Care Home: Creswick House

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What the care home does well Prospective service users are provided with good quality information about the Home, so they are able to make an informed choice about living there. People have the opportunity to visit the home and detailed needs assessments are completed before they move in. The people living at Creswick House have their changing needs and personal goals reflected in an individual plan of care, they are able to make decisions about their lives and are supported to take risks as part of an independent lifestyle. The people living at Creswick House are able to take part in activities that suit them, be part of the local community, enjoy leisure activities as they wish and have good relationships with their family and friends. People are offered a healthy diet and enjoy their food. Each person at Creswick House has a detailed care plan which describes their health and personal care needs. Residents have access to healthcare professionals and they are protected by the home`s medication policies and procedures. The people living at Creswick House, their families and friends are assured that their complaints will be listened to, taken seriously and acted upon. Robust procedures are in place that help protect residents from abuse. Creswick House continues to provide a homely, clean, safe and well maintained environment for residents. Creswick House has robust recruitment policies and practices, the staff have a good mix of skills and they are trained and competent. Creswick House is a well run home and the people living there benefit from good quality leadership and day-to-day management. A good Quality Assurance process is in place and the people living at Creswick House know their health, safety and welfare is promoted and protected. What has improved since the last inspection? All staff who didn`t already have NVQ level 2 or 3 have now been enrolled and are currently working towards completion of these awards. The communal areas have improved greatly in respect of the previous `blandness`. What the care home could do better: Information relating to the Care Quality Commission in the sections `Details of Your Service` and `Complaints Procedure` is out of date, referring to the Commission for Social Care Inspection (CSCI), and needs to be amended to reflect current information. Appropriate storage and recording facilities need to be put in place in respect of controlled drugs. Key inspection report Care homes for adults (18-65 years) Name: Address: Creswick House 77-79 Norwich Road Fakenham Norfolk NR21 8HH     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: Debby Ames     Date: 0 8 1 2 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 31 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 31 Information about the care home Name of care home: Address: Creswick House 77-79 Norwich Road Fakenham Norfolk NR21 8HH 01328851537 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: creswick.jeesal@virgin.net Mrs Sally Subramaniam care home 14 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 14 The registered person may provide the following categories 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 Creswick House is a large house situated on the edge of the town of Fakenham. It provides accommodation for up to thirteen adults with a learning disability. Seven of the service users may also be over the age of 65 years. The building is divided so as to provide living accommodation for the group of older, more frail service users on the ground floor and for a group of more physically able service users on the first floor. The service users living on the first floor may have behaviours which staff may find challenging. There are currently separate staff teams working on each floor. There is a large garden to the rear of the Home, which has been divided so that each floor has access to their own part of the garden. The Home is owned and managed by Jeesal Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 14 Brief description of the care home Residential Care Services Ltd. The fees vary according to peoples individually assessed support requirements. Care Homes for Adults (18-65 years) Page 5 of 31 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: Care Services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out, by using information from previous inspections, information from the providers, the residents and their relatives, as well as others who work in or visit the home. This has included a recent unannounced visit to the home. This report gives a brief overview of the service and the current judgements for each outcome group. The fieldwork of this inspection was carried out over a period of seven hours, during which time a number of people living at Creswick House were observed and spoken with and a tour of the premises was undertaken, which included seeing some peoples personal rooms - with their permission. Discussions were also held with some of the staff on duty and the manager. Various records were looked at in detail, which included care/support plans, staff files Care Homes for Adults (18-65 years) Page 6 of 31 and other records relating to health and safety. Meanwhile, a well completed and detailed Annual Quality Assurance Assessment (AQAA) was returned to The Commission, as requested, prior to this inspection. One requirement and one recommendation have been made as a result of this inspection. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Information relating to the Care Quality Commission in the sections Details of Your Service and Complaints Procedure is out of date, referring to the Commission for Care Homes for Adults (18-65 years) Page 8 of 31 Social Care Inspection (CSCI), and needs to be amended to reflect current information. Appropriate storage and recording facilities need to be put in place in respect of controlled drugs. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 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 31 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 are provided with good quality information about the Home, so they are able to make an informed choice about living there. People have the opportunity to visit the home and detailed needs assessments are completed before they move in. Evidence: Two care plans were looked at in detail during this inspection and both were seen to contain comprehensive information, which confirmed that a full assessment had been carried out prior to each person moving into the home. A discussion with the manager and information seen in the care plan confirmed that, for one person in particular, the family initially visited Creswick House with the prospective resident, which was followed by three further visits when the person stayed for lunch and saw their room. A copy of the service user guide was also seen during this inspection, which is also available on audio cassette. Although the service user guide was well designed and Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: clearly laid out, information relating to the Care Quality Commission in the sections Details of Your Service and Complaints Procedure is out of date and refers to the Commission for Social Care Inspection (CSCI). Care Homes for Adults (18-65 years) Page 12 of 31 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. The people living at Creswick House have their changing needs and personal goals reflected in an individual plan of care, they are able to make decisions about their lives and are supported to take risks as part of an independent lifestyle. Evidence: Two care plans were looked at in detail, one person was case-tracked and a number of people were observed during the inspection, which all helped to confirm that the contents of the plans were accurate. The contents of the care plans included very comprehensive information, to ensure consistency of care and make sure that each person is genuinely treated as an individual and receives the level of support they require. Some of the contents of the care plans were seen as follows: (1) Personal Profile - which included a pen picture, with the front pages in symbols Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: and words, details of the General Practitioner and the placing agency, date of birth, religion, past history, self help skills, health summary, risk indicators, communication and interaction. (2) Summary of Health Needs - this section was seen to have been reviewed and updated on a regular basis and included information such as allergies, skin care, hair & scalp care, eye care, foot care, dental care, nail care, toileting, mobility, diet/food, physical stature, epilepsy, well person issues, pain management, illness, infections and medication. All the health and medication information was seen to be very descriptive, personal, regularly reviewed and up to date, with clear PRN medication guidelines and a staff signature sheet. (3) Summary of Communication and Communication Dictionary - this area was found to be extremely well detailed and autism assessment outcomes were noted for one person in particular i.e. Need: [name] has difficulty understanding pronouns such as I/you/he/she. Approach to Meet Need: Staff to use [person]s name when commencing interaction and other peoples names when referring to them. Gestures and pointing will also help [name] to understand intentions. A communication chart was seen to contain descriptions of how the person indicates and communicates things such as being in pain, wanting to go to the toilet, wanting to go out, wanting to be alone, needing help, liking someone and not liking someone. (4) Summary of Social Interaction - this section was seen to be very person specific and, again, reviewed and updated on a regular basis. Some of the needs identified, included poor eye contact, need for a large amount of space, difficulty understanding social rules and the failure to understand other peoples feelings or points of view. (5) Summary of Imagination - this again identified needs and the approach required to meet those needs such as lack of pretend play and inability to appreciate competitiveness, insistence of sameness difficulty with humour, waiting for events to happen and intrusive anxiety prior to entering a new environment. Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: (6) Summary of Domestic Daily Living Skills - descriptions were seen in respect of why daily schedules and routines are so important to the person - i.e. tasks needing to be carried out in order and are non-negotiable such as waking, breakfast, morning routine, lunchtime etc. were all seen to be specifically time portioned. (7) Daily Living Schedule and Support Plans - this section included likes and dislikes which were categorised into: Likes Very Much, Likes a Little and Dislikes and covered areas such as food, drinks, special events, animals, domestic activities, personal appearance, entertainment, places of interest, types of music, sport and games, board games, art and craft. (8) Weekly Schedule of Activities (9) Teaching Plans and Monitoring Sheets - included clear guidelines and protocols, together with detailed care objectives, actions required and regular reviews. (10) Risk Management Guidelines - this section contained very comprehensive information in respect of identified risks, which were categorised into levels of Serious (requiring one-to-one support), Moderate (can manage as part of a group) and Minor (can be alone). Some of the areas covered included physical and emotional issues, self-harming, activities, money and holidays. All the risk assessments seen were noted to be very empowering and enabling and described clearly how staff should support the person and to what extent the person could manage for themselves. (11) Last Monthly Summary, Progress Reports and Reviews - all of these were seen to be carried out consistently on a regular basis. (12) Any ABC/Incident Reports for the Month - these were seen to include management plans, which staff had signed, which were comprehensive but clear and monitoring sheets were seen to have been regularly completed. (13) Priority Needs List - this area contained the date, recommendation (i.e. build up day care), person responsible (i.e. named staff/keyworker) and the outcome. (14) Significant Events Form Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: (15) Checklist for Support Workers - this contained very good guidance in respect of helping staff to support the person consistently. Meanwhile, observations and informal discussions with some of the people living at Creswick House confirmed that the people living there are genuinely supported and encouraged to make decisions for themselves, take risks appropriately and live their lives as independently as possible. All the records and personal information