Care Home: Down House

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What the care home does well The care plans are up to date and have relevant information about people`s assessed needs meaning the care is based on individual need. This information informs the staff what they need to do to ensure people are looked after in a way that is appropriate for them. The staff are friendly and work together to deliver care to the people living in the home. Staffing levels are designed to meet people`s needs throughout the day and night. The manager is approachable and manages the home in a style that is open, positive, and inclusive for everyone living there and staff working there. Down House is clean and hygienic. What has improved since the last inspection? Since the last inspection the Registered Manager has introduced an information gathering form. This has enabled people to have a smoother transition from home into twenty-four hour care. The Registered Manager has introduced a thorough induction and supervision programme for all new staff. This means that all new staff are working with a senior/ experienced member of staff until they have completed their induction programme and have been assessed as competent. All the care staff have received training about the Liverpool Integrated Care Pathway. This is an evidence-based methodology for a multidisciplinary approach to caring for someone who is in the end stages of their life. The lounge and other communal areas of the home have been redecorated and refurbished. What the care home could do better: The Registered Provider must ensure that there are at least two written references for each new member of staff. This is to ensure that the people using this service are protected from harm. The Registered Provider should ensure people`s continued safety by promptly and accurately recording the fire safety equipment tests in the fire logbook. Key inspection report Care homes for adults (18-65 years) Name: Address: Down House Down House 277 Tavistock Road Derriford Plymouth Devon PL6 8AA     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: Megan Walker     Date: 1 0 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 32 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 32 Information about the care home Name of care home: Address: Down House Down House 277 Tavistock Road Derriford Plymouth Devon PL6 8AA 01752789393 01752769747 down.hs@btinternet.com mayhaven.co.uk Mayhaven Healthcare Limited care home 49 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) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 49 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 categories: Physical Disability (Code PD) Physical Disability (Code PD(E)) Old age, not falling within any other category (Code OP) - Maximum number of places 3 Date of last inspection Brief description of the care home Down House is a Care home that is registered to take up to 49 people of either gender, from the age of 40 years old, who require nursing care, and a maximum of 3 people who require personal care only. The home is situated in the Derriford area of Plymouth close to Derriford Hospital, and is on a main bus route to Plymouth City Centre. Down House is a large adapted house with a modern, purpose built, single storey Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 3 49 0 49 Brief description of the care home extension. The main house has two floors with bedrooms. Access to the first floor is via a stair-lift and the home currently has no passenger lift, so people using the first floor bedrooms need to be able to climb up and down stairs and/or to use a stair lft. A new extension is being built and this will incorporate a shaft lift that will stop at each floor. Most bedrooms have an en-suite. There is good provision of equipment for people who need it. Externally there is a well-maintained patio and garden area that has level access. The current weekly fees for Down House range from local authority rates (including Funded Nursing Care) starting at £504.00 pwk up to Continuing Health Care rates of £620.00pwk, and are according to assessment of the persons individual care needs. Additional charges include hairdressing, chiropody, toiletries, newspapers, magazines, personal telephone line, etc, all charged at commercial rates. All charges information was provided to the CQC in September 2009. The previous inspection report is available on request and the Patient Information brochure (given to anyone enquiring about the home and those that move in) provides details of how the previous inspection reports can be accessed. The Complaints Procedure is clearly displayed on the notice board in the main entrance hall and on notice boards next to other entrances. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is three star. This means the people who use this service experience excellent quality outcomes. This was a Key Inspection undertaken by one regulation inspector. The fieldwork part of this inspection was unannounced. It took place on Thursday 10th September 2009 between 10:00 and 17:20. Throughout this report, the term we will be used as the report is written on behalf of the Care Quality Commission (CQC). An Annual Quality Assurance Assessment (AQAA) was completed by the Registered Manager prior to the inspection. The AQAA is a self-assessment that focuses on how well outcomes are met for the people who live in the home. This inspection included talking to people who live at the home and care staff working at the time of this visit , observation of interactions between staff and people using this service, a tour of the premises, and inspection of care plans, staff files, medication and Care Homes for Adults (18-65 years) Page 6 of 32 other records and documentation. The Registered Manager was available throughout the inspection visit to provide relevant information such as the day-to-day routines as well as the management of the home. Three surveys were returned from people living in the home. Seven surveys were received from relatives. Six staff members were spoken with and five surveys were received from staff. Two surveys were received from health and social care professionals. In addition we used the last Key Inspection report and all other information relating to Down House received by the CQC since the last inspection to inform this inspection. One requirement and two good practice recommendations were made as a consequence of this inspection. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Adults (18-65 years) Page 8 of 32 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 32 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 32 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 residents can be confident that their needs will be assessed to ensure that these can be met when they move into the home. Evidence: Seven out of nine people living at Down House who completed and returned a survey about the care home, told us that they had received enough information before they moved in that helped them to decide if it was the right place for them. The Statement of Purpose that includes the Service Users Guide has been updated. The Registered Provider has told us that he plans add to photographs of all the current staff in the near future. We looked at four care plans. They all had pre-assessments of care needs. One of the care files also had a comprehensive Health and Social Care Assessment and Plan completed by the funding authority. Each care file had a signed contract. The AQAA states that anyone enquiring about Down House would be actively encouraged to look around the home and prospective residents would be offered a Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: trial period of residency. There is also wide consultation with families and carers who know the person to glean better insight and understanding about an individual. About six months ago the manager of the care home introduced All about me. This is an information gathering form for the resident &/or family & friends to contribute basic information to ease transition from home to care. This helps the staff to make a comprehensive holistic assessment on which they base a decision to offer someone a place at the home. Care Homes for Adults (18-65 years) Page 12 of 32 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. People using this service are involved in their individual plan of care and are supported and encouraged to make decisions as part of an independent lifestyle. Evidence: The people we spoke to about living at Down House were all positive about it. Observation of the people living at Down House and staff interactions throughout this visit found that each person was supported and encouraged to manage their own daily routines and personal decision-making within the risk-strategies agreed with them. Staff were courteous and we observed that they explained what they were going to so those people who were more confused did not become alarmed or agitated. Each person using this service had an individual Care File with a full assessment of their care needs, and a plan of care. Inspection of four of these files found that they had been reviewed and updated regularly and/or when required and this was recorded clearly. Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: At the time of this visit the manager and the administrator told us that they do not hold monies on behalf of residents. Generally there was a receivership arrangement with the local authority, or Power of Attorney arrangements with peoples families. The administrator explained that if, for example, someone needed new clothes or toiletries and a family member was unable to do this, then a member of staff would purchase the items. An invoice for payment would be sent to whoever was responsible for handling the finances for that individual. Care Homes for Adults (18-65 years) Page 14 of 32 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 living at Down House are encouraged to exercise choice and control over their lives. People are supported to continue to enjoy familiar supportive relationships with family and friends, and within the local community. Evidence: For people who require twenty-four hour care Down House provides a home where each person is treated with respect and dignity, choice is encouraged and self-esteem is promoted through person-centred care - every day routines and practices are adapted to suit individual people and improve their daily life so it is meaningful to her/him. The four care files we inspected included risk assessments personalised for the individual person. Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: During our visit we saw people around the home. Most people prefer to stay in their bedrooms although there is a large lounge available should they choose to have company. People can choose to eat alone in their rooms or in the lounge. (At the time of this inspection the home did not have a dining room.) We saw evidence on care files about people who were able to go out either alone or with their relatives. The cook as worked at Down House for a number of years. She is commended on her ability to produce a choice and wide range of meals from limited facilities in a temporary port-a-cabin. Her cooking was very popular with the people living at Down House. Individual preferences of food were recorded, and dietary needs catered for. Nutritional assessments were monitored and reviewed regularly as part of the care plan reviews. The cook told us that she speaks to individuals about their preferences, likes and dislikes as well as any dietary needs. This information is also collected as part of the assessment process on the All About Me information sheet. This means that the cook is informed as soon as someone moves into the home thereby helping with the transition form home to care by giving people food they like. The people we spoke to told us that they had a choice about what they ate. On the day of this visit the lunchtime menu was roast chicken and vegetables or chicken curry and rice. Supper was an extensive list of options including chicken drumsticks, sandwiches and salads. The cook also told us that people could have a snack at any time if they wished, and that for those people who were more poorly and had little appetite there was always soup available as well as milk puddings, ice cream and jellies. Care Homes for Adults (18-65 years) Page 16 of 32 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. The practice regarding the planning and delivery of care means that people can be sure that their health and personal care needs will be always be met. Evidence: Comments we received in surveys about Down House included: Given the chance to make choices in my care (who I would like to shower me for example) is an excellent idea The standard of care is extremely good and the staff are both professional and helpful. Staff make time to interact with X. I dont feel she is just left in a room and forgotten. Other comments told us that the staff listened to relatives and would take the time to explain and reassure about any worries. Two health care professionals told us that the nurses communicate well the needs of their patients and were always willing to discuss care options. As we toured the premises we observed daily life at Down House. Staff were seen to be courteous and sensitive with people, explaining what they were doing, and reassuring when giving care. Two people we spoke to told us that they received the care and support they needed, the medical support they needed, that the staff listened and acted on what they say, and that the staff were available when they Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: needed them. Feedback from relatives and staff, as well as information contained in personal files, confirmed that people living in the home have access to health care services such as doctors, the tissue viability nurse, dentists,chiropodists, opticians and hospital consultants. The manager told us that when possible people can see a General Practitioner (GP) of their choice. This is dependent however on where the person lived prior to moving into Down House. In some circumstances it is necessary for a new resident to be registered at a local health centre near Down House because their own GP will not travel across the city. We chose four people, both men and women, to look at their care files and care generally. Each care file seen stated the name by which the person preferred to be called. Each had a full assessment of care needs, and a care plan that was reviewed regularly with the individual. If the persons health deteriorated so they were limited in their ability to be involved with their care planning, then a family member/representatives would be invited to become involved (if not already). The care plan continued to focused on the person. We saw evidence of multi disciplinary care planning to enable a pro-active approach by staff to provide suitable care for individual health care needs. Daily Records showed that any medical condition was monitored and recorded. There was evidence of recording of nutritional assessments, tissue viability, weight checks, medications, and personal preferences. People were able to choose to have dental checks, eye-sight checks and chiropody services and these can be provided at the care home by visiting contractors. We looked at Accident records. These were kept securely according to relevant guidelines. The manager explained the medication system at Down House to us. All the trained nursing staff were responsible for medication handling and administration. For those people prescribed controlled drugs, we saw these were securely stored in a separate controlled drugs lockable cupboard. There was also a lockable medication refrigerator. Each month two members of staff complete an audit of all medication. Inspection of the medication records found that all had been given correctly and signed for accordingly. Most people had medication at mealtimes however for anyone requiring specific times, these were adhered to. There were clear procedures for staff to follow regarding refused medication, spoilt medication and medication for return to the dispensing pharmacist. There was a clear audit for all drug disposals. All the care staff (with the exception of those very newly appointed), have received Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: training about understanding and how to use the principles of the Liverpool Integral Care Pathway (LICP). This is an evidence-based methodology for a multidisciplinary approach to caring for someone who is in the end stages of their life. Care Homes for Adults (18-65 years) Page 19 of 32 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 Down House and their families and friends can feel confident that any issues of concern or complaints raised by them will be dealt with appropriately. People are protected from abuse, neglect and self harm by the homes policies and procedures, and by a robust recruitment process. Evidence: Ten people living at Down House or their relative returned a survey about Down House. They all told us that there was someone they could