Care Home: Dryad Spinney

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What the care home does well Person centred plans for people living in the home including risks and goals are developing.Signs and visual aids are increasingly used by people living in the home and staff to make choices.People are supported to join in a number of activities in the local community including cinema, walks in the forest, playing football, shopping, going to the beach and doing college courses.The staff are organized and are also given specific tasks to complete such as sorting out the menus.The manager is arranging staff training to give them the skills for the job.The manager is working to improve the quality of the service. What has improved since the last inspection? This is the homes first inspection. What the care home could do better: There are a few areas for attention and requirements have been made three things.Safeguarding procedures agreed with social services must be followed.Records of recruitment must always be completed fully.Clare plans must be in place for all behaviours which staff need to help people with. Key inspection report Care homes for adults (18-65 years) Name: Address: Dryad Spinney Dryad Spinney West Common Blackfield Southampton Hants SO45 1XP The quality rating for this care home is: one star adequate 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: Sue Kinch Date: 1 7 1 1 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 34 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 34 Information about the care home Name of care home: Address: Dryad Spinney Dryad Spinney West Common Blackfield Southampton Hants SO45 1XP 01276418000 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): info@ilg.co.uk Independent Living in a Caring Environment Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 5 Number of places (if applicable): Under 65 Over 65 5 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is 5. The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category; Learning disability (LD) Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 34 A bit about the care home When we inspected the home it was registered for four adults with learning disabilities and the focus of the service was to provide a service to young adults. Since our visit the registration team has increased the numbers to 5 people living in the home. The home is situated in a quiet area of Blackfield with local facilities available including a local park and beach. The home has its own transport and they hope to soon have an additional vehicle to offer more choice in activities in the community for people living there. Care Homes for Adults (18-65 years) Page 5 of 34 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: one star adequate 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 34 How we did our inspection: This is what the inspector did when they were at the care home An inspector visited the home for the first time. We read surveys from 4 staff, 1 person living in the home, and 2 care professionals. We listened to people living in the home staff and the manager. Care Homes for Adults (18-65 years) Page 7 of 34 We viewed records, policies and procedures. We looked at the house and garden. What the care home does well Care Homes for Adults (18-65 years) Page 8 of 34 Person centred plans for people living in the home including risks and goals are developing. Signs and visual aids are increasingly used by people living in the home and staff to make choices. People are supported to join in a number of activities in the local community including cinema, walks in the forest, playing football, shopping, going to the beach and doing college courses. Care Homes for Adults (18-65 years) Page 9 of 34 The staff are organized and are also given specific tasks to complete such as sorting out the menus. The manager is arranging staff training to give them the skills for the job. The manager is working to improve the quality of the service. Care Homes for Adults (18-65 years) Page 10 of 34 What has got better from the last inspection What the care home could do better There are a few areas for attention and requirements have been made three things. Safeguarding procedures agreed with social services must be followed. Care Homes for Adults (18-65 years) Page 11 of 34 Records of recruitment must always be completed fully. Clare plans must be in place for all behaviours which staff need to help people with. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector Care Homes for Adults (18-65 years) Page 12 of 34 please contact Sue Kinch Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA Tel: 03000 61 61 61 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 13 of 34 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 14 of 34 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. Difficulties arose with early transitions to the home but recent admissions have been more successfully managed. To ensure this continues the manager plans to increase the depth of pre-admission planning and manage the process more closely. Evidence: Since the home has opened there have been five admissions and one person has left as it was recognised that their needs could not be met at the home. Problems arose in respect of early admissions to the home and there were issues about staffing, training and the homes ability to meet needs and communication. Subsequently the latter admissions have been reported by the home and external professionals to have been more successful. One professional person said that the transition to the home for the person they supported was good. For another person we saw a record of a recent review indicating that progress was good. Aspects of the history of the admissions to the home were discussed with the manager who was aware of the issues that arose at the beginning of the service and of a more recent admission being successful. He expressed plans about increasing the communication, assessment and planning before any further admissions to the home Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: were made to ensure that needs could be met. Care Homes for Adults (18-65 years) Page 16 of 34 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 living in the home are being supported to communicate their needs and to be increasingly consulted about the support they receive taking risks into account. Support plans are being developed to ensure that least restrictive plans of support are used but further checks are needed to ensure that all necessary behaviours have been included in plans and staff are clear about all agreed interventions. Evidence: Since the new manager has been in post he has reviewed the way that needs are assessed and planned to be met in the home. We looked a sample of records and noted that the formats for care plans and risk assessments have changed and include more information about individual needs and wishes. We noted from conversations with staff that they are being actively involved in the ongoing assessing of needs with the people living in the home and devising ways of meeting them. They are recording progress. Key workers are also in the process of devising goals and plans to help people achieve them. For one person work was taking place to consider options for day time activities after recent changes in regular commitments based on that persons choice. Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: We noted that the staff are thoughtful about the choices and decisions of people in the home and include that in their planning. There was evidence in the records that consultation about the care planning is taking place with care professionals and relatives. Staff also said that they feel able to make suggestions and that these would be listened to. Care plans cover a comprehensive range of needs and wishes and risk assessments are in place. In the files sampled these had been recently written and the manager had evidence of consultation with care professionals about interventions and said that he intended to consult more about risk assessments. People living in the home have varied abilities in verbal communication and their individual ways of communicating non verbally are being taken into account. The home is developing visual aids for this through the use of pictures and photographs. Makaton signing is used and development of skills is being encouraged among the people living in the home and the staff. We saw the use of signing throughout our visit. We were also shown the life books for one person containing much information about that persons past. These books were in the persons room ready for everyday use. The person also had a series of cards readily available on the wardrobe door to help them express emotions. We had confirmation from care professionals that the service is working positively with people. One said that there had been problems at the beginning when staff did not have the skills to deal with challenges but training has been addressed and the home is now moving in the right direction. Another said that the person they supported had been involved in their recent review, that the person liked it at the home and that the home was working well with them. Both professionals commented that the manager is good at communication with them about meeting needs. We noted that there are some restrictions such as to the utility room and going out alone but these were in the risk assessments where sampled. We also discussed the physical interventions agreed for one person with a member of staff and these were documented in the care plan. Risk assessments preceded these and we found similar recording was in place in the other file sampled. We noted that one person went into a bedroom not belonging to them and was physically blocked from going further into the room by a member of staff. Staff and the manager said that the person did do this sometimes. This was discussed with the manager and the file for that person was checked. We noted that the care plan did not include a strategy for dealing with this or a risk assessment. The manager said that verbal prompting should be sufficient to address the behaviour. We made an immediate requirement for this to be assessed so that a least restrictive intervention is used. The manager agreed to address this. Care Homes for Adults (18-65 years) Page 18 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home benefit from being increasingly able to do the things they like doing at home and in the community. They also benefit from support with family and other relationships, and encouragement in exercise and a healthy diet. Evidence: The assessments, risk assessments and care plans show that peoples individual, emotional, recreational and social needs are being taken into account in planning the day to day service. Conversations with staff showed that they were aware of interests, and hobbies in and out of the home. They were also aware of some of these changing and gave an example of someone who recently decided to stop going to school and of the need to explore further about how that person wished to spend their time. Another person had recently changed college courses and the key worker said the person was enjoying the current ones more. Some activities are planned to happen on a weekly basis. An example of this was a person being supported three times a week to go to college. Staff said that they know Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: what people enjoy doing but they were not yet able to have a weekly regular programme of activities for each person because more funding was being sought to ensure that recent changes in needs were taken into account. Also one person needed to have two people with them when out in the community. However, they said that they aimed to take people out daily for activities including: walks, exercise, shopping and car rides. They said that all staff can drive but they hoped to have another car soon to increase the options available. We noted that there is some recording of what people do on a day to day basis but this is not always completed to give full details of what the person did. We observed and noted that people are involved in their own interests and one person had been supported to buy more model cars that morning. Another person had books that they enjoyed and several people were noted, at different times, to be kicking a soft football along a corridor during our visit. We also saw that people are involved in some computer activities. Help with communication skills is provided and referred to in more detail in the section on individual needs and wishes. Recording of recent events in the home has shown that the individual emotional and social needs of people living there are increasing considered in the care provided. These aspects of care provision are included in care planning records. Links with families are encouraged and some people have regular weekends with them. Staff said that people are involved in the planning, shopping and cooking of meals and that one person sometimes cooks a whole meal. There are visual aids to assist with meal choices and staff said that these are to be increased. One staff member said that the food provided for people now is a lot healthier since the new manager was in post including more fruit and vegetables. The food is also more varied. One person living in the home said that they liked the food provided and had enjoyed their lunch. One member of staff is responsible for planning the menu with people living in the home and the current menu