Care Home: Deerhurst

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What the care home does well Staff know the people who use the service well and understand what they need and how they like to be supported. One person said `I like the staff` and felt they looked after them well.People who use the service are able to choose how they spend their time.One person likes to go out to various activities on a regular basis, whilst the other person prefers to make their choices on a daily basis. What has improved since the last inspection? People are offered lots more to do.They are being involved in looking at what help they need and what they want to be able to do.This is being written down in a way that they can understand.The home is being made to look better. People are helping choose new furniture and colours for the rooms. What the care home could do better: It will be much better for people who live in Deerhurst when their care plan is written in a way they can easily understand it.It will also be better for them when they can add the things they think are important to the plan and it shows what they want.The staff need to be able to show that they can help someone who does not like to eat very much have enough food to stay healthy. Key inspection report Care homes for adults (18-65 years) Name: Address: Deerhurst 20 Deerleap Way New Milton Hampshire BH25 5EU The quality rating for this care home is: two star good 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: Patricia Trim Date: 1 4 0 7 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 Care Homes for Adults (18-65 years) Page 2 of 38 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 38 Information about the care home Name of care home: Address: Deerhurst 20 Deerleap Way New Milton Hampshire BH25 5EU 01425619952 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Contemplation Care Ltd care home 3 Number of places (if applicable): Under 65 Over 65 3 0 learning disability Additional conditions: The maximum number of service users to be accommodated is 3. The registered person may provide the following category/ies of service only: Care home only (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 (LD). Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 38 A bit about the care home Deerhurst provides care and accommodation for up to 3 people who have a learning disability. It is a large family home situated in a quiet residential area near New Milton. It has 3 single bedrooms with a shared bathroom and toilet on the first floor. The ground floor has a large lounge/dining room and conservatory that everyone can use, a toilet, a kitchen and the office. There is a big garden and patio area. The fees are from £950.00 to £1600.00 per week. Care Homes for Adults (18-65 years) Page 5 of 38 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: two star good 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 Care Homes for Adults (18-65 years) Page 6 of 38 How we did our inspection: This is what the inspector did when they were at the care home We used lots of information from different places to write this report. We looked at anything the home might have told us about what has happened since we last visited Deerhurst. We used some of the information Chris Taylor, the registered manager gave us about the home in a form called the Annual Quality Assurance Assessment (AQAA). This is something the home has to fill out every year to tell us what they are doing to make sure people are helped to do the things they want to and get the care they need. Care Homes for Adults (18-65 years) Page 7 of 38 Chris sent this form into us when we asked forit. It had lots of good information about the service and told us what he wants to do to make things even better. We meant to send some forms to the people who live in Deerhurst and the staff who work there, so they could tell us what it was like to live there, but we made a mistake and they did not get them Care Homes for Adults (18-65 years) Page 8 of 38 One of our inspectors visited the home and stayed for five and a half hours. While she was there she spent time talking to one person who lives at Deerhurst to ask them what it was like. There was also an opportunity to talk to one of the staff and to look at some of the bedrooms, lounges, dining rooms, kitchens and bathrooms to see that people lived in a clean, comfortable and safe place. Care Homes for Adults (18-65 years) Page 9 of 38 Time was spent looking at the information written down about two people who live at Deerhurst. We did this to try and see if they had been able to say what they wanted to do for themselves and what help they thought they needed. We also wanted to see if they were able to choose what they did each day. Care Homes for Adults (18-65 years) Page 10 of 38 We also looked at some of the records Deerhurst has to keep to make sure they were being kept up to date. The registered manager, Chris Taylor, was working in the home on the day we visited and helped us to find out the things we needed to know. Care Homes for Adults (18-65 years) Page 11 of 38 What the care home does well Staff know the people who use the service well and understand what they need and how they like to be supported. One person said I like the staff and felt they looked after them well. Care Homes for Adults (18-65 years) Page 12 of 38 People who use the service are able to choose how they spend their time. One person likes to go out to various activities on a regular basis, whilst the other person prefers to make their choices on a daily basis. What has got better from the last inspection Care Homes for Adults (18-65 years) Page 13 of 38 People are offered lots more to do. They are being involved in looking at what help they need and what they want to be able to do. This is being written down in