Care Home: Community Places Ltd

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What the care home does well The home provides a modern, spacious and comfortable environment for the people that use the service. People that live at the home stated that they liked their rooms and said that the home was always clean and tidy. The meals in the home are also very good, although healthy meals are always an option and are promoted. People say that they receive the food that they like. Direct observations of staff working with people that use the service showed that they have a good working relationship with them and the staff clearly understand how individuals want to be supported. What has improved since the last inspection? Medication recording in the home has improved this means that people can be sure that they only receive the medication that is prescribed for them. The non registered buildings are no longer in use. This means that the people that use the service can be sure that their environment is safe and id suitable to meet their needs. Staff have received lots of training to make sure that the have all of the knowledge and skills to care for the people that they are responsible for. What the care home could do better: The staff need to receive supervision on a regular basis to make sure that they understand their jobs and know what their responsibilities are. The home needs to ask other people about how they think that the service can improve. The management of the home need to make sure that new staff have had all of the appropriate safety checking made before they start to work at the home. This will help to keep the people that use the service safe from any possible harm. Key inspection report Care homes for adults (18-65 years) Name: Address: Community Places Ltd 43 John Street Great Houghton Barnsley South Yorkshire S72 0EA     The quality rating for this care home is:   one star adequate 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 Robertshaw     Date: 2 8 0 1 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) 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. The material should be acknowledged as CQC 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: Community Places Ltd 43 John Street Great Houghton Barnsley South Yorkshire S72 0EA 01226755070 01226753547 cplaces@amserve.com None Community Places Ltd care home 16 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) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 16 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 category: Learning disability Code LD, maximum number of places: 16 Date of last inspection Brief description of the care home Community Places is a 14-bed home for younger adults between the ages of 18 and 65, it provides social and personal care for people with a learning disability. The home is in a residential area in the village of Great Houghton, where there is good access to public services. There is a bus route, a variety of shops, health centre, post office, pubs, and church near by. The home has disabled access and a there is passenger lift to the upper floor. There are 13 single accommodation bedrooms and one self contained flat; all have en-suite facilities. There is an additional bathroom with a Jacuzzi and an additional shower and toilets. There are a variety of lounges and seating areas, and some are designated as quiet places. The home provides a room Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 16 Brief description of the care home with access to a computer and there is an activities room. The dining room is spacious and leads out onto a patio area, and there are spacious well-kept gardens with seating and a table. Car parking is available within the grounds of the home and the home has its own transport. Within the home there is a no smoking policy, however there is a summerhouse provided in the garden for people who do wish to smoke. The manager said fees are based on individuals needs and assessments. If there are any additional charges these are agreed in the contract of care. Prospective service users and their families can get information about Community Places by contacting the manager. The home will also provide a copy of the statement of purpose and the latest inspection report. 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: one star adequate 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 home is one star - adequate service. This was an unannounced key inspection. The site visit took place on the 28th January 2010 between the hours of 09:00 and 17:30. The registered manager and the Responsible Individual were present during the visit. An Annual Quality Assurance Assessment (AQAA) had not been requested to be returned prior to this site visit taking place. Therefore no surveys were sent out to people that use or have contact with the service. On the day of the site visit the Commission also spoke with four of the people that use the service, two commissioners of care, and a care consultant that were present in the home. We also spoke with five of the homes care staff. Care Homes for Adults (18-65 years) Page 6 of 30 On the day of the site visit opportunity was taken to make tour of the premises, inspect a sample of care records and check records relating to the running of the home. Time was spent observing and interacting with people, and feedback from people present during the visit is also included in the report. 