relating to the people living at Creswick House were seen to be stored securely, thus ensuring confidentiality is maintained. Care Homes for Adults (18-65 years) Page 16 of 31 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. The people living at Creswick House are able to take part in activities that suit them, be part of the local community, enjoy leisure activities as they wish and have good relationships with their family and friends. They are also offered a healthy diet and appear to enjoy their food. Evidence: Discussions and observations during the inspection confirmed that independence and empowerment continues to be highly promoted at Creswick House and people are supported and encouraged to live their lives as they choose, at their own pace, as much as possible. Daily routines and activities were seen to be quite varied. From the information noted and observations on the day of inspection, it was apparent that peoples individual wants, needs and choices are genuinely considered. Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: Some of the timetables seen included activities during the week such as music, aroma-therapy, cleaning, puzzles, foot spa, art, household tasks, look good - feel good, cooking, food shopping, person centred planning and letter writing. Some of the other activities and hobbies that were seen to be recorded in peoples personal records included kitchen tasks, painting and drawing, table top games, swimming, personal shopping, bus trip out, watching a film, watching a video or television, karaoke, disco, pub visit, knitting, sewing, going for a walk, clay modelling and papier mache. Evidence and records seen in the care plans also supported the fact that the people living at Creswick House are able to maintain relationships with their friends and family on a regular basis and there were records of visits to and from family, together with notes of letters and telephone calls made or received. Menus are planned in advance on a rolling basis and good records were available to support peoples likes, dislikes, special dietary requirements and any allergies. Some examples from the menus included: Monday Breakfast: Cereal or Toast with Assorted Jams Lunch: Cheese Salad Tortillas or Beans on Toast / Jelly and Ice Cream or Fruit Dinner: Fish, Chips and Peas or Sausage, Egg and Waffles / Cheesecake or Yoghurt Wednesday Breakfast: Cereal or Toast with Assorted Jams Lunch: Cauliflower Cheese or Scrambled Egg on Toast / Banana Custard or Yoghurt Dinner: Pork with Mediterranean Vegetables or Mince Cobbler / Rice Pudding or Spotted Dick and Custard Sunday: Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: Breakfast: Fried Breakfast, Cereal or Toast with Assorted Jams Lunch: Assorted Sandwiches or Soup and a Roll / Treacle Tart or Yoghurt Dinner: Roast Chicken with Roast Potatoes, Mashed Potatoes, Vegetables, Yorkshire Pudding and Gravy or Pork Stir Fry and Rice / Gateaux or Yoghurt Care Homes for Adults (18-65 years) Page 19 of 31 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. Each person at Creswick House has a detailed care plan which describes their health and personal care needs. Residents also have access to healthcare professionals and they are protected by the homes medication policies and procedures, although appropriate storage and recording facilities need to be put in place in respect of controlled drugs. Evidence: The physical, emotional and health needs of the people living at Creswick House are quite varied and it was evident that a great deal of time and effort has been taken by the staff team as a whole and external professionals to ensure that individual needs are met. Each of the care plans included very detailed information with regard to how each person likes and needs to be supported, in virtually every aspect of their daily life. Very detailed information was seen to be recorded on a Health Profile Event Log such as date, health need, reason, outcome, follow up and who completed the information. Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: Examples included involvement with healthcare professionals such as the GP, Speech and Language Therapist, District/Community Nurse, Aroma-therapist, Physiotherapist, Community Learning Disability Nurse and Consultant Psychiatrist. Well completed body charts were also seen in respect of recording any wounds. Accidents and incidents were also seen to be clearly recorded and monitored. Observations of the medication administration at lunch time was seen to be very organised, respectful and unhurried. Two members of staff were seen to double check the persons identity, the medication and dosage and each person was offered a choice of drink to have with their medication. Meanwhile, Creswick House uses a Monitored Dosage System (MDS) and regular medication audits are carried out as part of the Homes quality monitoring process. From the records seen during the inspection, no errors or omissions were noted. However, it was noted that the Home does not currently have adequate facilities for the storage or administration of controlled drugs and although staff confirmed that, to date, there has not been a need for this, a recommendation has been made for the appropriate storage and recording facilities to be put in place, to ensure peoples needs can be met if the situation should change in the future. Care Homes for Adults (18-65 years) Page 21 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at Creswick House, their families and friends are assured that their complaints will be listened to, taken seriously and acted upon. Robust procedures are in place that help protect residents from abuse. Evidence: It was confirmed by the manager that no formal complaints have been received since the last inspection, although staff are encouraged to raise any issues or concerns they have - of their own or on behalf of the residents. There is a separate complaints book on each of the two floors and appropriate records and information were seen to be contained within both of them, everyone is supported to be aware of the Homes complaints procedure. The manager stated in the AQAA: We promote the view that complaints can bring about change and encourage individuals to make their views known. Meanwhile, all staff have full recruitment check carried out before starting work at Creswick House, they are trained in adult protection and have an understanding of the whistle blowing