a way that they can understand. Care Homes for Adults (18-65 years) Page 14 of 38 The home is being made to look better. People are helping choose new furniture and colours for the rooms. What the care home could do better It will be much better for people who live in Deerhurst when their care plan is written in a way they can easily understand it. Care Homes for Adults (18-65 years) Page 15 of 38 It will also be better for them when they can add the things they think are important to the plan and it shows what they want. The staff need to be able to show that they can help someone who does not like to eat very much have enough food to stay healthy. If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 16 of 38 If you want to speak to the inspector please contact Patricia Trim CQC South East Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA Tel 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 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 17 of 38 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 18 of 38 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. Detailed pre admission assessments are completed that enable the registered manager to be sure people who use the service will only be offered a place if the home can meet their needs. Evidence: The home currently had one vacancy, but no-one had been admitted to the service since Contemplation Care took over. The AQAA recorded that a comprehensive admission procedure was in place. This included having a visit from someone from the organisation prior to admission, who would talk to the person about the service and complete an in depth needs assessment. Further information would be obtained from other sources, such as the care manager, the current placement, family or advocate. The person wishing to move in, would be expected to visit the service several times, including an overnight stay. The views of the people currently living in the home would be sought and care would be taken to make sure the person was likely to fit in with those already living at Deerhurst. The AQAA also recorded that an interim care plan and risk assessment would be completed to support the person during their initial visits. The two people currently living at Deerhurst have been there for several years. Their Care Homes for Adults (18-65 years) Page 19 of 38 Evidence: initial assessments, care plans and risk assessments are being reviewed and re-written to make sure they continue to reflect the aims and objectives of the people who use the service. The service does not provide intermediate care. Care Homes for Adults (18-65 years) Page 20 of 38 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The introduction of person centred care plans will enable people who use the service to be actively involved in deciding what support they need to achieve their aims and objectives. Risk assessment is used to enable people to achieve their aims and objectives, but the service has imposed limitations on people who use the service which are not regularly reviewed and cannot therefore demonstrate that they continue to be in their best interests. Evidence: At the previous inspection it was noted that care plans were excessively complicated, repetitive and not easy to follow. They showed no evidence that the person to whom they related had been involved in the planning or reviewing. In the AQAA, Contemplation Care identified they were introducing a new, person centred care plan that would reflect the individual preferences and wishes of the person using the service. It was expected that the person using the service would be involved in planning Care Homes for Adults (18-65 years) Page 21 of 38 Evidence: and reviewing it. A draft plan for one person who uses the service was seen. This looked at all aspects of their daily routine and personal care needs. It clearly identified what the person could do for themselves and what help they needed. For example, under the heading getting dressed the plan recorded I get out my own underwear and socks and with advice on the present weather I choose what clothes I would like to wear. Staff then put these out for me so I am able to dress myself. A measurable outcome is recorded for each section. For the above one it was I get to wear what I want and I am given the privacy I need whilst getting dressed. The plan for the second person using the service remained unchanged as this has not yet been re-written. A record had been kept which showed the plan had been reviewed on a monthly basis, but there was no evidence to show what had been looked at to reach the decision of No change recorded by each date. Both the people living in the service have limitations imposed on them. These have been agreed at a multi-agency level, but there was no evidence they had been reviewed to see if they were still necessary or whether they could be amended to reduce the limitation. One person had an objective that was not achievable. The registered manager said this had now been explained to them, but there was no record of this and the person concerned was still saying this was their main objective. The service manager said limitations would be reviewed as part of the process of changing to a person centred plan and dsicussed with the person they related to and other involved professionals. Risk assessments remained unchanged from the previous inspection. These gave staff clear guidance on how to manage various aspects of the persons care. For example, one risk assessment showed staff how to use distraction techniques to support someone with challenging behaviour. The record showed this had been used effectively, resulting in the need for medication to calm the person being unnecessary. One person who uses services felt able to make their own decisions about things. They chose not to join in group