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: 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 8 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 9 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. People using the service experience good quality outcomes in this area. We made this judgement through a randge of evidence including a visit to the service. This means that there are systems in place to make sure that peoples needs are fully assessed before they are admitted to the home to make sure that their individual needs can be met there. Evidence: At the time of the site visit there were seven people living at the home. There was a voluntary embargo on admissions and two funding authorities had withdrawn their service users from the home. Since the last inspection the management of the home have contracted a team of consultants to support their assessments and care planning for the people that use the service. On the day of the site two contract managers from a local health authority were Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: visiting the home. They stated that they are visiting the people that they have placed there at least every two weeks. They also said that there had been great improvements in the homes assessment and care planning abilities. They also said that they would have no problems admitting anyone else to the home as long as their needs were within the registration of the service. The Commission spoke to four of the people that use the service and asked them about how they came to live at the home. One person said I was brought to look around and decided to stay here. The Service User Guide and the Statement of Purpose for the home were observed and the information detailed the services available through the home. However these needed to be developed further and include various formats to make sure that the people that they are intended for can understand them. This could include using pictorial guides. The management of the service agreed that this was important and said that it would be implemented shortly. They also said that this may be an area that their consultants help them with. We looked at the care files for three of the people that use the service. These all included an assessment of their needs provided through their placing authorities. These described the care needs of the individuals that they involved. The management of the home have developed new admission assessments of need to make sure that the people that are admitted to the home can have their needs met there. These documents were beginning to provide evidence that they are planned in a person centred care perspective. Due to the admission embargo on the home these documents have not yet been implemented. At the time of the last inspection of the service unregistered buildings were being used by the service. At the time of this site visit none of the unregistered units were occupied. Care Homes for Adults (18-65 years) Page 11 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This means that the people that use the service can be confident that their needs can be safely met through the services provided at the home. Evidence: The Commission looked at the care plans for three of the people that use the service. The manager of the service stated that all of the care plans in the home were being updated on new documentation that demonstrated person centred care. The completed care plans seen by us were very clear and identified peoples individual care needs and how they need to be supported with these needs. We also spoke with a consultant that was in the home on the day of the site visit and they stated that they have been involved in developing the homes documentation including the individual care plans to make sure that they identified and supported all of the individual needs of the people that use the service. They stated that the management and the care Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: staff have been very involved in the development of the in paperwork in the home and were gradually introducing it in to any working files in the home. The consultant and the commissioning managers that were spoken to at the home by the Commission both stated that the management of the service had asked their advice on the training that was needed for the homes staff to be able to safely deliver care to the people that live at the home. The staff training records showed that all of the mandatory training had been completed by all of the staff and additional training in relation to the individual needs of the people that use the service had been completed. This included care planning learning disability, risk assessment and challenging behaviours. We spoke with three of the people that live at the home to see what their experiences of care were. One person said Its good here, the staff are great and another said Ive been out this morning. I have come back for dinner. One of the Commissioning managers stated said that there had been a change in the whole demeanour of the home and stated that the quality of the homes care plans had tightened up. People said that they had been given the opportunity to visit the home before being admitted there. The manager of the home stated that the introduction of the homes new assessments of need and care plans should ensure that people will not be admitted to the home outside of its registration categories. Consultants had also been used by the service to help them devise appropriate risk assessment tools. These were seen to have already been introduced alongside care plans where they were needed. The consultancy firm had also provided risk assessment training to all of the care staff. People spoken to by the Commission knew about their care plans and said that they had some involvement in creating them. Some of the homes care plans had also been supported with pictorial images to help the people that they involved understand them better. The care plans were also supported with daily and night time records, however these were very task orientated and did not identify how people had been during their tasks. These records would be improved if they gave clearer detail of how people reacted to the things that they were involved in. This may also help to identify challenging behaviours at an earlier stage for example if the behaviours are in Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: response to particular circumstance or stimuli. 