Care Home: Credence House

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What the care home does well Credence House is a very well run home. People living in the home feel at ease. They tell us that they like the owners and said things like "this is the best place I have ever lived". People tell us the team are very good at finding out about them and ensure that every person has a care plan.People living at Credence House said things like "I have the freedom to do what I want to do". There a few house rules around safety but people tell us these are reasonable. People are listened to. They feel valued.The activities, events and work that people do are tailored to their likes and dislikes. For example, people say things like I like "going to college" and "take turns in doing the cooking". Family and friends are made welcome. Credence House is a comfortable place to live. People see it as their "own home" and tell us it is always clean and well maintained. .Staff are supported and do a lot of training so that they have the right skills and experience to care for people. What has improved since the last inspection? Detailed notes are written when risk assessments are done, to support decisions made with people about when to update or continue a care plan.People get very few colds or flu because the staff do everything they can to make sure people are protected as far as possible. What the care home could do better: People should be able to understand their care plan. This means that for some people it should be in pictures and for other people in easy words. The manager must always do checks on people before they are allowed to work. This will make sure that people are protected that live there. Key inspection report Care homes for adults (18-65 years) Name: Address: Credence House 6 South View Terrace Devon EX393LR three star excellent service The quality rating for this care home is: 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: Susan Taylor Date: 0 3 1 1 2 0 0 9 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Information about the care home Name of care home: Address: Credence House 6 South View Terrace Devon EX393LR 01237477313 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): credance77@btinternet.com Credence Care Ltd Name of registered manager (if applicable) Mrs Elaine Barnes Mr John Keith Huddy Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 5 0 care home 5 learning disability Additional conditions: The maximum number of service users who can be accommodated is 5 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection A bit about the care home Credence House is a large house in Northam. 5 people with learning disabilities live there. People pay £356.54 to £438.19 per week to live there. This is usually paid by Social Services. Additional charges are made for certain activities, hairdressing, magazines and newspapers. There is a car, which is often used to take people out in. Buses pass near the home. There are lots of different bus routes. This means that the people who live at the home can get around easily. 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 How we did our inspection: This is what the inspector did when they were at the care home Credence House is an Excellent Home. It has 2 stars. We looked closely at the experiences of 2 people. included looking at their records with them. This We also spoke to people alone in private, and in groups about their experiences living at the home. We sent surveys to all of the people living in the home and had 4 back. We also sent surveys to staff and had 1 back. The comments of people are in the report. The owner sent us a lot of information about the home, which tells us what is good and what can be better. What the care home does well Credence House is a very well run home. People living in the home feel at ease. They tell us that they like the owners and said things like this is the best place I have ever lived. People tell us the team are very good at finding out about them and ensure that every person has a care plan. People living at Credence House said things like I have the freedom to do what I want to do. There a few house rules around safety but people tell us these are reasonable. People are listened to. They feel valued. The activities, events and work that people do are tailored to their likes and dislikes. For example, people say things like I like going to college and take turns in doing the cooking. Family and friends are made welcome. Credence House is a comfortable place to live. People see it as their own home and tell us it is always clean and well maintained. . Staff are supported and do a lot of training so that they have the right skills and experience to care for people. What has got better from the last inspection Detailed notes are written when risk assessments are done, to support decisions made with people about when to update or continue a care plan. People get very few colds or flu because the staff do everything they can to make sure people are protected as far as possible. What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Susan Taylor CQC South West Citygate Gallowgate Newcastle upon Tyne NE1 4PA Tel. no. 03000 616161 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website http:/www.cqc.org.uk/. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. 