activities. The person explained I prefer to do things with my family or with staff. I dont like a lot of noise. The registered manager explained the service was actively seeking opportunities for this person to be supported on a one to one basis outside the service. The care plan for another person recorded Having choice is very important to this person. Staff were told they must allow the person to make their own choice about what they do. Care Homes for Adults (18-65 years) Page 22 of 38 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 adequate 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 offered a range of activities but these need to be developed if they are to meet the individual needs of people who use the service. A wide range of meals are offered that people who use the service enjoy, but one person is being put at risk by the failure to monitor their nutritional needs. Evidence: There was evidence that people now have more choice about how they spend their day and Contemplation Care is actively seeking more opportunities for activities in the local community. Planned trips out included a boat ride, trip to the Spinnaker Tower, Boldrewood deer sanctuary and the Watercress line. Information about these trips was displayed in easy read and pictorial formats on the notice board. One person said they had been invited to go on these trips but did not want to as they found the people from the other services too noisy. This persons care plan showed they preferred to do things independently with staff support. The registered manager showed he was looking for opportunities for this person and had found a day out they might be interested in. Care Homes for Adults (18-65 years) Page 23 of 38 Evidence: Both the people who live at Deerhurst had decided they did not want to go on holiday this year. One person said they were able to choose how they spent their day; deciding when they got up and went to bed. Daily records showed that the time people went to bed varied according to how they felt and what they were doing. For example, one person often liked to go to bed early as they got very tired. They enjoyed listening to music and did this before settling down for the night. The care plan for this person showed they liked routine, attending a social club and day centre each week and choosing regular in house activities such as doing exercises and playing their keyboard. They also enjoyed cooking at the weekends and the care plan and risk assessment enabled them to do this safely. The second person living in Deerhurst chooses not to join in organised activities, preferring to decide what to do on a daily basis. The registered manager said it was difficult to encourage this person to take part in activities and the care management review confirmed this, stating the person did not like going out much. The person said they enjoyed going out with their family and liked things relating to nature. The registered manager had found a nature course for the person that they could attend with staff support. The same person also loved Harry Potter and said staff were trying to make arrangements to take them to see the new film. This person said how much they loved animals but that it was not possible for them to have a pet at Deerhurst. They did not like to see things kept in cages. The service manager said arrangements were being made for someone to bring a dog to visit Deerhurst on a regular basis. She also confirmed this aspect of the persons care needs would be explored during the care plan review. One person said staying in contact with their family was very important to them. They were able to go out with their family on a regular basis and telephoned them each night. The second person was helped by staff to maintain contact with their roots by speaking about their country of origin and listening to their mother tongue. The AQAA stated the choice of meals offered in the service was going to be reviewed by a member of the management team. Meals offered have improved, with more fruit and salad now available. The registered manager said meals for the week were planned on Fridays by the people who use the service and staff. One person who uses the service said they were able to choose what they had. This person had a history of not eating well. Daily records showed that this person often missed meals, but no nutritional assessment had been completed. Their weight was being monitored, but there was no record of staff offering meals throughout the day, although the person said staff did do this. This was discussed with the registered manager and service manager, who stated a nutritional assessment and care plan would be included as part of the care planning Care Homes for Adults (18-65 years) Page 24 of 38 Evidence: review. The records for the second person showed they had the choice of a range of well balanced meals offered throughout the day. Care Homes for Adults (18-65 years) Page 25 of 38 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service receive help with personal care in the way they like it. They are able to see health care specialists when they need to, which makes sure they receive the health care they need. There are robust systems in place that ensure medication is managed safely. Evidence: The new care plan for one person was very person centred and detailed and gave staff clear guidance about what the person wanted to do for themselves and how they wanted staff to help them. The second person still had the old format of care plan, but the guidance about what help the person needed was still easy to follow and enabled them to receive care in the way they liked it. the guidance for both people ensured they received their care in a way that upheld their rights to privacy and dignity. People who use the service said they were able to see