indicated that people had been involved in the decisions. Staff said that they know what people like and they can have different things if they dont like what is on the menu. It is also planned, by management, to provide a choice more often. Care Homes for Adults (18-65 years) Page 20 of 34 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 receive personal and health care support in an individualised way, are supported with their emotional needs and are supported carefully with their medication. Evidence: Discussion with staff, and including people living in the home where possible, confirmed that they are aware of individual needs of people living in the home and take their choices and preferences into account. In the sample of records viewed, we noted that personal care and health needs are included in the plans for care. One file was more detailed and included a health action plan. The manager said he is helping staff to develop assessments and care plans further including health needs. In the sample of records viewed we noted that there is evidence of health monitoring such as visits to the doctor and of epilepsy monitoring. There is evidence of inclusion of health professionals in ongoing assessments of need. We had positive feedback about the support being provided from some care professionals. A member of staff talked about their key worker role and how this included monitoring to see if and how support is provided to ensure it meets people’s needs. Staff also spoke of promoting healthy eating and exercise and gave examples of the things that the young people living in the home enjoy. Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: There is a system for safely storing medication in the home. The staff roles are mainly met by the team leaders and a list of staff trained is held. Medication is mainly provided on an as required basis and we found guidelines for this in place for individuals. We checked a sample of records against the stock to find that medication had been recorded when given. The manager said that as there are few demands on the use of medication staff competence had not been assessed. He agreed to review this to ensure that the staff are competent and remain competent in the areas that they are involved in. Care Homes for Adults (18-65 years) Page 22 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a clear complaints procedure for people to use in the home and staff are trained in safeguarding. However, following a recent investigation into an allegation social services were not satisfied that the homes internal procedures were robust. Evidence: The home has a complaints procedure which includes pictures and is on the notice board in the front hall of the home. In the AQAA the management acknowledged could have been quicker to respond to concerns raised by relatives and with better communication. A complaints log book is now ready to be used and the manager showed us a record of a more recent complaint that the home had addressed. Communication with care professionals indicated that the manager is responsive and provided good communication. A training matrix in the home showed that staff are being trained in safeguarding and those who have not yet completed it are being nominated for it. One staff member spoken with about it was aware of the possible action to take if an allegation is made and had recently been trained. Another staff member was aware of whistle blowing, the need to act and who to report to. The home has reported some incidents in the home to CQC. Some incidents, just after the home opened led, to safeguarding procedures being followed and the home responded by reviewing some of its procedures for supporting challenging behaviours and Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: providing staff training. We were provided with information about an incident by the home in August 2009 and were subsequently told about some safeguarding matters relating to it by social services. The home did not tell us about these allegations and we informed them of this in a letter. Social services have closed the safeguarding matter but the management of the home is aware that social services were not fully satisfied with the way that the home had addressed the matter. We have required the home to review some of their procedures in light of this and have written to the home separately about this. Care Homes for Adults (18-65 years) Page 24 of 34 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 living in the home are provided with a spacious clean and comfortable environment with attention to maintenance and infection control. This will be enhanced when environmental alterations are completed and more areas are fully accessible. Evidence: People living in the home are provided with individual bedrooms with en suite facilities, a moderately sized lounge and a kitchen/diner. A sensory room is not yet available due to rooms being exchanged to increase the amount of space for people to use. The utility room is not freely accessible as it is also currently used for the storage of substances needing to be locked away. A recent extension to the home not yet in use. It includes a room that will be used for this storage of these materials. The manager said that the utility room will then be open and freely accessible. The garden has been out of use since September 2009 while building work has been taking place. This is now completed and the management has provided an additional room and has submitted an application for an increase in resident numbers to 5. This is being addressed separately to this inspection report. Staff said that there is a park and beach nearby that they can use and have done so regularly. People living in the home are encouraged to have personal possessions in their rooms. Individual needs are taken into account with furnishings. We visited three bedrooms and these were maintained and adequately decorated. There was evidence of individual needs Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: being taken into account. In one room staff were doing spot cleaning which they said they did regularly. In two rooms curtains were folded and staff said that they are put up by the use of velcro at night. There is a maintenance book in the office and this had many entries by different staff and many had been signed off as completed. The home was noted to be clean with no unpleasant odours. Staff were using plastic gloves and aprons. They said they are having training in infection control and this was included in the training matrix that the manager showed us and is reviewing. Care Homes for Adults (18-65 years) Page 26 of 34 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. A recent review of staff training and supervision means that a plan is in place to ensure