Care Home: Ebbsfleet House

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What the care home does well People said they are listened to. Meetings to talk one-to-one are arranged for each person so that they can say what they want and if there is a problem.The people living in the home are assessed regularly to make sure the service is meeting their needs.People are supported to have an active lifestyle. They are encouraged and supported to do as much as possible for themselves.People are supported with their communication and challenging behaviour to increase the opportunities available to them. There is a person centred support team and a consultant psychiatrist employed by the company to provide direct support to the people living in the home. The home meets the physical and healthcare needs of the people who live there. There is input from specialists and local GPs. There is a good range of training including person centred planning and managing challenging and potentially destructive behaviour with positive behaviour support. People are protected well by the homes policies and staff training in safeguarding. What has improved since the last inspection? There are really clear contracts explaining exactly what services the fees pay for.Each person has a person centred plan with information about what is important to them and how they would like to be supported.Each person also has a communication passport which helps people who do not know them very well to understand what they want to say. The communication support is being developed further by one of the staff in the person centred support department.The incidents of challenging behaviour have continued to reduce and there have been no restrictive physical interventions.Different activities are being organised. Activities timetables that are meaningful are being designed using photos of the people living in the home doing things. This is so that they can make choices more easily. The people living in the home are also trying out new activities so that they have more to choose from. There have been great improvements to the inside and outside of the home. There are new windows all through. The kitchen door has been repaired so that it opens and closes easily. The whole home has been decorated with some areas like one person`s bedroom and one of the bathrooms in the process of being painted. There is a new stair carpet. The kitchen cupboards have been repaired.New protective covers have been put across the cooker that look more in keeping with the building. There is a new storage cupboard in the sitting room. The whole house looked airy and clean and smelled fresh.Improvements have continued to be made to the grounds to make it more decorative and colourful outside. There are also plans underway to plant an allotment The office has been organised. All the documents requested as part of the inspection visit were found so that we could look at them. The staff also knew where everything was.Staff said they felt well supported by the manager.All the service checks needed to maintain the home well have been made.The fire training and fire risk assessment have all been updated and maintenance checks of fire equipment have been routinely checked. What the care home could do better: It would be good to have a registered manager for this service. The manager has put an application in to the care quality commission to be registered so this is in the process of being completed.The manager has written a development plan outlining all the areas needed to continue the improvements for the home. This includes replacement of the roof and repairs to the outside walls of the building, continuing with the communication project and giving all the staff an appraisal. Key inspection report Care homes for adults (18-65 years) Name: Address: Ebbsfleet House Ebbsfleet House Tubbs Lane Ramsgate Kent CT12 5DH 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: Julie Sumner Date: 2 6 0 6 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 35 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 35 Information about the care home Name of care home: Address: Ebbsfleet House Ebbsfleet House Tubbs Lane Ramsgate Kent CT12 5DH 01304613004 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) : ebbsfleet@hqls.org.uk www.hqls.org.uk High Quality Lifestyles Ltd 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 35 A bit about the care home Ebbsfleet House is an old fashioned cottage in the countryside. 5 people with learning disabilities live in the house The house is in two parts. One part is for one person to live in. Each person is supported by one or two staff at a time. Care Homes for Adults (18-65 years) Page 5 of 35 There is parking to the front of the building There is a large garden at the back of the house There are two cars that the people living in the home can use. There is bus stop nearby. The fees are agreed differently for each person. They can range from low to higher thousands of pounds following a persons assessment. Care Homes for Adults (18-65 years) Page 6 of 35 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 Care Homes for Adults (18-65 years) Page 7 of 35 How we did our inspection: This is what the inspector did when they were at the care home The manager sent us an annual quality assurance assessment (AQAA) which tells us about the service provided, what improvements have been made and how they plan to develop it further. The AQAA was very clearly written and gave us all the information we needed to plan the inspection visit. We sent 5 surveys out to the people living in the home and 17 to the different people who are involved with them. We did not get any of these surveys back this time. We visited the home without telling anyone we were coming so that we could see what they do on a usual day. We were in the home from 10.30 in the morning to around 4 oclock. Care Homes for Adults (18-65 years) Page 8 of 35 We talked to all the people living in the home and also had lunch with them. We talked to the manager and the all the staff who were working that day. We had a look around in the house and outside. We looked at some of the policies and procedures. We also looked at staff records like what checks have been made before they started work and training they have been given. We looked at plans and records for supporting the people living in the home. Care Homes for Adults (18-65 years) Page 9 of 35 What the care home does well People said they are listened to. Meetings to talk one-to-one are arranged for each person so that they can say what they want and if there is a problem. The people living in the home are assessed regularly to make sure the service is meeting their needs. People are supported to have an active lifestyle. They are encouraged and supported to do as much as possible for themselves. Care Homes for Adults (18-65 years) Page 10 of 35 People are supported with their communication and challenging behaviour