Care Home: Cranbrook Road (477-481)

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What the care home does well The service is flexible and is able to respond effectively to the needs of the people who use the service. It offers a safe, secure living environment, with well trained staff support, which enables service users to take acceptable levels of risk in their lives. The home has good staff retention and this reflects in the care being provided, as the staff are very aware of the service users needs. The manager and staff are working with the service users to enable them to retain a level of independence and to express their wishes and needs. All of the service users have comprehensive care plans together with any associated risk assessments. All of the people who use the service are encouraged to participate in daily activities within the home and leisure activities within the community. Contact with families is also seen as a priority and service users visit their families regularly and are also encouraged to keep in contact with their friends and families via phone calls. People who use the service comments were, "I like living here", "the staff are good to me", "they look after us well". Relatives comments include," staff are lovely,S is well looked after there, she is very very happy". "My daughter was admitted to Cranbrook Road, and settled in very easily thanks to the staff who went to great pains to make her feel welcome." Another parent stated on the homes feedback form, "On our initial visit the staff were very friendly and helpful and any questions I had were answered fully. The atmosphere at Sahara house was a happy one and I felt at ease leaving my daughter in their care. When L finally went to stay they knew so much about her as the staff had read the assessment from social services. I was amazed at how much they knew, it was great. I was told I could telephone whenever I wanted to check on L and was also told that it had an open door policy so I could visit or pop in, whenever I telephoned, on numerous occasions staff were friendly and helpful. A fantastic job done by all". As far as possible all people who use the service are supported to contribute towards the daily running of the home, primarily through service user meetings, informal discussions and key worker sessions. Family forum events are held on a regular basis to involve and inform them about the running of the home. Staff training is given a high priority and 90% of the staff team have achieved NVQ Level 2/3 qualification. What has improved since the last inspection? The requirements set at the last inspection have been met. There is an on-going programme of refurbishment of the home. What the care home could do better: The service must recruit a competent manager to operate the service who must be registered with the Registration team, Care Quality Commission as a fit person. It was suggested to the operations manager that they use the Key Lines of Regulatory Assessment (KLORA) to assist and continue to identify and evidence the excellent quality of the service provided. Further improvements will be acheived by implementing the changes identified in the Annual Quality Assurance Assessment. Key inspection report Care homes for adults (18-65 years) Name: Address: Cranbrook Road (477-481) 477-481 Cranbrook Road Ilford Essex IG2 6ER     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: Harina Morzeria     Date: 2 8 0 9 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: Cranbrook Road (477-481) 477-481 Cranbrook Road Ilford Essex IG2 6ER 0205542057 02085186091 mandy.warren@saharahomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Sahara Homes Ltd care home 19 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: 19 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection Brief description of the care home 477 Cranbrook Road is a care home providing accommodation and support for service users with a learning disability/ physical disability and associated challenging behaviours. The registered providers are Sahara Homes Limited. The home is registered to accommodate 19 service users in two separate units of 10 and 9. House One is wheelchair accessible and has a passenger lift. House Two is more suitable for service users who are independently mobile. The home is situated in a busy residential area of Gants Hill in the London Borough of Redbridge. The area is well served by public transport and there are many easily accessible facilities and amenities within the local area. The home has its own transport. There is a large rear garden, which is wheelchair accessible. The home aims to integrate the service users into community Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 19 Brief description of the care home life and supports them to access and participate in mainstream as well as specialist resources in the community in which they live, within their individual capabilities. On the day of the inspection the range of fees for the home was between #500.00 and #2,000.00 per week. A copy of the Statement of Purpose and service user guide is made available to both the residents and their family or representative. A copy of both these documents and the most recent inspection report are available in both houses. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 Star. This means that people who use the service experience excellent quality outcomes. This inspection was unannounced and was carried out as part of the inspection programme for 2009/10. The inspector spoke to the manager and staff as well as people who use the service, present at the time of the inspection. A tour of the premises was undertaken and a number of records were checked including staff records and services users files. The manager was asked to complete the Annual Quality Assurance Assessment. Some of the information provided in the assessment has been incorporated into this inspection report. Care staff were asked about the care that people who use the service receive and were also observed carrying out their duties. A tour of the home was undertaken and the rooms seen were clean and tidy. Service users files were case tracked; including risk assessments and care plans, together with the examination of staff files and other home records. These included staff rotas, menus, accident/incident forms, staff records and health & safety records. Additional information relevant to this inspection has been gained from the Care Homes for Adults (18-65 years) Page 6 of 30 Regulation 37 notifications, whereby providers of the service are required to inform the inspector of any significant events occuring in the home which may have an impact on the people who use the service. The inspector had a discussion with the manager on the broad spectrum of equality & diversity issues and she was able to demonstrate an understanding of the varied needs of the service users around religion, sexuality, culture, disability and gender. 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. Care Homes for Adults (18-65 years) Page 8 of 30 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users and their relatives have the information they need to be able to make an informed choice about moving into the home. The assessment of needs and other information received from health and social care professionals means that staff have detailed information to enable them to determine whether or not they can meet the needs of prospective service users. Evidence: A Statement of Purpose is available and the Service User Guide is comprehensive and in a pictorial format, which enables prospective service users to know what the home is like and what specific services they can offer. The Statement of Purpose and Service User Guide have been reviewed and updated. All service users are given a copy of the guide. Admissions are not made to the home until a full needs assessment has been undertaken. The home have a detailed pre admission assessement procedure which is followed by a skilled and experienced member of staff to ensure that the home is able to meet the needs of the prospective service user and staff have the skills and ability Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: to meet the assessed needs through the service delivered. Admission to the home will only take place if the home is confident that the staff have the skills, ability and qualifications to meet the assessed needs of the prospective service user. The funding authority and health professionals would also provide assessments. Further information would be gathered from the prospective service user, their families and an advocate where required. The admission process would be designed around the needs of the prospective service user. The prospective service user would be encouraged to make several visits to the home and have overnight stays to ensure that they like the home and to meet the other service users. This transition period would also allow staff to get to know the prospective service user and to know whether they can meet the service users needs. The AQAA states we encourage the service users to come and visit the home as much as practicable to ensure the right choice is made. We encourage visits for lunch, overnight stays or short respite periods to enable the service user to get a feel of the home and get a taste of what is on offer. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All of the service users identified needs are reflected in up to date care plans and risk assessments. This ensures that service users needs are being appropriately met. Staff provide the service users with assistance and support so that they are able to participate in all aspects of life in the home and are enabled to make independent decisions about their lives. Evidence: The manager and staff have ensured that the service users are involved in the decision making process about their lives. There is a good pictorial care planning system in place that is clear and concise. An individual profile of the service user is drawn up using information gathered from various sources for example, from the service user, family, social services and other professionals involved in the persons life. The care plans for four service users were case tracked which were completed with the involvement of the service user, key worker, manager and/ or deputy. These are comprehensive documents and cover areas of the service users lives such as; how I eat, how I communicate, my medication, my mobility, how I sleep, likes and dislikes, Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: things that are important to me, what I need help with. Pictorial, sign and photographic cues are in place to aid the making of choices. A comprehensive individual profile of each person is in place to enable staff to better understand and interatct with individual service users. For service users in the home who are nonverbal, staff have found various means of communicating with each individual to seek their views. This was evident during the course of the inspection. The AQAA states, use of multi-disciplinary team and advocacy where shortfalls are detected in the ability of the service user to voice their individual needs or make choices. The care plans include needs identified in relation to a persons ethnicity for example, for one person who braids her hair in different African styles appropriate guidelines and risk assessments were in place to support the hairdresser to facilitate this, as it involved the use of boiling water in the braiding process. For another person their care plan stated, I am unable to rise from the chair without help from the staff. I need assistance to get dressed. I can identify when I feel unwell, staff