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 using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This means that the people that use the service have good opportunities to follow their interests and hobbies while they are resident at the home. Evidence: The Commission observed the routines and the activities taking place during the time of the site visit and spoke to people living in the home and the care staff that were working with them. A good range of activities were available in relation to leisure activities. On the day of the site visit one of the people that uses the service was looking at brochures for different activities with a member of staff to see what they wanted to do over the Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: following weeks. This included walks, visits to pubs and cafes, bowling, swimming and going to the seaside for a fish and chip meal. One person stated that the care staff help them to go on holidays of their choice and said that they would like to go to Spain this year. Another person that uses the service said that the care staff supported them with personal relationships and this included taking them on visits to see their family and friends. However one person had specific needs in relation to the contact that they wanted with their family and this had not been reflected in a care plan. Staff spoken to by the Commission were aware of how individuals needed to be supported to maintain and develop their personal, social, emotional, communication and independent living skills. Peoples individual care plans identified the activities and hobbies that they were interested in. The people that that use the service that were spoken to said that the food provided in the home was of a good quality and they had choices on a four week rotating menu. They also stated that they had been asked the type of food that they wanted to be included on the menu. Cooked meals were available at all meal times including breakfast. One person said I like to have bacon and eggs for breakfast. Observation of the dinner time at the home supported the evidence that alternative meals are available to the people that use the service. One person had chosen a meal and then didnt like it as it was too spicy for them. They asked for something else a different meal of their choice was provided for them. Fresh fruit and fruit juices are available at the home throughout the day and home cooked vegetables are also provided. Peoples care plans referred to promoting healthy diets and healthy options were available. One person said that they were on a diet and the staff where helping to support these needs. 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. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This means that the people that use the service have all of their personal and healthcare needs supported through the services provided by the home or through their professional partners in the community. Evidence: As stated earlier in this report the home is beginning to develop and introduce new care plans for all of the individual needs of the people that use the service. The examples seen by the Commission are designed in a way to promote person centred care. This included detailing how people had their health and personal care needs met. Discussions with people that use the service, interviews with management and staff and direct observations sported the evidence that people are encouraged and are supported to have their personal and healthcare needs met at the home. Individual care files that were observed by the Commission showed how peoples health and personal care needs were met. This included details of when people have Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: any contact with outside professionals including social workers, GPs, community nurses, dentists and opticians. Entries on each record checked showed the involvement of a range of health professionals that support the care needs of the people that use the service. Care plans also included information relating to individuals diagnosis. One person said that when I want to see my doctor I can. We looked at the care records for three of the people that use the service. Good progress was observed in the health and personal care plans for the people that use the service. These gave clearer details of how individuals problems affected their daily lives. Administration of prescribed medication in the home is only carried out by staff that had satisfactorily completed accredited medication. Observation of staff training records supported this. Direct observations were made at one of the medication times at the home. All relevant legislation and good working practices were followed. All of the medication records were up to date and had been accurately recorded. As recommended in previous inspections two people signed for each administration of prescribed medication. Management of the service stated that towards the end of February 2010, the home was changing its supplier for prescribed medication. They believed that this would improve the quality of the administration of medication in the home and also made sure that the staff would be updated with their medication training and regular review would be made of the medication that they had on stock at the home. At the time of the site visit to the service there were no controlled medications prescribed for people to use. The service however did have the facilities to safely store, record and administer controlled drugs. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This means that the home has the policies and procedures in position to safeguard people from harm. Evidence: At the time of the site visit there were still safeguarding investigations open with the local authorities. They stated that the service was working well with them to resolve any problems and improve services to minimise any risks to people that use the service. There had been five referrals to the local safeguarding teams since last year and so far only two of these have been resolved. Both of these cases resulted in no further action. The home had developed a new complaints and suggestions system. The complaints log registers any complaints that are received by the service, the investigation process and notes any outcomes from the investigation. Since the last inspection of the service there had been no complaint recorded in the home. The suggestions system has been established for people to put their views forward in relation to how they think that services can be improved at the home. Residents meetings are also held on a regular basis to make sure that they can state their opinions in the home in a safe Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: environment. People that live at the home were asked if they knew how to make a complaint about the service if they had one. One person said If I wanted to complain I would tell the staff. The home also has access to an advocacy service and the management of the home tries to encourage people that live there to have an advocate. Information about