care or environment, for example about one residents change of bedroom due to a broken hoist, and also about interior redecorations in the home. Records of the care and support provided to residents were maintained individually and in addition, collective shift reports were in place to assist with the continuity of information between shifts, via the handover meetings. However, the records of the activities undertaken by residents could be improved to enable this information to be more accessible for inspection or when compiling reviews. Where necessary behavioural support plans are in place to enable staff to offer support in consistent ways to manage particular situations or behaviours, and a range of risk assessments help enable activities, where an element of risk is identified. These documents are regularly Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: reviewed to ensure they remain relevant, and have a positive focus on encouraging self-care and decision making where possible. Information was present within files about the individual communication methods used by each resident and in some cases a communication passport had been prepared by the speech and language therapist, who also visited on the day of inspection to observe one resident for this purpose. Reports were also on file from other external healthcare professionals where relevant. Where residents do not have involved relatives, independent advocates are in place to monitor their best interests. Staff had also been provided with specialist training to meet specific needs. Feedback from two advocates and several family members was very positive about the degree to which the home provides for the needs of each individual and respects their individuality. Where a residents behaviour or decision making has a potentially negative impact on their wellbeing the home has been involved in best interest meetings to agree the appropriate way forward. A file had been prepare to provide new or agency staff with the core information on each resident as a quick reference source. Individual fire evacuation plans have been written for each resident to ensure that staff are aware of support needs. Records of routine healthcare appointments and regarding any specific individual health needs are within the care file and are maintained appropriately. Weight charts were up to date and recent appointments with healthcare professionals were recorded. A hospital information file had been established to ensure that key information was readily available to accompany any of the residents to hospital should the need arise. The home uses a monitored dosage system to manage medication on behalf of residents, none of whom is able to manage this for themselves. Each resident has a medication profile, including details of any allergies, and a medication support plan was in place for one resident to ensure that staff follow a particular agreed process. The most recent pharmacist inspection in September 2009 had a positive outcome. However, examination of the current medication administration record, (MAR) sheets indicated a small number of gaps in the dual signatory recording which is the homes policy. this should have been picked up within handovers as a check of the medication is included here, so the senior staff may need reminding of this aspect. In no case was there a double gap on any particular occasion, however. Although an audit trail was in place for most prescribed medication, including a record of the quantities received into the home, this was not so for the PRN (as required) medications which were held in stock from a previous delivery, as these broughtforward quantities were not being recorded. It is recommended that best practice would be to maintain the full audit trail for these medications also. Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: The manager agreed to review the medication issues with the senior staff. Care Homes for Adults (18-65 years) Page 17 of 27 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. The home has an appropriate procedure in place to respond to complaints and has systems to safeguard residents from abuse. Evidence: The home has an appropriate complaints procedure which is given to residents next of kin or advocates. Staff are aware of their role in advocating in the case of a complaint on behalf of a resident to support the process. The complaints log had no complaints recorded since the previous inspection in April 2007, so it was not possible to examine the procedure in operation. However, feedback had been obtained from two advocates and four residents families for this inspection and no issues were raised about the homes operation or the care provided. No complaints had been made to the Commision about the home since the last inspection, for forwarding to the service. The home has an appropriate safeguarding procedure in place. The manager stated that there had been no safeguarding issues relating to the home in the previous twelve months. None has been brought to the attention of the Commission over the same period. Staff have all received a safeguarding training update in 2010 apart from one team member who has been on maternity leave, and one other team member for whom no date for this training is recorded. The manager will need to ensure these two team members receive this training at the first opportunity. Care Homes for Adults (18-65 years) Page 18 of 27 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. Residents are provided with a homely, safe and comfortable environment which is adapted to meet their needs. Standards of hygiene are well maintained and the home has an appropriately equipped laundry. Evidence: The home is purpose built and all on ground floor level to promote accessibility for residents wtih impaired mobility, and also provides accessible bathroom and toilet facilities. Furnishings are homely and the communal areas are bright and airy. The kitchen is of satisfactory size to enable a resident to be supported to prepare food, and is reported to be due for refurbishment in the near future. Each bedroom is personalised to reflect the individual needs and interests of its occupant, and they are pleasantly furnished. When areas are redecorated, residents are consulted about the colour scheme and also about any new furniture purchases. The home has a good sized garden which is accessible via a portable ramp from the patio doors onto a paved patio with paved slopes to other areas. Sun awnings are installed to provide outdoor shade and help to reduce the lounge temperature on sunny days. The laundry facilities are appropriate to residents needs and the observed standards Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: of hygiene were good. Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by a well qualified staff team, who are supported in their role through regular supervision. The recruitment system helps to safeguard residents and appropriate records of the process are maintained for inspection. Although not all staff training is up to date, the majority of staff have attended the required training and updates to help ensure they maintain current knowledge of best practice. Evidence: The home has a well qualified and experienced staff team with thirteen of the sixteen permanent staff having at least NVQ level 2, and some at a higher level. The home is now re-recruiting having had to reduce staff numbers for a period when resident numbers were reduced. The home also has a bank of known staff to call upon when required. Agency staff have been used at times and an agency information file was available to inform them of the necessary day to day and emergency information about each resident. Examination of a sample of recruitment records indicated that current recruitment Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: practice was thorough and that the required records were retained. In one case, however, where an employee had been with the organisation for some years, no new references had been taken up for a more recent promotion. Residents meet prospective new staff when they attend the home for interview, and on occasions may sit in on interviews, but are not formally involved in the process. Copies of supervision and appraisal records were available indicating a regular process of staff support and development and there was evidence of the appropriate management of performance issues. A schedule of supervisions was also posted in the office. Minutes of team meetings were also filed which showed regular meetings had taken place. The training records available for inspection were individualised but there was no overview record available. The manager agreed to produce this and maintain it. A copy was forwarded to the Commission soon after the inspection. The training overview supplied indicated that the majorty of staff had received the required training, though some newer recruits still had to complete some of the core training and one or two loger-standing staff needed to undertake updates in some areas. The Manager should ensure that these shortfalls are addressed as soon as practicable. The feedback received on behalf of residents was very positive about the staff, and observation during the inspection indicated a respectful and enabling approach by staff, who encouraged residents to express themselves and to make decisions. Care Homes for Adults (18-65 years) Page 22 of 27 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. The home is managed by a competent and appropriately qualified manager and staffed by a well qualified team. An appropriate quality assurance system is in place to enable ongoing monitoring and review of performance and outcomes for residents. The health, safety and welfare of residents is promoted by the home. Evidence: The home is the sole establishment owned by the registered provider who has a nursing background and used to manage it herself. The current manager is appropriately experienced and qualified to manage the service. She has a Certificate in Management Studies and a City and Guilds Foundation Management For Care. She has been manager for five years and has previous care experience including management. She has continued to update her practice and knowledge. The deputy manager has also attained NVQ level 4 and the Registered Managers Award. Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: The proprietor undertakes the required monthly monitoring visits, and copies of the resulting reports were available for each month since December 2009. Previous reports had been archived. The reports contained good detail including observations of the interactions between staff and residents, and of any feedback obtained. An appropriate quality assurance system was in place but the returned forms from the September 2009 survey had been destroyed in error. The outcomes from the 2008 survey were seen and included a letter to participants summarising the outcomes, which is good practice. Surveys are reportedly sent to next of kin, advocates and care managers. The manager agreed to undertake another round of surveys before the anniversary of the previous survey. A building maintenance plan for 2007-2011 was in place demonstrating a planned schedule of improvements and maintenance, and there was also an overall business plan in place for 2009-10. Examination of a sample of health and safety-related certification indicates that appropriate inspections have taken place. The environmental health inspection in May 2009 led to a five star hygiene rating, and the fire authority inspection around the same time was also satisfactory. The fire alarm has been regularly serviced, most recently in March 2010. The home has a fire risk assessment in place which was last reviewed in May 2009. Staff had received a fire safety update in 2010, and there are records of reriodic fire evacuation discussions with staff. Each resident also has an individual fire evacuation plan in place. Records of accidents to residents were still being logged collectively rather than on the currently appropriate tear-off accident recording pads. The manager agreed to obtain an appropriate accident recording pad and establish individual records within residents files and a collective record for monitoring purposes. Care Homes for Adults (18-65 years) Page 24 of 27 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 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 26 of 27 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). 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