talk to informally if they were not happy. Four out of these ten knew how to make a formal complaint.Two out of the six who didnt know how to make a formal complaint said that they had not needed to make a complaint however if the occasion arose then they would ask. We saw the Complaints procedure prominently displayed in the entrance hall above the Visitors Signing In book. Another copy was displayed next to the patio entrance. It was clear and included up to date contact details for CQC. The AQAA told us: The Registered Manager is available at all times to discuss any concerns. Complaints are dealt with promptly and appropriately. Investigations are detailed and filed including action taken. Robust whistle blowing and protection from abuse policy and procedure. Since the last inspection there have been no safeguarding referrals and the provider has received three complaints. These were all dealt with within twenty-eight days Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: using the homes Complaints Procedure. None of them was upheld. The evidence showed that these were being managed pro-actively with the involvement of families and the individuals. All the staff working at Down House have had training about how to recognise abuse of vulnerable people and how to report it. This was either a training session run by the local authority, or as part of their NVQ training. Some people had this training a few years ago. The manager agreed that some sort of in-house refresher session could be beneficial and good practice for all staff. Care Homes for Adults (18-65 years) Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at Down House have a comfortable and safe environment that is adapted to promote their independence and meets their needs. Evidence: Down House is a large adapted house with a modern, purpose built, single storey extension. The main house has two floors with bedrooms some of which are double rooms. Access to the first floor is via a stair-lift and the home currently has no passenger lift, so people using the first floor bedrooms need to be able to climb up and down stairs and/or to use a stair lift. A new extension is being built and this will incorporate a shaft lift that will stop at each floor. The rooms in the main house are mostly used by people admitted from their own homes via the Rapid Intervention, Treatment and Assessment (R.I.T.A.) Team for short stay respite care. As we toured the premises we met people in their rooms. Some people had brought personal items of furniture from their own homes with them. Most people had photographs and other personal items. Each room was decorated in a domestic style with matching curtains and bedspreads. We were told that these were optional and that people could bring in their own curtains and bed covers. All the rooms seen were personalised to suit individual preferences. All the bedrooms have a wash hand basin and some have en-suite facilities. We observed that there were no extra chairs for Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: visitors. One regular visitor to the home told us that they would prefer a chair to be available in their relatives room as sitting on the bed was uncomfortable especially for any extended period of time. There were toilets, a bathroom and a large wet room in the home. These had adaptations to meet the needs of the people living at Down House. They are all in the single storey part of the home. The lounge has recently been redecorated including replacing all the fixtures and furniture. Also the corridors have been painted and new lighting fitted. The home has a large laundry that is staffed by a laundress every day of the week from 07:30 until 14:30. Care staff cover hours outside these times. All the homes bed linen and towels are laundered at the home as well as residents laundry (except for dry cleaning that people pay for to be done outside the home). Staff are also offered a laundry service for their uniforms should they so wish. At the time of this inspection visit the kitchen still comprised of a port-a-cabin. Its facilities were domestic in size. This is now the fourth year. A recent Environmental Health inspection report commented that this facility needed to be upgraded so it would be more practical and better suited to meet the needs of a large care home. Down House has extensive grounds including a large garden and two large patio areas. Seating was provided. The manager told us that the patio furniture was new this summer and replaced the plastic tables and chairs with more sturdy metal ones. All the grounds have level access. The home employs two gardeners who maintain the grounds to a high standard. The home was clean and tidy with no offensive odours. There are two Infection Control link staff and all the staff on the Domestic team have completed or nearly completed an NVQ II in Cleaning and Support. At the time of this visit the Registered Provider told us that there was still an ongoing legal dispute about the proposed new extension. During our visit we observed that the staff have adapted to their working environment. Whilst the majority of residents are not directly affected by the building works and the temporary corridor, there is a risk to staff and visitors to the home, particularly at meal times. This is because the corridor near the kitchen was cramped and precarious with staff endeavouring to get food to people in their bedrooms. Two visiting health care professionals who returned surveys about Down House commented that the building works were not conducive to Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: a peaceful residence for the people living at the care home. Care Homes for Adults (18-65 years) Page 24 of 32 