need to act upon what I tell them. For another person her religious needs are identified and facilitated by the staff, as she states, I am Church of England and like to go to Church every Sunday, when I am not visiting my sister. Comprehensive health action plans are in place for each individual including nutritional, falls,pressure care, moving and handling, well being and ill being. These are regularly reviewed. The key workers also seek feedback from speech and language therapists as well as the community matron who visits the home regularly. The matron commented ,The manager has empowered staff by sending them for training, staff always ask questions and act on any instructions given. The care plans include comprehensive risk assessments which are regularly reviewed and updated as the individuals needs change. For example, evidence was seen that risk assessments were in place for two people who self medicate and a monitoring form is used to assess their ability to self medicate on a monthly basis. The manager is aware that risk assessments must be continually reviewed to reflect changing needs and record how decisions have been made and who was involved. There is a focus on maintaining and promoting independence whenever possible, and individual staff were observed providing service users with information, assistance and support and were respectful of their right to make decisions. For one person who had requested a key for her bedroom the care plan stated,to provide -- with a bedroom key as she has requested, to assist with independence. Each service user works on a one to one basis with staff/their key worker about how to maintain their independence skills such as tidy room, change bed linen, do own laundry and make breakfast. The manager stated staff are being encouraged to engage with service users to further identify their individual interests and capacity and are attempting to motivate people to pursue these in order enhance the variety of activities provided and their Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: level of independence. Daily logs seen indicate how peoples needs are being met. Care Homes for Adults (18-65 years) Page 15 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. Opportunities for social and leisure pursuits and personal development are actively promoted and supported by staff for all people who use the service to enable them to participate in the wider community in which they live. People who use the service are provided with appropriate, varied and nutritious meals, staff promote healthy eating and individual preferences are catered for. Visitors are made to feel welcome in the home and people who use the service are supported to maintain and establish family links and friendships Evidence: The service has a strong commitment to enabling service users to develop and maintain their skills including social, emotional, communication and independent living skills. The staff have sought the views of the service users and considered their varied interests when planning the routines of daily living and arranging activities both in the home and the community. Service users care plans identify lifestyle choice such as Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: local leisure activities, activities within the home and family contact which are very flexible and show that the service users have been consulted about making choices in major areas of their life. For example, one service user is being supported by staff to do the twenty one kilometer run at Hyde park and was training for it. He has enrolled at the local gym and goes training with the Ilford running club. He told the inspector that he thoroughly enjoyed this activity and that staff help him when he needs their assisstance. Service users who are non verbal are fully supported by staff to make their own choices about their daily activities. Each person has an activity planner which is displayed where the service users see them regularly, these are broken down in to individual days rather than a weekly activity plan. The plans list various activities they like to do such as bowling, snooker, pub, freetime, keyworker session, free choice, mudchute farm, and also include developing independent living skills such as preparing and cooking lunch, tidy bedroom and washing. People who use the service are encouraged and assisted to stay in contact with friends and relatives. Most of the service users have some form of contact with their families/representatives who may visit them regularly and staff also help people to remain in contact with their families via phone calls and home visits. All service users have a birthday celebration to which family and friends are invited. Those service users spoken said that they liked the food and there is sufficient choice. The staff prepare and cook meals with involvement from some of the service users and staff know what each person likes to eat. The evening meal was observed to be hectic, as two of the service users were preparing separate meals on different cookers, one was using halal meat for his meal. Staff were patient and helpful, and the service users were clearly enjoying the activity. During the visit, the inspector checked the menus which constituted a varied and nutritious diet taking into account personal preferences hence menus are flexible and take into account peoples differing dietary, cultural and religious needs. Care Homes for Adults (18-65 years) Page 17 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are prompted and encouraged to take responsibility for their own personal care. Service users physical and emotional health care needs are monitored and this ensures that their needs are recognised and met. The medication policies and procedures are clear. Staff have undertaken medication training in order to ensure the safety of