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 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 are given a lot of information enabling them to decide whether Credence House is the right place or not for them. The assessment process ensures staff have detailed information about the needs people have and how they are to be met. Evidence: In a survey 100 percent of people responding (4) tell us that they had sufficient information that enabled them to make a decision about whether to move into the home. One of the people living in the home had been involved in developing a guide for prospective residents, which is available in easy read format with photographs. Additionally, there is a taped version. This means that information about the home is easily accessible to people. All of the people at Credence House have lived there for some years. We case tracked 2 people, by talking to the individuals and looking at their care files. The manager demonstrated that comprehensive assessment information had been obtained. Assessments had been regularly reviewed with the individual concerned. Excellent examples seen demonstrated how this had been done with people in a document entitled About me, which contained information about each person; their goals, desires and social networks in a format that was individual to the person and in a total communication format. The home had obtained a copy of the care plan produced for care management purposes for people. There is a system for cascading important information to other professionals that support people living at the home. We looked at another persons file and concluded that this had ensured that continuity of care was paramount for the individual concerned who has a physical disability and is seen regularly by healthcare specialists. Evidence: The manager verified that they had done Mental Capacity Act and Deprivation of Liberty Safeguards training. As a result of the knowledge gained, she told us that she would be doing comprehensive mental capacity assessments for all of the people living in the home. Whilst there was some information about this across the range of care plans we looked at, this did was not explicit about whether the individual had the capacity to make decisions about all aspects of their life. Similarly, the manager demonstrated that they understood that if the person did not have capacity the assessment and plan would need to clearly outline who would be responsible for making best interest decisions of the individuals behalf. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning at Credence House is generally person centred. This might be improved further by ensuring that the diverse needs of people are accounted for by using total communication formats. Evidence: 4 people returned surveys about their experiences living at Credence House. In these people tell us that they can always make decisions about what they do each day, with comments like I am happy where I am and happy doing what I want to. Information sent to us by the provider (AQAA) tells us that they are trying to promote greater independence for people. We read minutes of meetings, which demonstrated that these regularly take place with people in the home. Therefore, people are consulted about all aspects of their life at Credence House. We case tracked 2 people, which included reading the care files for these individuals and talking to them. Both had detailed care plans that had been discussed with the person. Regular reviews had taken place and corresponded with changes in peoples needs. For example, one person with a learning disability requires support to ensure that they keep to a budget with their money. The care plan was clear to follow and instructions were detailed. The main aim was to help the person stay within budget. This included some restrictions for one persons spending, for example, they had agreed to only buy 1 book per month so that they could manage their money better. We read a risk assessment that highlighted that the person had the potential to get into debt. There was a clear strategy in place, which corresponded with the persons care plan to prevent this from happening. Daily records demonstrated that it was being followed by staff. The individual told us that the plan was working and that they only buy 1 book a month and had been able to Evidence: stay within the agreed spending budget. Another persons file highlighted that the person had communication difficulties, which sometimes results in the person not getting their point across. The care plan had been developed to help the individual communicate in a positive way and to build the persons confidence. We observed the care plan being put into effect with the individual in a positive way that respected the persons dignity and encouraged them to be more engaged in decision making. The person confidently showed us their care plan and things which are important to them such as their interest in football for example. Therefore, peoples goals are being achieved. Other people living in the home told us that their care plans are discussed with them individually, and that they are asked what they would like to achieve to maximise their independence. We asked them whether they had a copy of their plan of care, which people said they did not. Some of the people had life plans that had been done with them by professionals involved in the persons care. These were in alternative formats. However, none of the care plans we looked at for the people we case tracked were in an alternative format. Information sent to us (Annual Quality Assurance Assessment) tells us that the provider is aware of this and they intend to improve this by using formats such as easy read and pictorial formats and had sought guidance from the community speech therapist about this. We asked people what involvement they had with the recruitment of new staff. One person told us that they had chosen to be part of the whole process, and would be on the interview panel. This demonstrates that peoples views are taken into consideration and reflects good practice. We looked at 2 peoples financial records. We saw statements and saving account books that verified this. Balances were checked and found to be in order. Two signatures were seen on balance sheets denoting withdrawals. Receipts were kept for items bought on behalf of people and corresponded with entries seen in the records. Therefore, there are systems in place which protect peoples interests and enable them to manage their own finances where possible. 