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. People living at Down House are supported by well-motivated and caring staff in sufficient numbers to meet the needs of those currently living at the home. Staff training and supervision is carried out regularly for all staff to ensure that the assessed needs of the people living at the home are met. Evidence: At the time of this visit the staff employed to work at Down House were in teams of nurses, care assistants, domestic,laundry, catering, maintenance and gardening, overseen by the Registered Manager, with two deputy managers and an administrator. We looked at four staff files,three of which were relatively new employees. Each file had a New Employee Check List. Three out of four had a reference outstanding. Police checks had been completed. Everyone had a job description and a statement of the main terms of employment. The staff rota showed that any new member of staff was supernumerary and worked under supervision. We were also told about this when we spoke to the cook who was training a new cook. The Registered Provider later informed us that there was sometimes difficulty obtaining two written references hence the strict policy and procedure that all new staff worked supervised for up to three months. Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: The AQAA told us that care staff all complete mandatory training and once they have completed their NVQ2 they are encouraged to follow a path of their choice be it Dementia, Palliative Care or Continence etc. and courses are arranged in the particular field chosen. Trained nurses are encouraged in the same way. All training is then disseminated throughout the rest of the team to the benefit of our clients. We believe this encourages self worth and pride in the work the care staff carry out. We saw that all the staff had an up to date training record and for those newer employees there was evidence of induction training.We also saw evidence of supervision and staff appraisals. None of the files we looked at had a photograph of the staff member however the Registered Manager confirmed she would arrange for photographs to be taken and ensure every file had one. The staff group at the time of this visit was all female, assorted ages, and from different backgrounds, beliefs, cultures and nationalities. People using this service therefore receive care that is unprejudiced and recognises their differences and values. Throughout this visit our observation of the staff found they were friendly and caring towards everyone. They were gentle and respectful as they assisted people with daily living tasks, and mindful of preserving peoples dignity and self respect. Care Homes for Adults (18-65 years) Page 26 of 32 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 Registered Provider shows a responsible attitude and continues to implement changes and improvements in order to keep improving and achieving positive outcomes for people using this service and staff working with them. Evidence: The person in day to day charge of the home at the time of this visit (the Registered Manager) was found to be approachable. She was willing and able to provide information to assist with the inspection. We saw evidence of quality assurance checks showing consultation about the home, for example, communal areas and individual bedrooms, meals, staff and staff attitudes, the manager, activities and events. The manager confirmed that all the necessary maintenance checks as reported in the AQAA were correct and up to date. We inspected the Fire Log and confirmed that the smoke detectors, emergency lighting and fire alarms had been checked regularly, dated and signed. There was a fire alarm check recorded as taking place during our visit however we confirmed with the Registered Manager that it had in fact been the previous day. Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: The Accident Book was seen and accidents had been recorded correctly. The CQC had been notified of any serious incidents affecting the health, safety or well being of any of the residents. Care plans inspected had risk assessments included in them that were relevant to the individual person. Strict rules were in place about staff not leaving the premises in their uniforms to prevent cross infection. On the day of our visit, the home was clean and tidy, free from offensive odours throughout. Care Homes for Adults (18-65 years) Page 28 of 32 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 32 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 34 19 The Registered Provider must ensure that there are robust recruitment procedures that must include taking two suitable written references prior to an individual starting work in a supervised capacity. This is to ensure that only people suited to the work may be employed and that the peple using this service are protected form harm. 16/10/2009 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 1 The Registered Provider should ensure that the Statement of Purpose is up to date so that prospective residents have the information they need to make an informed choice about where to live. The Registered Provider should consider the provision of chairs for visitors in residents bedrooms. 2 26 Care Homes for Adults (18-65 years) Page 30 of 32 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 3 41 The Registered Provider should ensure that all fire safety equipment checks and outcomes are correctly documented in the fire safety log book at the time of testing the equipment so that there is a clear and accurate record. Care Homes for Adults (18-65 years) Page 31 of 32 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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