to increase the opportunities available to them. There is a person centred support team and a consultant psychiatrist employed by the company to provide direct support to the people living in the home. The home meets the physical and healthcare needs of the people who live there. There is input from specialists and local GPs. There is a good range of training including person centred planning and managing challenging and potentially destructive behaviour with positive behaviour support. People are protected well by the homes policies and staff training in safeguarding. Care Homes for Adults (18-65 years) Page 11 of 35 What has got better from the last inspection There are really clear contracts explaining exactly what services the fees pay for. Each person has a person centred plan with information about what is important to them and how they would like to be supported. Each person also has a communication passport which helps people who do not know them very well to understand what they want to say. The communication support is being developed further by one of the staff in the person centred support department. Care Homes for Adults (18-65 years) Page 12 of 35 The incidents of challenging behaviour have continued to reduce and there have been no restrictive physical interventions. Different activities are being organised. Activities timetables that are meaningful are being designed using photos of the people living in the home doing things. This is so that they can make choices more easily. The people living in the home are also trying out new activities so that they have more to choose from. There have been great improvements to the inside and outside of the home. There are new windows all through. The kitchen door has been repaired so that it opens and closes easily. The whole home has been decorated with some areas like one persons bedroom and one of the bathrooms in the process of being painted. There is a new stair carpet. The kitchen cupboards have been repaired. Care Homes for Adults (18-65 years) Page 13 of 35 New protective covers have been put across the cooker that look more in keeping with the building. There is a new storage cupboard in the sitting room. The whole house looked airy and clean and smelled fresh. Improvements have continued to be made to the grounds to make it more decorative and colourful outside. There are also plans underway to plant an allotment The office has been organised. All the documents requested as part of the inspection visit were found so that we could look at them. The staff also knew where everything was. Care Homes for Adults (18-65 years) Page 14 of 35 Staff said they felt well supported by the manager. All the service checks needed to maintain the home well have been made. The fire training and fire risk assessment have all been updated and maintenance checks of fire equipment have been routinely checked. What the care home could do better Care Homes for Adults (18-65 years) Page 15 of 35 It would be good to have a registered manager for this service. The manager has put an application in to the care quality commission to be registered so this is in the process of being completed. The manager has written a development plan outlining all the areas needed to continue the improvements for the home. This includes replacement of the roof and repairs to the outside walls of the building, continuing with the communication project and giving all the staff an appraisal. 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 35 If you want to speak to the inspector please contact Julie Sumner The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 01622724950 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 35 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 35 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Admissions are not made to the home until a full needs assessment has been made and the person has had the opportunity to visit the home and decide if they like it. Evidence: One person has moved into the home in the last few months. He said that he visited the home before moving in and was helped to make the decision about whether this was the right place for him. We looked at two assessments. These contain clear information that has been completed by the home and one of the assessments has also been completed by the care manager. The assessments are undertaken by people who have been trained to do so and are members of the Person Centred Approaches Department within High Quality Lifestyles. We looked at the new style contract. It is written in a style that is easy to understand. The information is organised so that it is clear what the fees are and how they are used. Care Homes for Adults (18-65 years) Page 19 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service recognises the right of individuals to make their own decisions and support people in a positive way. Staff have the specialised training and skills to support, engage and encourage each person to be fully involved. Evidence: Each person has a person centred plan. We looked at two of these. They contain clear information about the person and how they would like to be supported. The plans are reviewed every six months and more often if there is a change in need. The review is organised and everyone who is important to the person and is involved in their care is invited. They are called circle of support meetings and the person chooses how much of the meeting they want to stay for. We asked two people if they choose when they get up and go to bed and what they have to eat and they said yes. We saw that the staff listened to the people living in the home and gave them choices. We saw this at dinner time and when they were deciding what activities they wanted to do. The manager is organising photos to be taken of each of the people living in the home doing different activities and in different places that are significance to them. This is so Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: that these can be incorporated into the person centred plans, communication passports and activity planners. They are being supported staff in the person centred approaches team and by the community by the speech and language therapist with developing the communication aids. The company have a risk assessment format and risks are also assessed as part of the positive behaviour support analysis. Risk assessments contained clear information and were relevant to day to day activities that the person participates in. They contain clear guidelines for staff to describe how to respond in each situation to minimise and manage potential negative responses. There were risk assessments for different activities like going swimming, going out in the car and making meals. Care Homes for Adults (18-65 years) Page 21 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home are involved in meaningful daytime activities of their own choice and participate in the day to day running of the