policy. Care Homes for Adults (18-65 years) Page 22 of 31 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. Creswick House continues to provide a homely, clean, safe and well maintained environment for residents, with ongoing improvements having been made to various internal and external areas. Evidence: As described in the previous inspection report, all the bedrooms seen were very different from each other and highly personalised and reflected individuality. Specialist and sensory equipment was observed throughout and continues to be available and provided as needed. Some of the individual sensory equipment included a spa bath, fish tank and colour-changing light/water feature. The communal areas were noted to be much improved in respect of the blandness and attractive pictures were seen to have been securely hung on the walls throughout the Home. Meanwhile, the manager confirmed in the AQAA that a high level of work was completed on both floors last year and the internal environment continues to be decorated as and when required. Additionally, new high backed chairs have been purchased for the ground floor lounge, Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: new pictures have been hung, curtains have been replaced and new dining tables and chairs have been purchased for both floors. The roof and chimneys have been serviced and the gulleys and guttering around the whole house have been renewed. It was also confirmed that white goods are purchased and updated as required, an office area has been created for the ground floor staff and new computers have been purchased for each of the staff offices. Overall, all areas seen on the day of inspection were found to be clean, hygienic and well maintained, with a very homely atmosphere and no unpleasant odours. No safety hazards were noted during the inspection. Care Homes for Adults (18-65 years) Page 24 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Creswick House has robust recruitment policies and practices, the staff have a good mix of skills and they are trained and competent. Evidence: Four personnel files were looked at in detail during the inspection and each of these was found to be very well organised and contain comprehensive information, which confirmed that Creswick House has robust recruitment procedures. Some of the documents seen in the staff files included: Application Form, References, Enhanced Criminal Records Bureau (CRB) Disclosure, Terms and Conditions and Identification including a photograph. Staff members were also seen to have a Professional Profile folder, which included a current job description, induction record, educational attendance record and certificates, supervisions records and an annual review record. Training records were also looked at and evidence was seen of training courses attended such as health and safety, food hygiene, first aid, medication administration, moving and handling, fire safety, epilepsy awareness, person centred planning, infection control, Autistic Spectrum Disorders, mental health, behaviour analysis, signCare Homes for Adults (18-65 years) Page 25 of 31 Evidence: along, equality and diversity and adult protection. It was confirmed in the AQAA that all staff who didnt already have NVQ level 2 or 3 have now been enrolled and are currently working towards completion of these awards. Meanwhile, the rotas were also looked at during this inspection and the numbers reflected a good level of staff on duty at all times and observations during the inspection also confirmed sufficient numbers of staff on duty to meet peoples needs as required. Staff meetings were confirmed to be held on a regular basis, during which any issues raised by staff can be discussed and acted upon accordingly. From the records seen, together with discussions held with some staff and the manager, it was confirmed that staff receive regular support and supervision both formally and informally, although the manager confirmed in the AQAA that there had been occasions, since the last inspection, when staff did not feel as supported as they would like to have been. Care Homes for Adults (18-65 years) Page 26 of 31 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. Creswick House is a well run home and the people living there benefit from good quality leadership and day-to-day management. A good Quality Assurance process is in place and the people living at Creswick House know their health, safety and welfare is promoted and protected. Evidence: The current manager has been in post at Creswick House for a number of years and discussions with some of the staff members confirmed that she continues to be respected and has the best interests of the service users at heart. The Quality Assurance process continues to be very clear, easy to understand and genuinely encourages people to provide constructive and quality feedback. The financial records were looked at for one resident in particular and these were found to be accurate, with details of income and expenditure recorded, signed and witnessed appropriately. Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: Policies and procedures were looked at and continue to be in good order and are regularly reviewed and updated. Excellent risk assessments were seen in respect of fire safety for each person living at Creswick House and records confirmed that the regular checks and tests continue to be carried out and recorded on a regular basis. Meanwhile, cleaning materials/hazardous chemicals were seen to be stored appropriately in locked cupboards and staff training in areas relating to health and safety was seen to be up to date. Care Homes for Adults (18-65 years) Page 28 of 31 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 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 5 5 The information relating to 30/06/2010 the Care Quality Commission in the sections Details of Your Service and Complaints Procedure is out of date, referring to the Commission for Social Care Inspection (CSCI). This needs to be amended to reflect current information for the Care Quality Commission. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 20 It is recommended that appropriate storage and recording facilities are put in place in respect of Controlled Drugs, to ensure peoples needs can be met if such medication is required in the future. Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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