the service users Evidence: People receive personal and healthcare support using a person centred approach with support provided based upon the rights of dignity, equality, fairness, autonomy and respect. Personal health care needs including specialist health, and dietary requirements are recorded is each person centred care plan or health action plan. Care plans and daily records were examined and discussed with the manager. The care plans clearly identify health and personal care needs and how these needs should be met. Whilst some of the service users require encouragement and prompting, others need physical assistance. The delivery of personal care is individual and flexible, consistent, reliable and person centred. Service users have a choice in relation to same gender care preferences when receiving personal care, and their care Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: plans set out how their personal care is to be provided. Records inspected showed that service users have very comprehensive personal health records and health action plans; all of these have been reviewed within the past six months. As stated above a health action plan has been developed for all service users. Most of the service users have a high number of specialist medical appointments and staff support them to attend these and follow up on actions required. Appropriate referrals are made for individuals to specialist health professionals for example physiotherapist,psychologist,diabetic nurse specialist and community learning disability service. Service users are supported to access dental care, opticians, chiropody, GP as required. At the time of inspection, the inspector was informed that the community learning disability team are carrying out a health needs assessment and are going to compile a hospital pack so that when service users need to be admitted to hospital all the health information about the individual is collated in one pack which they can take to hospital with them so that hospital staff know how to care for that person. The manager pointed out that they have good partnership working with colleagues in CLDT and advocates. Staff have access to training in health care matters. The aims and objectives of the home reinforce the importance of treating individuals with respect and dignity. There are policies and procedures for the handling and recording of medication within the home. Staff have received medication training and there is a list of staff (with their signatures) that are competent in the administration of medication. The manager and deputy carry out audits and check competency levels to ensure that staff are administering medication appropriately. Refresher medication administration training is provided to staff on a rolling basis. One service user self medicates with staff support and staff monitor their ability to continue doing this on a monthly basis and appropriate risk assessments are in place. Feedback from the pharmacist is as follows, medication always ordered on time and record keeping very good ie MAR sheets. Care Homes for Adults (18-65 years) Page 19 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users views are listened to and acted upon. Service users are protected by the homes safeguarding adults policies and procedures and the monitoring systems within the home. Evidence: The home has an open culture that allows service users to express their views and concerns in a safe and understanding environment. There is a clear complaints procedure, which is available in written and pictorial format which is easy to understand. It is available upon request in a number of formats (other languages,sign,makaton,large print). A copy of the procedure has been made available to all of the service users and is displayed in a number of areas within the service, as well as the entrance to the home and in communal areas. Service users and others involved with the home do understand how to make a complaint and are clear about the procedure that will be followed if a complaint is made. The manager informed the inspector that there is always a discussion around the complaints procedure at each family forum event.A relative spoken to confirmed that they were reminded of how they can complain at one of the forums. Evidence was seen that all complaints received are investigated and the manager makes sure that individuals are regularly updated on the progress of any investigation into their complaint.The manager is aware that all complaints, no matter how small should be recorded so that they can be evaluated over a period of time to establish any patterns and take action to remedy this.The AQAA states that a complaints audit takes place regularly to track Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: them, paying attention to any themes emerging. The manager has worked hard with staff, service users and their representatives to see complaints as a positive tool to be used to improve services, not damage them. Service users were asked individually what they would do if they were unhappy with anything at the home, responses included, they would tell the manager, key worker. The service users spoken to told the inspector that they were happy at the home. There are weekly service users meetings, this ensures their views are listened to. The service users are encouraged to participate in decision making on issues, activities and events within the home. There is also a suggestion box in the foyer to encourage communication. All staff working in the home are fully trained in safeguarding adults and know how to respond in the event of an alert. There is a comprehensive safeguarding adults policy and procedures; there was evidence that these have been read by the staff. All staff receive this training during their induction period and complete refresher training periodically. Staff members