home. Evidence: Everybody living in the home has the opportunity to say what they like to do and to try new activities. The activities each person likes and what they regularly do is written in their plan of support. We also saw an activity timetable for each person in the office. The manager explained that this is to assist with organising the support needed but that the timetable is flexible. Three people were out swimming during the morning and others went out shopping and for walks. During the afternoon one of the people changed his mind and decided to play golf instead of swimming and this was supported. Staff complete records which can be referred back to see what everyone has done. We looked at two of the activity logs to see what had been happening in the last 2 weeks. We could see that people lead an active lifestyle and everyone does something different reflecting their own interests. When people go out into the community they are supported by two staff. Care Homes for Adults (18-65 years) Page 22 of 35 Evidence: Families are involved with each persons support and they attend the reviews of their care. The manager said the families keep in touch and he keeps them up to date with events at the home. People spend time with their families and some go and stay for long week ends. The people living in the home are supervised by staff and supported in the home. They are able to access any part of the home and garden. Each person has a lockable bedroom to protect their belongings. Each person has a risk assessment and if they are able to have their own key they do, if not they are supported by staff. We observed that staff were responsive to the people living in the home and there was no restriction to accessing their bedroom if they do not have their own key. Menus are planned and everyone joins in with this. Meals vary and an alternative is provided if people change their minds about what they want. Each person can also cook their own meal and have something different to the others. People are supported to cook and also to participate in the preparation of the main meals. One of the staff supported one of the people living in the home to cook the evening meal on day of visit. They showed us what they were preparing and both looked like they were enjoying themselves. Care Homes for Adults (18-65 years) Page 23 of 35 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. Personal and health care support is responsive to the varied and individual needs and preferences of the people who live in the home. Evidence: Each person has guidelines written in their person centred plan that explain what is important to them and how they would like to be supported. This includes support with their personal care and their general day to day routine. The staff find out what people want by having one-to-one meetings with them. These are organised to suit each persons needs like how long and how frequent the meeting are. We saw staff talk to the people living in the home and respond to their wishes. People said staff listen to them. Each person has a health action plan. These have been updated recently and contain clear information to assist staff to support the person with their health care. We could see that people are getting support from community health care services for specific medical conditions and as required. The health action plans have clear print but at present there are no pictures or photos that may assist people to use them to help understand their health. The manager said that the health action plans are going to be developed individually and will be designed differently including pictures and photos for people who will benefit from them. The manager said he will do this following the work that the member of staff from the person centred approaches team is carrying out to develop the Care Homes for Adults (18-65 years) Page 24 of 35 Evidence: communication support in the home. This is so that they use the best ways they have found to support each person. The people living in the home are supported by the staff to take their medication. We saw one of the staff carrying out part of the medication round at lunch time. He very politely asked one of the people living in the home if he would like his medication and the person came over to him and went into the room where medication is stored. We looked at medication storage and records. The manager explained that they are making sure that everyone taking medication is assessed by the medical services so that they can reduce it as much as possible. Where people have come into the home with high levels of medication because of their challenging behaviour they have been able to reduce it. This is because they can support the person and manage the behaviour using positive active support instead of medication to calm them. Care Homes for Adults (18-65 years) Page 25 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home are supported to voice their concerns and the procedures in the home protect people from abuse. Evidence: The company has produced a service user friendly complaints procedure. The manager said that he holds one-to-one meetings with the people to give them an opportunity to express their views. We saw that the people living in the home were listened to and staff were responsive to them. One person also has the support of an independent advocate. There have been no complaints about the service provided. The company reviewed the safeguarding adults training last year to make sure that it is giving the staff the right skills and knowledge. The training takes place over a full day. Staff work with individuals and monitor behaviour so that they can recognise when a person is unhappy and take appropriate action. We looked at the staff training records, the daily logs and the behaviour graphs. We could see that people do not display as many incidents of challenging behaviour and that there have been gradually less since the beginning of the year. We could see that staff have a good range of training to support people to say what they want and staff know what to do if there is an incident. The service is active in making sure that if there is an incident that they think may need reporting that they contact us and firstly the local social services safeguarding team. Care Homes for Adults (18-65 years) Page 26 of 35 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 living environment is appropriate for the particular lifestyle and needs of the people living there and is clean, safe and comfortable. Evidence: Ebbsfleet is a large detached cottage situated in a rural setting with a large garden and a front parking area. It is spacious inside and everybody has their own bedroom and two of them have ensuite toilets. Part of the home has been made into a separate annex for one person who has his own sitting room, kitchenette, bathroom and bedroom. One of the people living in the home and one of the staff showed us around the home. We saw that it has much improved since the last inspection visit. All the windows have been replaced and are double glazed so it keeps the noise of the traffic out. The house has been redecorated throughout and looked light and fresh. One of the people who has moved in recently has chosen the colour for his bedroom and it is going to be painted. He is going to help. The bathroom is also going to be painted and he is going to help with this also because he told us he likes painting. The kitchen has had some new cupboards built and the cooker surround has been made more attractive. The kitchen door has been repaired and opened and closed properly. Further work is planned. The roof is to replaced and the house is also to be re-rendered. Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: We saw this in the homes development plan. We saw that the home looked clean and it smelled fresh. The staff have a cleaning schedule with a checklist that is completed at the end of each shift to make sure all the jobs get done. We saw the laundry which is in a building outside. It has all the equipment needed. The grounds are regularly maintained by a gardener. There is an activities room with sensory equipment. Some of the people living in the home spoke to us in the garden. They showed us around and talked about the plans for the tidy up and the allotment. Some garden furniture and a swing is also going to be bought for the garden. Care Homes for Adults (18-65 years) Page 28 of 35 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has plentiful staff available at all times to support the needs, activities and aspirations of the people using the service in an individualised and person centred way. Evidence: The company has a thorough recruitment process to make sure the people applying for the job are who they say they are and will work in the right manner. The company asks for identification like a passport and 2 references from people who know the person including their previous employer. They request a Criminal records bureau (CRB) check and protection of vulnerable adults list (POVA) check to make sure they have not done anything in the past that will indicate that they are unsuitable or cannot be trusted. Staff work for a trial period of time in the company while everyone gets to know each other and the member of staff decides whether this is the right job for them. We looked at two staff files with the manager and saw that all these checks had been carried out. We talked to the manager about the staffing level and looked at the duty rota. We could see that there were enough staff to support the individually assessed needs of the people living in the home. Most people need one-to-one support in the home and two staff each to support them in the community. There was lots of activity during the day and enough staff so that everyone could do different things and did not always have to stick to the activity plan if they chose not to. Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: We talked about staff training with the manager and the staff. They told us that they regularly attend training that they need to do to comply with the law like health and safety training. They also told us that they have training for their specific job roles and to support the individual needs of the people living in the home. Training is undertaken both in house and at local colleges. Specialist training on issues relating to learning disability are accessed from the Tizard Centre, which is part of the University of Kent. The staff have received training in positive behaviour support and person centred planning at the Tizard Centre. The majority of staff have achieved their NVQ awards and all other staff are scheduled to achieve the award over the next 12 months. Staff spoke enthusiastically about their roles and we saw that they behaved in a calm and confident manner and were respectful and positive when talking to the people living in the home. The manager holds one-to-one meetings with the staff and each person will have an annual appraisal. These meetings and the appraisal give them the opportunity to discuss any issues and to consider their knowledge and skill development. Care Homes for Adults (18-65 years) Page 30 of 35 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 manager is highly competent to manage the home based on the organisations values and in the way the people who live in the home want. Evidence: Since the last key inspection the management of the home has changed. The new manager of the home has 18 years experience of working with people with learning disabilities and challenging behaviour. Most of this experience has been obtained within High Quality Lifestyles. The manager has several qualifications in care the most recent being the achievement of a Diploma in Positive Behaviour from the Tizard centre which was organised and funded by the company. There has been a handover period from the previous manager to enable the current manager to get to know the people living in the home and the staff team. The manager has made an application for registration for Ebbsfleet which is being processed by CQC. The home has a quality assurance system in place and uses a model based on periodic service reviews. The service must provide data for a number of standards on a monthly basis, it then receives a report on how the service is performing and areas where it must make improvements. The manager has designed a service development plan which Care Homes for Adults (18-65 years) Page 31 of 35 Evidence: clearly identifies what and how improvements are going to be made. We looked at the development plan and could see that some of the planned improvements had already been implemented. This included organising the office and creating a filing system, reviewing the person centred plans, holding one-to-one supervision meetings with the staff, replacing the windows throughout and tidying the garden. The manager showed us the fire risk assessment, fire checks and drills. We could see that fire training has been carried out for all the staff. All routine servicing necessary has been carried out to the building including electrical hard wiring, small electrical appliance testing and the heating system has been repaired and serviced. We could see from all the checks that the home has been maintained safely. There is an ongoing training programme for the staff to make sure that all training required by law has been completed and is updated as necessary. We have made the judgement for this outcome area to be good because the service does not have a registered manager at this time. Care Homes for Adults (18-65 years) Page 32 of 35 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 33 of 35 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 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 34 of 35 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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