Care Home: Cornerstones

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What the care home does well From our observations of people during our visit they appeared happy and comfortable. The staff were able to demonstrate a very clear knowledge and understanding of each person and were skilled in communicating with each person and understanding their responses. The care plan files contained an excellent range of information about each person. The information was very clearly written and easy to find and gave care staff clear instructions about how each person wanted to be supported throughout each day. There were a good range of assessment tools used regularly by the home to review all aspects of the health and personal care needs of each person. The assessment tools also helped the home to recognise any potential risks and alerted them to any further action they must take. The records showed the home has liaised closely with all relevant health care professionals and people have received regular health checks and potential illnesses have received prompt treatment. People have been offered a wide range of activities and interests. The home has two vehicles and people also regularly use local bus services or go out for walks in the local area. They have had holidays and lots of day trips to local places of interests. There was a Snoezelum room in the grounds of the home plus other equipment including a running machine, garden swing, televisions and hi fi equipment. On the day of this inspection we saw people going out for walks and car trips, and we saw evidence of arts and craft work. People were smiling and clearly enjoying the activities. People have been offered a varied and balanced diet to suit each person. The staff were able to demonstrate a good knowledge of each person`s likes and dislikes and dietary needs. People`s weight has been regularly monitored. The home has good procedures in place to address all complaints or concerns. There are complaints procedures displayed around the home in different formats to help people understand their rights. The staff we talked to said they were very confident that any concerns or complaints would be listened to and acted upon promptly. They have had training on the protection of vulnerable adults. The bungalow has been well maintained both internally and externally. All areas are liable to frequent damage by the people living there, but the staff team have acted promptly to repair damages, and all areas have been decorated regularly to keep the property looking as homely as possible. Some special measures have been carried out to reduce the possibility of damage including televisions and items of interest being securely boxed in behind toughened perspex. Bedrooms and living areas have been individually decorated and furnished to reflect each person`s interests and preferences. There is a very stable staff team with very low staff turnover. This has resulted in all staff having a very good knowledge and understanding of each person. The staffing levels were good and the level of staff training and qualifications was high. The staff team expressed complete satisfaction in all aspects of their work and there was very good teamwork. The proposed closure of the home has affected staff morale, but despite this the staff team have remained loyal and positive. The home has been well managed. There was a good management structure and the staff team have been well supervised and supported. There were good procedures in place to make sure people`s best interests have been considered at all times. The home has maintained good links with people`s families and kept them informed about all matters relating to the home. The home was clean and safe. Good procedures have been followed to make sure staff and people living in the home are protected from the risk of injury or harm. Staff have received regular training and updates on all health and safety related topics. Equipment has been regularly serviced and maintained. What has improved since the last inspection? No requirements or recommendations were made at the last inspection. They have good quality assurance systems in place to make sure they are constantly looking at the services they provide and considering ways of improving them. They have made a number of improvements in the last three years including new windows, the provision of a Snoezelum, redecoration of the building both externally and internally, New `person centred` plans have been drawn up. What the care home could do better: While medications have generally been safely stored and administered there were a few areas where improvements could be made to reduce the risk of potential errors, and to make sure medicines are stored safely at all times. Key inspection report Care homes for adults (18-65 years) Name: Address: Cornerstones 43-45 St. John`s Road Exmouth Devon EX8 4DD     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: Vivien Stephens     Date: 1 6 1 0 2 0 0 9 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: Cornerstones 43-45 St. John`s Road Exmouth Devon EX8 4DD 01395275892 01395275892 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Premier Living (Devon Partnership NHS Trust) care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: Age range 30 to 60 years Date of last inspection Brief description of the care home Cornerstones provides support and personal care for up to five residents with a learning disability. The home consists of two semi detached bungalows, which are linked internally. One bungalow provides care for one resident and the other can accommodate up to four people. Each of the two units has a lounge, dining room, kitchen, bathroom and bedrooms. The home also has an additional toilet and an office. There are gardens to the front and rear of the property. The home is operated by Premier Living (Devon Partnership NHS Trust). Inspection reports will be made available to service users, their representatives and relatives on request from the home. Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 0 5 5 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: Several weeks before this inspection took place we asked the home to complete an Annual Quality Assurance Assessment (AQAA). They returned the completed form by the date we requested and the form gave us very useful information about their day to day routines and the way the home is managed. We also asked the home to distribute some survey forms for us. We received 5 completed forms from care workers, 4 from health and social care professionals and 4 from people living in the home (these had been completed with assistance from the care workers). The responses we received have helped us to form the judgements we have made in this report. This unannounced inspection began at approximately 10am and finished at approximately 4pm. There were four people living in the home at the time of this inspection. During the day we talked to the manager and three care workers at length. We also spoke briefly to other staff during the day. The people living at Cornerstones have limited verbal communication skills and therefore we were unable to talk to them, Care Homes for Adults (18-65 years) Page 5 of 30 and instead we observed the way the staff team communicated and supported them throughout our visit. We looked at some of the records the home is required to maintain including care plans, medications, and staff records. We also carried out a tour of the home. At the time of this inspection the NHS Trust have given Premier Living a Notice of Closure. The plans for these changes are likely to take place by 31st march 2010. Care Homes for Adults (18-65 years) Page 6 of 30 What the care home does well: From our observations of people during our visit they appeared happy and comfortable. The staff were able to demonstrate a very clear knowledge and understanding of each person and were skilled in communicating with each person and understanding their responses. The care plan files contained an excellent range of information about each person. The information was very clearly written and easy to find and gave care staff clear instructions about how each person wanted to be supported throughout each day. There were a good range of assessment tools used regularly by the home to review all aspects of the health and personal care needs of each person. The assessment tools also helped the home to recognise any potential risks and alerted them to any further action they must take. The records showed the home has liaised closely with all relevant health care professionals and people have received regular health checks and potential illnesses have received prompt treatment. People have been offered a wide range of activities and interests. The home has two vehicles and people also regularly use local bus services or go out for walks in the local area. They have had holidays and lots of day trips to local places of interests. There was a Snoezelum room in the grounds of the home plus other equipment including a running machine, garden swing, televisions and hi fi equipment. On the day of this inspection we saw people going out for walks and car trips, and we saw evidence of arts and craft work. People were smiling and clearly enjoying the activities. People have been offered a varied and balanced diet to suit each person. The staff were able to demonstrate a good knowledge of each persons likes and dislikes and dietary needs. Peoples weight has been regularly monitored. The home has good procedures in place to address all complaints or concerns. There are complaints procedures displayed around the home in different formats to help people understand their rights. The staff we talked to said they were very confident that any concerns or complaints would be listened to and acted upon promptly. They have had training on the protection of vulnerable adults. The bungalow has been well maintained both internally and externally. All areas are liable to frequent damage by the people living there, but the staff team have acted promptly to repair damages, and all areas have been decorated regularly to keep the property looking as homely as possible. Some special measures have been carried out to reduce the possibility of damage including televisions and items of interest being securely boxed in behind toughened perspex. Bedrooms and living areas have been individually decorated and furnished to reflect each persons interests and preferences. There is a very stable staff team with very low staff turnover. This has resulted in all staff having a very good knowledge and understanding of each person. The staffing levels were good and the level of staff training and qualifications was high. The staff team expressed complete satisfaction in all aspects of their work and there was very good teamwork. The proposed closure of the home has affected staff morale, but Care Homes for Adults (18-65 years) Page 7 of 30 despite this the staff team have remained loyal and positive. The home has been well managed. There was a good management structure and the staff team have been well supervised and supported. There were good procedures in place to make sure peoples best interests have been considered at all times. The home has maintained good links with peoples families and kept them informed about all matters relating to the home. The home was clean and safe. Good procedures have been followed to make sure staff and people living in the home are protected from the risk of injury or harm. Staff have received regular training and updates on all health and safety related topics. Equipment has been regularly serviced and maintained. 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 can be confident they would not move in unless they had been given plenty of information and opportunity to get to know the home and feel satisfied it is the right place for them to live. The home has good admission procedures in place. Evidence: The home has a range of written and pictorial information, including a statement of purpose and service user guide, that would be given to any person (and their relatives and professionals involved in their care) who may be thinking of moving in. This information is set out in a format that people who may have difficulty reading can understand. Each person has been given a copy of the Terms and Conditions of Occupancy including information about the fees and how they are structured. The people living at Cornerstones have lived there for a number of years. Detailed assessments were carried out before they moved in. We were satisfied that, if any person was considering moving in at any time in the future, the home has good Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: assessment procedures in place that would ensure no person is admitted unless the home is completely satisfied they could provide the right level of support to meet the persons needs. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs and goals have been met safely and consistently. People are supported by a team of consistent and skilled staff who know and understand each person well and help them make choices and decisions about all aspects of their daily lives. Evidence: The people living at Cornerstones at the time of this inspection had poor verbal communication skills and therefore their ability to contribute towards their care plans was limited. However, there was a stable staff team in place who had worked at the home for many years and knew each person well. They used various communication methods to understand as far as possible each persons wants and needs. Each person had two separate files containing a wide range of information about them. One file was called the Service Design and Person Centred Plan. The information in this file was written as if they were in the persons own words. There was a detailed life history with lots of photographs of the person and their family and friends. There was also detailed information about the persons health and support needs. The whole Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: document was clearly written, easy to read, and gave the reader a very clear picture of each persons personality, likes and dislikes. The care plan files were also set out in a very clear and easy to read format. These gave very clear instructions to the staff team about how each person wanted to be supported each day. We saw and heard lots of evidence of how people have been given choices throughout each day. There were clear guidelines in place to explain to staff how to respect each persons privacy and dignity. We sat with people during their midday meal, and saw staff interacting with each person. The staff team were able to demonstrate an excellent understanding of each persons reactions and were able to provide prompt, calm and cheerful responses and support. Due to the skills and competence of the staff team people have been supported to take part in a wide range of activities both within the home and out and about in the community that in the past may have been considered too great a risk. During our visit people went out for walks or trips out in the car, and we heard about recent holidays and outings that had been a great success. The manager and staff team were able to recognise potential risks and had considered the safeguards necessary to enable the person to do the things they wanted to do. Care Homes for Adults (18-65 years) Page 13 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. People lead varied, interesting and stimulating lives with full access to the local community and families and friends. The home offers people a healthy diet to suit each persons likes, dislikes and dietary needs. Evidence: The people living at Cornerstones have enjoyed a wide range of activities both inside the home and out and about in the community. Due to their limited verbal communication skills they were unable to talk to us about the things they enjoyed doing. However, on the day of our inspection we saw people smiling and happy when they went out for walks and car trips, clearly very enthusiastic about the activity. The manager and staff team were able to demonstrate a very clear understanding of the abilities and interests of each person and they talked about the many things they have introduced since the last inspection, including a Snoezelen room in the back Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: garden, and the introduction of swimming lessons. There was a running machine for one person, a garden swing for another person, and a tent in the garden for another person. Tactile signs have been created on the bedroom wall for a person who is deaf and blind. We also saw some impressive papier mache models made by one person in preparation for Halloween night celebrations. Other regular activities have included visits to the Donkey Sanctuary, local parks, Woodbury Common and the sea front. They have admission cards to local places of interest including Crealy Park and Escot Gardens. Everyone living in the home has a bus pass for local journeys and the home has two vehicles to take people out for other trips. One person has received support from the Additional Support Team at Creative Therapies and a programme of activities has been developed. Everyone living in the home has had a holiday each year. We heard about the holidays people have had this year and some of the fun and enjoyment they had experienced. The manager, Jackie Platt, told us how she has actively encouraged people to keep in touch with their families. Where families have been unable to visit the home regularly the manager or a staff member has taken the person to visit their family. There were photographs around the home of some of the families, and evidence of regular visits and communication with the home. The manager and staff team demonstrated great sensitivity and professionalism in recognising peoples sexuality and the need for privacy and dignity. We sat with three of the people living in the home and the staff group for the midday meal. The staff talked about how people have been consulted and involved as far as possible with menu planning. The staff had a very good knowledge of each persons likes and dislikes and had used this knowledge to plan healthy and varied menus. Peoples weights have been regularly monitored. The home had provided special plates where necessary to help people eat their meals with minimal assistance, and the staff were sat at the table with them to give gently prompts or support when needed. Menus have been regularly discussed at staff meetings to ensure they are varied and regularly adjusted to suit each person. Care Homes for Adults (18-65 years) Page 15 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 receive the personal and health care support they need from experienced and well trained staff. Support is given in a way that respects peoples privacy and dignity and well being. Medications have generally been stored and administered safely, although there are a few things the home could do to make the administration systems even safer. Evidence: The care plans provided clearly written and detailed information setting out each persons daily routines and the way they needed to be supported with all personal care tasks. The staff team were able to demonstrate a close relationship and understanding of each person and were sensitive to each persons moods and reactions. There were a range of assessment tools in place to make sure the persons health was closely monitored, and we saw and heard evidence of the homes close liaison with all relevant health and social care professionals. We heard how the home had used their knowledge of each person to spot early signs of possible illness and to make sure health professionals took appropriate action. Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: We received four completed surveys from health and social care professionals who regularly support people living at Cornerstones. They were all positive about the home, although there were a few suggestions for possible areas for improvement. Comments included Given the resource/environment constraints that staff work within there is often demonstrated good examples of person centred practice/attitudes., and Always helpful and concerned. Staff represent views of family members. The home used a monitored dosage system of medicine administration provided by a local pharmacy. All staff had received training on the safe administration of medicines. The medicines were stored securely in locked cabinets. At the time of this inspection no controlled drugs were stored in the home, and there were no medicines that needed to be kept cool. The home did not have secure storage facilities for controlled drugs or medicines that needed to be kept cool. We advised the manager that if such medicines were prescribed at any time in the future they must ensure the correct storage facilities are put in place immediately. The records of medicines administered were generally well maintained. However, there were two unexplained gaps in the records and no evidence that these had been investigated. We asked the manager to check this out and find out what had happened. We also asked her to look at ways of preventing similar mistakes happening in future, and to make sure that all unexplained gaps are taken seriously and investigated as soon as they are found. There was a handwritten entry on the administration charts showing that one persons dose of medication had been changed. The entry was not signed or dated, and there was no evidence to show which health professional had authorised the change. We talked to the manager, Jackie Platt, about the need to provide clear evidence to support any changes authorised over the telephone, and to have a second member of staff to sign the handwritten entry to confirm it is correct. The home relied on the information provided by the pharmacy on the printed medication administration sheets to explain to staff how the medicines should be administered. In some instances more information was necessary, for example, any medicines that were prescribed on an as required basis, or creams and lotions for specific skin conditions. We suggested that additional information on each medication is provided for staff in the files containing the medicines administration sheets and/or in the care plans. Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: Daily reports written by staff provided information about each persons daily activities and evidence of any changes in their health or well-being. There were good communication systems in place to make sure all staff were aware of any changes or events that may affect their care needs. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has good systems in place to make sure people are protected from harm or abuse. People can be confident that concerns or complaints will be listened to and acted upon appropriately. Evidence: The home had several complaints procedures displayed in different formats around the home to help people understand what to do and who to talk to. The home uses pictorial cards to help staff explain the procedure to people and guage each persons responses and understanding. They have not received any complaints in the last year, and no complaints or concerns have been received by the Commission about the home. All staff have received training on the safeguarding of vulnerable adults and further training has also been provided recently through computer based training. The manager has implemented a feedback form to be completed bank and agency staff at the end of a shift. This feedback form asks the staff to confirm if they have received appropriate induction and information needed for their shift. It also asks if the agency staff thought people were appropriately supported. This feedback was designed to make sure that any poor practices or concerns seen by the agency staff were picked up and acted upon promptly. Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: We looked at the records maintained by the home of all cash and savings handled by the home on behalf of people living there. Each person had a building society account and we were able to see clear evidence of all money withdrawn from the accounts and how it was spent. Invoices for purchases have been retained. Balances of cash held in the home have been regularly checked. There were good systems in place to prevent possible financial abuse including liaison and consultation with families and representatives for any expensive purchases. 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 live in a comfortable, well maintained and safe home that has been furnished and decorated to suit their individual preferences and needs. Evidence: The home is laid out in two separate units. At the time of this inspection one person lived in a self contained unit at one end of the bungalow and three people lived in the other part of the bungalow. There were bathrooms, lounges, dining rooms and kitchens in each separate area of the home. We found the bungalow had been well maintained and was in good order throughout. The outside had recently been re-painted and the lawns had been regularly mown. Glass in the windows in one part of the home have been replaced with special mirrored glass to provide greater protection from possible breakage using special glass and to prevent people from outside looking in. This provided added protection to peoples privacy and dignity. Several areas had recently been redecorated and staff were decorating one room at the time of this inspection. In a tour of the home we found all areas bright, modern and homely. Each persons room had been furnished and decorated to suit their individual tastes, interests and preferences. Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: Some furniture and decorations have been at high risk of damage by the people living in the home and where possible items such as televisions and hi fi equipment had been boxed in to reduce the risk of damage. The staff team have worked hard to create a comfortable and homely environment, replacing damaged items or repairing decorations promptly to make sure all areas remain in good order. The manager told us that infection control procedures had improved since the last inspection. All staff havd received training on infection contro,l and equipment and preventative procedures had been put in place to reduce the risk of infection. All areas of the home were clean on the day of this inspection. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by a stable and consistent staff team who have been carefully recruited, well trained and well supported. Evidence: On the day of this inspection there were four staff on duty plus the manager. At night there were two staff on duty. During the early afternoon there was an overlap between the early and late shifts providing even higher staffing levels. This allowed time for non caring tasks such as report writing to be completed. The staff rotas showed that this was the normal staffing during weekdays, apart from weekends when the manager was not on duty. Since the last inspection no new staff have been recruited and therefore we did not look at any recruitment files during this inspection. At the last inspection we were satisfied that the home had followed robust recruitment and induction procedures and we were satisfied these would be followed again in the future if any new staff begin work. The home has used agency staff from time to time and the manager told us she has attempted where possible to use agency staff who were already known to the home, while at the same time seeking an agency that provides value for money. Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: At the time of this inspection 14 permanent care workers were employed. Of these, 8 staff held a nationally recognised qualification known as NVQ level 2, 6 staff held NVQ level 3, 4 staff were NVQ assessors, and two staff held NVQ level 4 and held the Registered Managers Award. This demonstrated the homes firm commitment to good training and a competent staff team. In addition to the above qualifications the staff team have received a range of other training, mainly computer based, on topics relevant to their work, including all health and safety topics and the prevention of abuse. All staff had completed or were about to complete training on equality and diversity. Staff have also received training on epilepsy, person centred planning, autism, conflict resolution and breakaway. Regular staff meetings have been held in the home. During this inspection we talked to three staff members about their work. They were positive and cheerful and clearly enjoyed their jobs. They were satisfied with the way the home was managed and the support and communication systems. They said they felt the training was good. Before this inspection took place we received 5 completed survey forms from staff members. They told us about some of the things the home does well, including Good team support. Good communication. The service users are care, valued, supported and needs are met to a high standard. Advocate for our service users well. Have a nice home environment. Has a regular staff team that has worked her for a long time so service users have built very good relationships with the. Positive management team. Supports the service users well during times when they are anxious. Have a collective range of skills as a team to support service users in all aspects of their lives. Has a very open working atmosphere where management can be approached about any issue, positive or negative. 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 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 well managed and safe. There are a range of procedures in place to make sure people are consulted and their best interests are protected at all times. Evidence: The manager has many years of relevant experience in running care homes. She holds relevant qualifications for the job including NVQ level 4 and the Registered Managers Award. She has completed the Learning Disability Award framework (LDAF) to level 3. She was in the process of completing a degree in Health and Social Care at the time of this inspection. The Deputy Manager was previously the registered manager of another home, and she also has many years of relevant experience and is well qualified. The manager told us that Premier Living managers complete unannounced inspections of each service to make sure all services are constantly operating to a high standard. These inspections also offer the manager the opportunity to seek support and guidance. Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: The staff have been asked to complete annual surveys as part of the homes quality assurance system. Staff have also receive regular supervision and appraisals. The home has kept in touch with families and advocates and encouraged them to participate and have a say in the day to day running of the home. While the people living in the home have limited communication skills the home has used various communication tools to check with each person that they are happy with the care they have received. Recent involvement with the Citizenship team to look at the accommodation needs of each person has resulted in detailed consultation with each person, their families and advocates to look at future accommodation needs. The manager told us that all policies and procedures have been reviewed each year and updated where necessary. We looked at some of the records relating to health and safety including the fire log book and staff training records. We were satisfied that the home has good systems in place to protect staff and people living in the home from the risk of injury or harm. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 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 20 13 A record must be made of 30/10/2009 every medicine administered by the home. Any gaps in the administration records must be investigated promptly and action must be taken in accordance with the homes policy on medicine administration. This is to make sure that people receive all medicines prescribed to them in accordance with the instructions by the health professional who prescribed the medication. 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 20 If controlled drugs, or medicines that must be kept cool, are prescribed to any person living in the home in the future the home should make sure safe storage and recording systems are put in place. Page 28 of 30 Care Homes for Adults (18-65 years) 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 Where changes to the dosage of prescribed medicines are made over the telephone by a medical practitioner any handwritten entries in the medicines administration charts should be signed and dated and witnessed by a second member of staff to provide evidence that the entry is correct. There should also be a record of the medical practitioner who authorised the change. The care staff should have a clear understanding of the administration instructions for all medicines, either on the medicine administration chart and/or in the care plan. Medicines such as creams or lotions, or those prescribed on an as required basis should be clearly explained so that staff understand how, where and when these should be administered. 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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