the advocacy service was available in the public areas of the home and individuals care files identified when they had an advocate involved in their care. Staff training records and interviews with care staff and management supported the evidence that they understand what could constitute as a concern or as a safeguarding issue and they were all aware of the local safeguarding teams polices and procedures for reporting allegations of abuse. The Commission observed the staff recruitment and training records for four of the staff that work at the home. Three of these files showed that people did have a Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) check prior to commencing employment at the home. This was also supported with references and a suitable employment procedure. This helps to make sure that these people were safe to work with the people that live at the home. The fourth member of staff did not receive their full CRB until after they started work at the home. They commenced work on 17/08/2009 and did not receive a completed CRB until 26/10/09. The management of the home were reminded of the importance of having the CRB before they commence working at the home to help to safeguard the people that are living at there. The home also has a clear whistle-blowing policy and procedure and the staff that were spoken to appeared to be very aware of this. 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. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This means that the environment provided at Community Places is homely, safe and comfortable for the people that live and work at the home. Evidence: As part of the site visit the Commission made a tour of the premises to make sure that the environment was suitable and safe for the people that use the service. Three people also invited the Commission to look at their individual rooms. These had all been furnished and decorated to their own personal tastes and preferences. One person said these are all my things in here and another person told how they had been involved in the decoration of their room. They said I was asked to choose the colour. People that live at the home appeared to be generally very happy with the environment in the home and in its gardens. Their comments were all very positive and people felt that the home was kept clean and tidy. The observations supported that the home was clean, well maintained and was free from any offensive odours. Professional visitors to the home on the day of the site visit also confirmed that Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: whenever they visit the home it was always clean and tidy. The home has an activities room and included in this area are board games and a pool table. A computer is available for people to use in the main sitting room. The service has also bought a Wii Fit for the people that use the service. This appeared to be very popular with them on the day of the site visit. One person said I like playing bowls on it. The outside area of the home includes seating and plants and was well maintained. Observation of documentation in the home supported the evidence that routine checks and maintenance were carried out to make sure that all of the equipment in the home was working well and in a safe condition. The manager was aware of precautions regarding preventing the spread of infections. The manager of the home said that they were considering changing the use of the staff toilet area to a wet room for the people that use the service to have more choice in the way that they have their hygiene needs met. During the tour of the premises there were some minor concerns identified. This included some exposed hot water pipes in bathrooms and toilets and a sluice room where no hot water was available. Both of these issues were raised with the management of the service and before the Commission left the home the pipes had been covered for safety reasons and a hot water supply was returned to the sluice room. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This means that the staff working at the home have all of the necessary skills and knowledge to safely care for the people that use the service. Evidence: The people that live at the home were generally very happy that the care and personal support they received was appropriate to meet their individual needs. On the day of the site visit individuals were talking to their link workers planning activities for the summer and also planning for individual holidays. One person said Ive been in a lot of places but I like the staff here. The staff that were interviewed and those that were observed interacting with the people that use the service said that they felt that they clearly understood their roles and responsibilities and those of their colleagues. The staff also stated that they felt very confident with the support that they received from the management of the service. Staff training records and interviews with management and staff showed that the whole staff team has undertaken a wide and extensive range of training since the last inspection of the service. The training included: Schizophrenia, Personality Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: Disorder, Challenging Behaviour, Safeguarding Adults, Fire safety, First aid, Health and Safety, Moving and Handling, Food hygiene, Infection Control, COSSH, Teenage Suicide and self Harm, Substance Misuse, Person Centred Planning, Effective Supervision, Makaton, Medication and NAPPI training. The consultancy firm and the Commissioners of care that were in the home on the day of the site visit, confirmed that the management of the service had consulted with them to identify appropriate training for the staff group. Four staff recruitment and training records were seen by the Commission and showed that new staff had been appropriately recruited to work at the home. However as identified earlier in the report there was one concern over a late CRB check. The service provided evidence to support their induction process for new staff. This includes all staff undertaking LDAF training. The management of the home stated that they had been concentrating on making sure that all of the staff had received the training to provide them with the necessary skills and knowledge to safely care for the people that use the service. This has