their doctor when they wished. One person chose to visit health care professionals with their family and was happy for them to look after their appointments. Another person liked staff to arrange appointments. This person had chosen not to visit Care Homes for Adults (18-65 years) Page 26 of 38 Evidence: the dentist anymore and their care plan told staff they needed to check the person was not in pain. The service has good links to the Community Learning Disability team and there was evidence they make appropriate referrals for support and advice. One person had recently had a medication review to address specific health care problems. As recorded in the previous section, there was evidence the nutritional needs of one person were not being monitored effectively. The service manager stated this would be addressed as part of the care plan review. The registered manager said only staff who had completed training were permitted to give out medication. The member of staff on duty at the time of the visit confirmed this and certificates to evidence training were seen. Medication was stored in accordance with Royal Pharmaceutical guidance and records seen showed there was a system for checking supplies received to make sure it was correct. A record was kept of any unused medication returned to the pharmacist for disposal. The majority of medication is supplied in a monitored dosage system which helps to minimise the risk of error. The records were checked against the stock for both people who use the service. These showed the correct amounts had been dispensed for the morning and the record signed correctly. The AQAA recorded that a monthly medication audit was going to be introduced. Futher medication training was being arranged to make sure all staff training was up to date. Care Homes for Adults (18-65 years) Page 27 of 38 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. People who use the service have the information they need to be able to make complaints and be confident their concerns will be listened to. Staff have the training and guidance they need to minimise the risk of harm to people who use the service. Evidence: People who use the service said they knew how to make complaints and could understand the complaints procedure. This is available in easy read, pictorial and audio versions so everyone has access to it. The AQAA recorded that the complaints procedure is going to be reviewed to make it even more accessible. It also recorded that no-one had made any complaints since the last visit. All staff have had training in respect of safeguarding adults and those spoken with knew what action to take if an allegation of abuse was made. The service manager said staff were expected to attend annual training and a further session had been arranged for November 2009. No incidents had been reported since the last visit that required a referral to adult services under the safeguarding procedure. There was an effective system for looking after small sums of money on behalf of the people who use the service. Records were kept of any transactions and one person liked to sign the record when they put any money in or took any out. Both the people who use the service liked staff to look after their money as they did not like to have large sums on them. The amounts kept on their behalf were checked against the written record by the service manager and found to be correct. She said she regularly checked the amounts Care Homes for Adults (18-65 years) Page 28 of 38 Evidence: held. Care Homes for Adults (18-65 years) Page 29 of 38 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to live in a clean, comfortable, safe environment that meets their needs and that they like. Staff have the training and guidance they need to minimise the risk of infection. Evidence: The environment provides a comfortable, homely environment for people who use the service. One person said I like it here. I have my own room. There is a shared lounge/dining room and conservatory so people have the space they need to be alone if they wish to. The service has a maintenance plan to make sure all areas of the home are regularly redecorated and renewed. The empty bedroom has been repainted and the office, hall and lounge are to be redecorated next. The service manager said people who use the service would be involved in choosing the colour scheme and one person who uses the service was aware of these plans. The purchase of a new three-piece suite is also planned and again, people who use the service will be involved in choosing it. There is a cleaning schedule for both day and night staff. Staff were seen following this to keep the home fresh and clean. One person likes to help with some of the household routines and this is clearly recorded in their care plan. A risk assessment is in place to minimise the risk of harm. Care Homes for Adults (18-65 years) Page 30 of 38 Evidence: Staff have clear guidance on how to manage any soiled linen and the AQAA recorded 9 out of 10 staff have completed infection control training. The AQAA recorded the service is introducing a quality audit which will be used to monitor the environment. A maintenance man is employed to carry out minor repairs and renovations on a regular basis. Care Homes for Adults (18-65 years) Page 31 of 38 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. Robust employment procedures minimise the risk to people who use the service. Staff receive training that enables them to fully support people who use the service. Evidence: One person who used the service said they liked the staff and there was always someone to help if needed. A staff member felt there was usually enough staff on duty to meet the needs of the people who use the service. The service manager said the current staffing levels were being reviewed to make