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 have a good quality of life, which ensures they have freedom to mix, make friends and learn new skills. Evidence: In surveys, 100 percent (4) people living in the home tell us that they can do what they want to do during the day, evening and at the weekend. One person commented I am happy where I am and happy doing what I want to. At the home, another person said this is the best place Ive ever lived. I have the freedom to do what I want to do. We looked at 2 peoples files, which showed that they are involved in different activities in the community. For some people this has involved voluntary work. Others have been involved in the community resources doing a variety of creative activities with Branching Out organisation. The home has its own minibus, which we saw people using during the day. We were shown photographs from the holiday in 2009 to Butlins, which people said they enjoyed. The manager told us that some of the activities that people do such as college courses are funded by the provider. Therefore, people have a good quality of life and are encouraged to learn new skills. One of the people we case tracked told us that they are a member of the Devon Christian Fellowship and enjoy going to prayer meetings every week. They also showed us an activity plan for the week and said Ive been to keep fit today, Im trying to lose some weight. Additionally, the person told us that they are doing a photography and computing course at college and proudly showed us a file with all of the course work they had completed. All of these interests had been recorded in the persons social care plan. Evidence: Therefore, staff had a clear plan to follow, which ensured that the individual had access to all the resources in the community that they were interested in. We observed people being encouraged to learn new life skills. For example, one person took responsibility for laying the table at tea time and another individual helped to gather up plates after the meal. Information that the provider sent us (AQAA) tells us that they have tried to ensure that people have more one to one time with their key workers for shopping trips, hairdressing appointments or going to the library. One person who we case tracked showed us the daily records about themselves. We read that this person had made an apple crumble a few days earlier, and they said it was very good. We saw that people were at ease helping themselves to yoghurt, drinks and fruit from the fridge and cupboards during mealtimes. Therefore, people are actively encouraged to contribute towards the running of the home and their efforts are valued. We met the entire group of people that live at the home when everyone returned home after college, work or other activities. They verified that there is a four weekly menu and showed us this. Minutes of recent meetings highlighted that meals are regularly discussed and menus are altered as a result of comments made. Therefore, systems ensure that individual choice is promoted. 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 are treated with dignity and respect. The home works in partnership with other professionals to meet the healthcare needs of the people that live there. Evidence: In a survey, 4 people responding tell us that staff always listen and act on their wishes. From information sent to us by the manager, the gender balance of staff is relatively well matched to that of people living in the home. We case tracked 2 people and looked at how their needs were being met. One person told us that they have problems with blood pressure but its much better since the doctor looked at my tablets. Similarly, daily records demonstrated that the person had also seen the dentist and optician during the year. Additionally, the manager told us that 2 people had recently seen a consultant at the hospital for monitoring and tests. A person with a physical disability required regular monitoring at the medical centre for diabetes. They told us that they had been trying to get fit and showed us a chart, which showed a steady weight loss. The persons care plan highlighted the individuals desire to reduce weight to improve their state of health. Therefore, peoples healthcare needs are well met. Medicines were kept in a locked cabinet securely affixed to the wall in the kitchen. We discussed this with the manager who told us that they were in the process of obtaining a new cabinet for security reasons. Medication Administration Record charts are in use and no gaps in the records were seen. We observed that medicines had been administered as prescribed. One person told us that they had started to self medicate and this is one of the goals in their care plan. The individual had had training in June about the monitored dosage system being used and also safety issues. The person showed us that they had a secure place to keep their medication in their own room. We looked at this persons care Evidence: file. A risk assessment had been completed and clearly set out measures to minimise risks identified, all of which were being followed. We saw a personal medication profile had been completed for an individual whose care we tracked. This had been completed when the person moved into the home and had comprehensive medical and allergy information for staff to refer to. Training records demonstrated that key staff involved in administering medication had received appropriate training. Additionally, the manager said that all new staff was supervised and their competency assessed before being able to administer medication on their own. We saw records demonstrating this on some staff files that we looked at. Information sent to us [AQAA] by the manager highlighted that medication systems are regularly audited. Therefore, medicines are managed safely for people living at Credence House. 