that they are supported and trained to meet the needs of the people living in the home. Until recently recruitment practices have not been robust and left people in the home at risk of receiving service from people not adequately vetted. Evidence: Discussions were held with the staff and manager about the staffing levels and currently there are mostly three staff a shift, sometimes the third person works during the day across shifts and sometimes the level is reduced according to how many people are in the home. The main deficiency in staffing at the time of our visit, identified by the management and the staff was the support available to one person for activities do to recent changes in daily routines. All agreed that the need for additional funding for this had been requested. In the meantime various activities were being undertaken but were not as person centred as the home would wish. The sample of rotas viewed supported verbal information about staff levels. A staff member said that there had been a big turnover of staff. The manager said that the home was now not recruiting and had just had a new member of staff start and other staff covered other shifts that were vacant. All four staff responding to our survey said that the employer carried out checks before Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: they were employed. In the sample of records we viewed we found that recruitment checks were not thorough. Checks for the most recently recruited member of staff were fully completed but in two of the three other sets of records we found that there was not enough evidence that references had been obtained from those on the application form or followed up where necessary and one person had started before the ISA check has been completed. Issues were raised by external professionals when the home had opened, about how staff of the home were responding to some of the behaviours and needs of people moving in. This is referred to in the complaints and protection section of this report. The manager had evidence that the training needs of staff have been reviewed and has a computerised record of training that staff have completed and of training needed. He said that he was also checking the training that staff had received in previous jobs. He had a list on the wall of training planned for staff over the coming months including behaviour management updates, epilepsy, equality and diversity, health and safety, moving and handling, safeguarding, Mental Capacity ACT, food hygiene and infection control. One member of staff was on a training course and there was written evidence that another member of staff was undergoing induction. We also saw a certificate of the behaviour management training that staff had recently received and this detailed the types of physical intervention that the a staff member said that they had been trained in. Staff confirmed that they are receiving training and that this included areas such as fire, infection control and health and safety. Care Homes for Adults (18-65 years) Page 28 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The quality of the service has recently been under review with changes made to systems to offer people are more person centred service. However attention is needed to staff recruitment and safeguarding to ensure that protection of people living in the home is maximised. Evidence: The home has been open for seven months and the initial manager was replaced by someone temporarily acting in that role. During that time there were several safeguarding matters leading to local safeguarding procedures being followed and the home had to review how people were admitted, supported and how staff were trained. The current manager is not yet registered and has been in post for two and a half months. Feedback from staff members and local professionals about the new manager are positive. They included comments about good communication, about him listening consulting and involving other professionals. The manager is developing a system of quality assurance and some of the work taking place has involved reviewing systems and setting the standard required. There is a system of regular monitoring of the home by a Representative of the organisation and Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: there are detailed reports held in the home. The manager showed how he records all of the action points of these reviews and ticks them off when completed. We note that he is reviewing all of the procedures in the home and updating systems including: staff supervision and training; assessment and care planning with people living in the home; involving relatives; organisation of activities and stimulation, and monitoring processes. However, we have made requirements in other sections of the report which reflect on how the service to people has been managed since it opened. Although we noted that risk assessments are developing and interventions are being agreed we were concerned to view a restrictive intervention which was not planned. This indicated that more work is needed to ensure that least restrictive practices are always used. We have also made a requirement about the home not following safeguarding procedures fully in line with locally agreed procedures and another about recruitment of staff. We considered aspects of health and safety in the home. We noted from staff comments that they are receiving training in related topics such as infection control, fire, food hygiene and risk assessments. They have been provided with protective equipment for cleaning. The training plan included some of these subjects for further training. Hazardous substances are locked away. Care Homes for Adults (18-65 years) Page 30 of 34 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 31 of 34 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 1 9 13 The registered person must ensure that any physical intervention is always preceded by a risk assessment and an agreed intervention planned so. This is to ensure that people are not at risk of harm. 19/11/2009 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 23 13 The registered person must ensure that the home reviews procedures related to safeguarding. 24/12/2009 This is to ensure that people living in the home are not at risk of harm. 2 34 19 The registered person must 24/12/2009 ensure that no person is employed in the home unless records required under schedule 2 of the Care Homes Regulations 2001 have been satisfactorily met. Care Homes for Adults (18-65 years) Page 32 of 34 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 This to ensure that people supporting people living in the home have been fully vetted. 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 33 of 34 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!