had some repercussions in the supervision that has been provided to the staff since the last inspection. The management of the service were reminded that supervision in the home an important part of staffs development and monitoring of their work. The managers agreed with this and said that supervision would now be one of the homes priorities to re-establish an effective supervision system. This will help to make sure that the staff have the skills to care for the people that use the service and keep them safe. The home employs thirteen care staff and six of these have completed NVQ 2 in Care. A further four staff are registered o the award and are working towards it. Four staff were also registered for NVQ 3 in care. This means that approximately 46 of the staff had so far completed their NVQ 2 training. When the remaining four people have completed their NVQ 2 that will mean that 77 of the care staff will have achieved their NVQ 2 or equivalent in care. 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. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This means that the management of the home understands and is supportive of the needs of the people that live and work at the service. Evidence: Since the last inspection of the service the management of the home had made a great effort to improve the quality of care provided to the people that live there. This had included contracting a consultancy firm to help with the staff training and to support the supervision of the homes manager and completion of regulation 26 reports for the service. The Commission spoke with the manager of the home, the responsible individual, the staff team and the people that live at the home. Everyone responded that the management of the home was open and approachable. The staff also stated that they had much more confidence with the management team that they previously had. The Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: outside consultant stated that the manger of the home was more confident in her role than she previously was. The Registered Manager of the home had completed the Registered Managers Award and had recently completed a degree in Personality Disorders, a Diploma in Learning Disabilities and had several years experience of working in different care settings. The Responsible Individual is available every day at the home. People that live at the home that were spoken to by the Commission said that they were able to talk to them if they wanted to. The responsible individual was also observed throughout the day interacting with the people that use the service. Since the last inspection of the service the unregistered premises are no longer occupied. A number of records were seen that contained basic information, such as daily records. Many of the records in the home did not include either the date that they had been completed, or had not been signed by the people that have completed them. Peoples finances, where held by the service, appeared to be accurately recorded. Two samples of peoples finances were observed by the Commission. The services Annual Quality Assurance Assessment had not been requested from the service before the site visit took place. However it was discussed with the management of the home and the commission stated the importance of returning a comprehensive report when it is requested. This will help to determine the frequency for the next inspection of the service. The service is receiving support from their consultants to develop an effective quality assurance and monitoring system for the service. The Commission reinforced to the management of the home the importance of having a system that gives them the opportunity of finding out how other people view their services and identify say improvements that they may have to make. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes R 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 1 2 14 The needs of people must be 13/12/2009 assessed prior to being admitted to the home. This is to ensure that their needs can be met. 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 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 23 18 The registered person must make sure that new staff have all of the appropriate safety checking completed before they commence to work at the home. This will help to support the health and safety of the people that live at the service. 25/02/2010 2 36 18 The registered person must make sure that the staff receive regular formal recorded supervision. This will help to make sure that the staff have the knowledge and skills to safely care for the people that use the service and understand their roles and responsibilities. 30/07/2010 3 39 24 The registered person must develop an effective quality assurance and monitoring system. 30/06/2010 Care Homes for Adults (18-65 years) Page 28 of 30 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 This will help to identify any improvements that are needed at the service Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 The registered person should make sure that all of the new person centred paperwork is introduced to everyones care files that are resident at the home. This includes pictorial plans for people that would benefit from them. This will help to make sure that people have their care needs met in ways that are safe and are acceptable to them. The registered person should make sure that individual care plans and other records concerning their care provide more detail. This will help to identify any patterns of behaviour and allow for early interventions to be applied that minimise any risks to the people involved. The registered person should make sure that the homes complaints procedure is accessible to everyone that lives at the home and is provided in formats suitable to their needs. The registered person should continue with the homes commitment to NVQ training to make sure that a minimum of 50 of the care staff have achieved their awards. The registered person should make sure that all documents that are completed by the home are fully signed by the people completing them and a full date is included. This will help to identify anyone involved at a later date if it is required. 2 6 3 22 4 32 5 41 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. 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