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. People living at Credence House are protected and able to voice their concerns, if they have any, safe in the knowledge that these will be dealt with in an appropriate manner. Evidence: 100 percent of people responding in a survey (4) knew whom to complaint to if they needed to. The people living in the home showed us the complaint procedure, which was presented in a total communication format. People told us they are very happy living at the home and have a lot of freedom. Information provided by the manager verified that no complaints had been received. Surveys returned by 2 relatives had comments like the family have every confidence in Credence House and the staff they employ. XXX is very happy and settled there. We spent sometime observing interactions between staff and people living there. Staff engaged with people continuously at the right speed and demonstrated genuine warmth and attention, which people appeared to respond to and enjoy. Therefore, people are respected as individuals and they feel listened to. As discussed under the section Individual needs and choices, the financial systems ensure that people are protected and at the same time given support to promote independence. Training records demonstrated that all of the staff had attended a course covering the protection of vulnerable adults. Additionally, some staff had recently attended a Mental Capacity Act and Deprivation of Liberty Course with the provider. 100 percent of people responding in a survey felt that the staff always treated them well and listened to them. The home had a written policy and procedure for dealing with suspected allegations of abuse. Therefore, there are systems in place, including the training of staff, which help to protect people from the risk of harm or abuse. We discussed Deprivation of Liberty Safeguards with the manager and provider, when they returned to the home after attending training on the subject. They both verified that Evidence: people at Credence House live an unrestricted lifestyle and that there were no issues for people at the current time that would warrant referral to Devon County Council for a Best Interest assessment to be undertaken. 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 excellent 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 well maintained home that is a clean and comfortable place to live. Evidence: We case tracked 2 people, both of whom showed us around the home and their own bedrooms. Both rooms reflected the individuals interests and tastes and one person said I chose this colour and its nice and bright. All parts of the home were well maintained. Information sent to us by the provider tells us that all the appliances and the fire and gas systems have been serviced in 2009. People showed us the file where this is recorded and we saw recent service certificates, which also demonstrates that the home is well maintained. 100 percent of people responding (4) in a survey felt that the home was always clean and fresh. The home was spotlessly clean. We observed people being prompted to wash their hands before a meal. Training certificates demonstrated that all of the staff had recently done infection control training. Information sent to the Commission by the provider (AQAA) tells us that the Department of Health Essential Steps is not used to audit infection control management in the home although the provider and manager said they were aware of this tool. We were unable to observe staff practice in respect of infection control procedures as the manager and provider were on duty at the time. We discussed infection control systems that have been set up to consider the impact of a potential outbreak of swine flu. We were shown procedures and an emergency plan that had been drawn up to help minimise the impact on people living in the home. Therefore, systems are in place to minimise the risk of infection to people that live at Credence House. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment practices at Credence House are not consistently robust and therefore fail to protect people. The home has made good progress with training and development of staff, and ensures that competent and knowledgeable staff care for people. Evidence: 4 people living in the home tell us in a survey that they are always treated well by the staff. We looked at files for 3 staff recruited since the last inspection on 23/10/09. Two written references had been obtained. Additionally, checks had been carried out with the Independent Safeguarding Authority (ISA) and Criminal Records Bureau (CRB)and were satisfactory. However, induction records for these 3 staff demonstrated that all of individuals had started working at the home before some of this information had been obtained. For example, the induction record for an individual was dated 24/7/08 yet references were dated 3/10/08 and 30/9/08. The ISA for this individual was dated 4/8/08 and CRB dated 31/12/08. The provider told us that there had been a dispute with the umbrella agency and despite applying for the ISA and CRB on 27/7/08 the ISA did not arrive until mid August 2008. We concluded the appointment of the individual had been unsafe at the point of employment, however the provider had subsequently obtained information and was able to demonstrate the suitability of the person to work with vulnerable people. We discussed the regulatory requirements with the provider and manager who told us that they would put systems to ensure that the recruitment process is robust and protects people. On 3/11/09 we discussed what action the provider has taken with regard to recruitment procedures. They told us that they were in the process of recruiting new staff, however they had informed the individual that they would not be able to start the induction until the Independent Safeguarding Authority check had been obtained. This demonstrates that the provider had taken immediate steps to improve recruitment practice, which will Evidence: ensure that people are protected. The responsible individual and manager and several staff attended a training session about the Mental Capacity Act and Deprivation of Liberty Safeguards on 23/10/09. Information sent to us (AQAA) tells us that the home follows the Skills for Care framework. We looked at the training portfolio for one member of staff, which contained a number of certificates for training done in 2009. Information sent to us by the provider demonstrates 10 out of 14 (71 percent) of carers have either completed NVQ level 2. 