are clear about what constituted abuse and their responsibility to report any potential or actual abuse. Staff files indicated that all members of staff have attended safeguarding adults training. The inspector is informed of any safeguarding concerns and the appropriate procedure is followed should any incident arise. All staff understand what restraint is and alternatives to its use in any form are always looked for. Incidents when this method has to be used are recorded and staff have received training around restraint techniques and to always opt for the least restrictive action in any situation. A number of restraints have been recorded in relation to one service user. This was discussed with the manager who said that following a review, staff have been advised to follow other less restrictive measures to deal with behavioural issues. A review of the appropriateness of the persons placement has also been requested. Care Homes for Adults (18-65 years) Page 21 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is very welcoming and the furnishings are of a good standard. The living environment is appropriate for the particular lifestyle and needs of the service users living there. Evidence: The home was toured at the start of the inspection, some bedrooms and all communal areas were viewed with the manager. All the bedrooms are single with full en-suite facilities. The home provides an environment that is appropriate to the specific needs of the people who live there. The home has been refurbished recently and is therefore, well decorated in a homely fashion with modern furnishings and all areas of the home were well-maintained, clean, tidy and odour free. The bedrooms were individually decorated and personalised with the service users own possessions. In both houses there is a kitchen and a separate dining area. The service provide an environment that fully meets the service users diverse needs for example, the kitchen in one of the houses has two cookers and separate cooking utensils to meet the needs of service users who cook halal food. The service provides a friendly home which encourages independence of service users in an environment which is personalised and appropriate to meet the needs of people with learning disabilities. The service users are encouraged to see the home as their own, it is a very well maintained home and has very good access to community facilities and Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: services. There is a range of up to date specialist equipment and adaptations to meet the individual needs of people who use the service. The bathroom, shower room, hallway and stairs are fitted with appropriate aids and adaptations and all are adequately maintained.A lift is also available. Adaptations and specialised equipment are obtained for service users who require this to maximise their independence. The kitchen was clean, tidy and spacious. The kitchen is suitable for the service users to carry out domestic tasks, such as washing up, making cups of tea and preparing meals/snacks. There is a garden to the rear of the home which has ramped access, that service users make full use of during the warmer months. There is a selection of communal areas both inside and outside of the home. Service users are able to receive their visitors in the lounge or their own bedroom, which have comfortable armchairs or the garden in the warmer weather. The service users are fully involved in decisions about the decor and any changes to the accommodation. The home is well maintained and there was evidence that all repairs are dealt with promptly. Service users spoken said they feel safe and secure in the home. The home is close to community facilities and local services with good transport links. Some service users have a key to their room as well as the front door subject to a risk assessment and where this is agreed in their plan. The service does not employ any domestic staff and care staff have the responsibility for the cleaning. The service users are responsible for cleaning their own rooms as part of independence training. The home has a robust infection control policy and would seek advise from external specialist if and when required. Care Homes for Adults (18-65 years) Page 23 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels are satisfactory and there are sufficient staff on duty to meet the individual assesed needs of the service users. Service users benefit from a committed, culturally diverse staff team, who have the skills and training to meet their needs. The procedures for the recruitment of staff are robust and provide safeguards for people living in the home. Evidence: The home provides twenty four hour support to service users, with sufficient staffing levels maintained at all times to meet the needs and activities of the service users in an individualised and person centred way. There is a diverse staff team that has a balance of the skills, knowledge and experience to meet peoples needs. The employer demonstrates a pro-active approach to staff recruitment which incorporates equality and diversity throughout the recruitment, induction and training process. Staff spoken to were aware of individual service users needs which enabled them to deliver effective person centred care. They stated that the staff team support each other and share skills and knowledge with colleagues. The staff team were refelctive of the ehnic/cultural backgrounds of service users in the home. Hence, through observation and discussion it was evident that staff have a good understanding of their roles and responsibilities and of the individual and collective needs of service users. There is a Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: staff handover at the beginning of each shift and regular staff meetings take place. Supervision sessions are regular and staff confirmed