sure they reflected the needs of people who used the service. The AQAA recorded no new staff had been appointed since the last visit and the registered manager confirmed this. One staff who was working in the home at the time of the visit, said they felt their recruitment had been thorough and fair. They had been required to complete an application form, attend an interview, provide references and have a Criminal Records Bureau (CRB) and a Protection of Vulnerable Adults (POVA) check before starting work. Records contained in their file confirmed these checks had been completed. The records for two staff showed they had completed an induction course during their first two months of employment. They were required to complete a workbook to demonstrate they had understood the training, which was then assessed to judge their Care Homes for Adults (18-65 years) Page 32 of 38 Evidence: competence. Contemplation Care have introduced a training matrix to ensure all staff complete both mandatory and service specific training and have the opportunity to attend refresher courses. The files for two staff were seen which showed they were able to attend a wide range of courses. These included working with challenging behaviour, autism awareness and the Mental Capacity Act. One staff spoken with felt there were good opportunities to develop skills through training and qualifications. The AQAA recorded that all staff had completed their National Vocational Qualification (NVQ) 2. The records for two staff contained copies of their certificates and the member of staff spoken with confirmed they had completed their course. Care Homes for Adults (18-65 years) Page 33 of 38 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. The service is run in the best interests of the people who use the service and there are opportunities for people who use the service to express their views about it. There are systems in place to monitor the environment and minimise the risk of accidents to people who use the service. Evidence: The service sent us the AQAA by the date it was required. This gave detailed information about how the service was meeting the Regulations and what improvements were planned. The registered manager has many years experience working with people who have a learning disability and has been managing the home for several years. He is working towards the completion of the Registered Managers Award and was able to evidence his commitment to ongoing training. One person who uses the service said they liked the registered manager and felt able to talk to him about any concerns they had. A member of staff also commented he was easy to work with. Both people who use the service and staff were seen going to him Care Homes for Adults (18-65 years) Page 34 of 38 Evidence: throughout the day to ask questions and discuss issues. Contemplation Care provide good support for the manager and are actively involved in running and improving the service they offer. The registered manager is supported by the service manager to develop the service and it was evident changes were being made that will provide better outcomes for people who use the service. People who use the service have the opportunity to give feedback. The registered manager said that group meetings were not always successful, so each person is asked about the service on a one to one basis every two months. Their wishes and comments are recorded and action taken where necessary. For example, one person asked if they could have a birthday party and this was being arranged. The person had been asked who they wished to invite and invitations were being written on their behalf. The service is introducing a quality audit which, the service manager said, would involve gaining the views of people who use the service, their family, advocates and other people involved with the service, such as care managers. This would be done on an annual basis. Monthly visits are carried out by a representative of the organisation. A written record of this visit is left with the registered manager, which clearly identifies what is working well and what needs to be improved. For example, one visit identified a new fire log book was required and this was obtained. The visits include seeking the views of people who use the service and staff who work in the home. The training plan and training records showed staff are able to have the training they need to minimise the risk of injury to people who use the service and themselves. They have regular training in health and safety such as first aid, food hygiene and moving and handling. The records also showed they had regular fire safety training and that this was monitored to make sure everyone had at least two sessions per year. Records also showed that regular fire drills were carried out and staff asked questions to demonstrate their understanding of the procedure. The AQAA gave us information about how the service ensured equipment and the environment were maintained. This, together with a number of records viewed at the time of the visit, demonstrated people who use the service are protected against the risk of injury. Care Homes for Adults (18-65 years) Page 35 of 38 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 Care Homes for Adults (18-65 years) Page 36 of 38 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 17 12 01/09/2009 The registered manager must ensure a nutritional assessment is completed for each person who uses the service and that where a risk is identified a care plan and risk assessment is put in place so that staff know what action to take to support the person to have the nutrition they need. 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 37 of 38 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. 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