3 other carers (21 percent ) are the process of doing it. Therefore, the percentage of carers with this award exceeds the National Minimum Standard which is to be commended. Both the responsible individual and the manager hold the Registered Managers award and NVQ level 4 in management and are NVQ assessors. Appraisal records for 2009 were seen in the staff files we looked at. Staff told us that the manager and provider were always approachable. We saw formal supervision records on the 3 files we looked at. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is safe and very well run. Peoples views are valued and acted upon. Evidence: Since the last inspection, the provider registered as a Limited Company. However, the same people are involved in running the company that had previously been registered. The Registered Manager has the Registered Managers Award and NVQ Level 4 in Care Management. She told us that he continues to use the internet extensively, in particular the Commissions professional website, to keep up to date thus ensuring that the care delivered is best practice. Throughout the inspection we found her and the responsible individual to have a clear understanding of their roles in meeting the stated aims and objectives of the home. Similarly, they provided the Commission with a lot of information in a document entitled AQAA (Annual Quality Assurance Assessment). In it they outlined what the home could do better to improve the quality of life of people living there and how it would be done, in addition to explaining what had improved. They highlighted that they need to provide people with information in a format that is suitable for them. This was also borne out in our findings. Care plans and assessments should be in a format that is suitable for individuals. Our main concern at the inspection has been that the recruitment procedure was not consistently followed. However, we are confident that this will be addressed and audited in the future to ensure that this does not happen again. We observed that there are clear lines of accountability within the home. The provider also has extensive experience in running two homes - Burrough Farm and Credence House. The responsible individual was able to produce reports that he had completed every month which demonstrates that quality assurance is being measured, for example with regard to weekly safety checks of the vehicle used to transport people Evidence: to and from outings and appointments. People told us that their views are listened to and we observed individuals being asked for feedback throughout the day, for example as to whether they had enjoyed their meal and what they would like to do during the evening. We saw that the certificate of registration was displayed in a prominent position where people living in the home and visitors could see it. A new certificate showing the change to a Limited Company had been issued by the Commission but had to be returned as it was inaccurate. This has since been addressed. In surveys the responses people gave tell us that they are content living in the home with comments like this is the best place Ive every lived. I have freedom to do what I want to do and would rate the home as excellent. A quality assurance report had been written, which collated all the views from people living in the home, their relatives and other stakeholders. Resulting from this, the provider had compiled an action plan that is based on excellence and not just national minimum standards. Therefore, systems are in place that seek feedback from people about the quality of their life at Credence House and their views are valued and acted upon. Comprehensive Health & Safety policies and procedures were seen, including a poster displayed in the kitchen stating who was responsible for implementing and reviewing these. The fire log was examined and demonstrated that fire drills, had taken place regularly. We saw certificates demonstrating that staff had had fire training in 2009. Similarly, certificates from a contractor verified that the fire alarm had also been regularly serviced. People said the alarm is checked every week. In information sent to the Commission, the manager verified that risk assessments are carried out. Records of accidents were kept and showed that appropriate action had been taken. First aid equipment was clearly labelled. Maintenance certificates were seen for the heating, electrical and fire alarm systems. Therefore, peoples health and safety is maintained. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 34 19 The registered person must ensure that recruitment procedures are robust. 08/01/2010 This will help to ensure that people are cared for by appropriate staff. 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 2 Peoples capacity to make decisions should be assessed and explicit guidance provided for staff detailing how/who is responsible for making decisions for people that are assessed as lacking capacity. This will ensure that decisions are always made in the best interests of individuals concerned. People living in the home, should be able to access their care plan in a format that is accessible to them, for example by using pictures or simple language. 2 6 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) 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. 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