that they find them helpful with a focus on improving outcomes for people using the service. Staffing levels reflect the needs of the people using the service and rotas are flexible to fit around the lifestyles of individuals. Records showed that key workers spend specific allocated time with the service users. Through observation it was clear that staff have the skills to communicate effectively with service users, some of whom have complex communication needs, by using for example, makaton, sign and picture books. Staff were seen to interact with service users in a friendly and respectful manner. The AQQA provided by the home stated that all the staff group have acheived an NVQ Level two and/or Level three qualification. Staff spoken stated that they had undertaken a comprehensive induction programme on commencing work at the home. Staff have also completed specific training in relation to learning disability, (LDQ Level two) training and all mandatory training such as health and safety, fire safety, food hygiene,infection control, manual handling, safeguarding vulnerable adults and medication administration training. Staff also do specific training around dealing with physical and verbal aggression and all staff are trained in the use of a control and restraint technique, Non Violent Crisis intervention. There is a good recruitment procedure that clearly defines the process to be followed. The files checked and staff recruited confirmed that the home was clear about what was involved at all stages and was robust in following its procedure. Evidence was seen that some of the people who use the service are regularly involved in the recruitment process and their opinions are sought and respected. The service only confirm permanent employment when satisfied that competence and progress has been shown to be satisfactory. Care Homes for Adults (18-65 years) Page 25 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At the time of inspection, the home was being efficiently managed, service users interests are safeguarded and they benefit from living in a home which is run in their best interests. Monitoring visits are undertaken by the responsible individual to monitor and report on the quality of the service being provided in the home. Evidence: At the time of the inspection,the registered manager was present. She has the required qualification, experience, is highly motivated and competent to run the home. However, the manager informed the inspector that she was leaving the service and the operations director is going to oversee the management of the home until another manager is recruited. The service are aware that any new manager must register with the Care Quality Commission as a fit person to manage the home. At the time of inspection, it was clear that the current manager communicated a clear sense of direction motivating the staff to deliver a service based on the principles of respecting peoples diversity, age, sexual orientation, race, religion or belief and disability. Effective systems are in place to monitor practise and compliance with record keeping, Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: adherence to policy and procedure and management of medicines. The staff team stated that the manager is approachable and available to provide support and guidance at all times. They confirmed that they receive regular supervision from team leaders and responsibilities were delegated to various members of staff so that they have a collective responsibility for the smooth running of the home. There was evidence that the ethos of the home is open and transparent and the views of both staff and people who use the service are listened to, and valued. The AQAA contains good information that is fully supported by appropriate evidence. Discussion with the manager showed she had a high level of understanding about the importance of equality and diversity and there was evidence to show that good progress is being made to identify and meet the needs of people from diverse backgrounds. The AQAA identified areas where improvements need to be made and how these will be acheived. A good quality assurance process is in place to inform its own quality assurance. There are clear lines of accountability through named line managers. A representative of the registered organisation undertakes monthly Regulation 26 monitoring visits to monitor and report on the quality of the service being provided in the home. Currently the manager does not act as appointed agent for any service users. Service users finanacial afffairs are managed by their relatives/representatives. The home has resposibility for managing personal allowances for several service users. Appropriate procedures are in place to handle peoples personal allowances and two people sign all entries to provide safeguards for both service users and staff. Record keeping is of a consistently high standard. Records are kept securely and staff are aware of the requirements of the Data Protection Act. The home has a comprehensive range of policies and procedures to promote and protect service users and employees health and safety. Staff are trained, understand and consistently follow these. There is robust monitoring of its performance by the provider. Health and safety systems are regularly reviewed and updated and are developed on the basis of experience in the home. Staff have undertaken various health and safety related training. The AQAA contained evidence that the home has had all required health and safety checks within the appropriate timescales. The management of the home are aware that it is their responsibility to ensure that the service is operated in a way which ensures that the service users and staff are safeguarded at all times. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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