Care Home: Egmont Road (33)

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What the care home does well 33, Egmont Road provides a service to clients who have challenging behaviour and we remain clear that the focus and dedication of the staff team working with those using the service continues under the consistent and enthusiastic guidance and management of Ms Nickless. A recent admission has shown the care and attention given to ensuring a transition into the home was as seamless and constructive as possible. The culture of the house ensures that each service user is well regarded personally, and the plans of care and intervention are well formed. Documentation continues to be notable for its thoroughness. The home is clearly enabling service users to live an active and fulfilling life, making clear efforts to secure occupational and recreational activities for each individual, and ensuring a comfortable and stimulating home community life. The service has welcomed a newcomer to the home in the past year, after careful planning and preparation. The home remains a pleasant and bright environment, providing a modern, homely environment for people using the service, all of whom use the space, the opportunities and facilities to the best of their advantage. What has improved since the last inspection? The last inspection report highlighted a significant number of improvements following the arrival of the current manager; since then, an Annual Service Review in September 2008, conducted by the lead inspector - and including interviews with relatives or advocates, suggested that the quality rating of the service may have improved; this inspection visit therefore was seeking affirmation of the quality of the service provided; both from a management perspective, and also from the point of view of outcomes for people using the service. Two observations were made at the last inspection visit. The first was that the reintroduction of a deputy manager would support both the service and staff focused needs of the home; this is now being actively sought with the service advertising a management position to be filled. The second point was that the reintroduction of a Service Development Plan would assist the service to focus on getting things even better for the future; this plan is now in place. What the care home could do better: One caution was raised concerning the possibility of over recording with regard to medication profiles doubling up on the information now held in the newer Health Action Plans. It is a problem when recording has to be duplicated; the manager needs to monitor this dilemma carefully. Whilst acknowledging that the recruitment process is currently in process, the appointment of the deputy manager should be prioritised to ensure positive support for the manager and to share out some of the management workload, which principally falls on the shoulders of the current manager at this moment. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Egmont Road (33) 33 Egmont Road Sutton Surrey SM2 5JR     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: David Pennells     Date: 2 2 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2010) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Egmont Road (33) 33 Egmont Road Sutton Surrey SM2 5JR 02086426890 02086428271 Telephone number: Fax number: Email address: Provider web address: www.caremanagementgroup.com Name of registered provider(s): Type of registration: Number of places registered: Care Management Group Ltd care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection Brief description of the care home 33, Egmont Road is owned, managed and staffed by the Care Management Group (CMG). This residential care home was opened in 2003 and is registered with the Commission to provide care for up to six adults with learning disabilities with associated behaviours of a challenging nature. The home itself is a large semi-detached Edwardian building excellently situated in a suburban area of Sutton - close to local shops, transport links and other amenities that are available, nearby, in the main town centre. There is parking for two cars on the Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 6 Brief description of the care home front driveway, and free parking in the street. There is a garden - grassed - at the rear of the house, with an upper level open-air paved patio with seating and tables. Accommodation within the home comprises: six single occupancy bedrooms; one of which has an ensuite toilet and bath, the remainder having toilets and showers; there is also a kitchen, a separate dining room, a comfortable living room, a laundry and an office. A sensory room for people to use is provided on the ground floor. There is an additional bathroom for communal use, and toilets situated on both the ground floor and upper floor to meet service user and staff needs. All areas are attractively, brightly decorated and furnished in a modern, contemporary style. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The visit to the house was conducted over a day from mid-morning to late in the afternoon visiting the house; this was an unannounced visit, which fortunately found Vicky Nickless, the manager, present; having just returned from leave. She was able to helpfully assist the process of inspection of documentation and care records, and to review progress at the home since the last inspection visit. The manager of the service had previously provided an Annual Quality Assurance Assessment (AQAA) document concerning the service to the Commission; some elements and information within this report are taken from that statement. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service, and it also provides some up-to-date numerical information about the service. We also looked at notifications sent to us concerning incidents occurring at the home and considered any other information we had about the service. Care Homes for Adults (18-65 years) Page 6 of 31 We also received back a number of questionnaires sent out by us, these being from relatives of people using the service, and from the people actually living at 33, Egmont Road themselves. All those who live at the home were also met during the inspection visit, as were many staff members on both morning and afternoon care shifts. We are grateful to all at 33, Egmont Road for their welcome, help and positive cooperation during the visit. 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 Care Homes for Adults (18-65 years) Page 8 of 31 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 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering using the service will have the opportunity to find out about the home, to visit (including staying for short periods) and, through prior assessment and consultation, be assured that the home can meet their needs, before making a decision to stay at the home. Evidence: The homes Statement of Purpose and other documentation is available before a placement provides an active picture of life at the service. Four people using the service have been resident at the home since mid August 2003, when the home was first opened, with the fifth person arriving at the home in May 2004. The newcomer to the home arrived in February 2009. There has been little change in the general overall level of need / dependency of those who have been at the home on a long term basis, however the newcomer has been provided with 1:1 daytime care input to address their needs since their arrival. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: The admission more recently of the newcomer to the service was dealt with over a long period of time and involved many visits to and from the home to ensure familiarisation and recognition of the new environment. The initial assessment conducted by CMG extended to nineteen pages and an enhanced CPA and comprehensive discharge plan was devised. The transition to moving in took approximately four months of planning. This shows the commendable amount of work that was dedicated to ensure that the placement, when made, actually worked. Ethnic backgrounds of those living at the home include Anglo/African - as well as the British culture being strongly represented. Religious focuses are also acknowledged being important for three who attend Christian church Services at their own will. The majority of staff members are of African background. All referrals to the home are based on a full needs assessment, in consultation with the various Care Managers from the relevant Placing Authorities and the CMG Assessment Team staff. The manager of the service is also quite rightly involved in the assessments for potentially new service users, once the initial selections have been made. Compatibility of the newcomer is seen as a vital component in the admission process. The manager of the service was clear that any admissions would only be made when a probable integration with the current team would be possible. Health and Social Services Comprehensive Assessment documents were available from the relevant placing authorities for all people using the service. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensures that the needs of people using the service are identified and met in a focused & individual way, documented in their person centred care plans, with the aspirations of each person centrally taken into account. Service users can be assured that their voice can be heard through the service user consultation meetings and other modes of consultation. Those living at the home can be assured that risk-taking will be an integral part of the support and protection plans put in place by the home to promote each service users independence and ensure fun and fulfilment. Evidence: Individual person centred care plans have been developed for all those using the service, these being generated from the care management holistic assessment details, with additional input from the individual themselves, from annual reviews and from Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: the homes own ongoing assessments and observations. Monthly summaries are written by keyworkers, related to these care plan aims and objectives. Record keeping was again noted to be generally well maintained, from daily diary entries to keyworker and review notes. The manager has introduced an approach to running the service that aims to provide a fun and stimulating environment in which to live, that encourages the individual to achieve their wants and aspirations. Service user meetings have been held regularly and minutes seen evidenced a consistent routine cycle of decision making gatherings. These promote the concept of corporate decision making, and ensure equity in such processes. There are a number of very strong personalities within the service user group, with assertive attitudes; the need for democratic decision making is vital to keep a fair balance within the house. Those using the service are clearly generally well supported to take risks and to be themselves as much as is practicably possible. Risk assessments seen were comprehensive for each individual, and were clearly relevant to their individual circumstances. A standard CMG format is in place in regard to these documents. Some parents spoke of the difficulty in accessing social workers or care managers at any time other than the annual review, and one felt that their requests were not being heard by the placing authority. The manager described some annual reviews being conducted by telephone, this seemingly excluding real consultation with the person using the service. The manager is making every effort to ensure that the person using the service remains at the centre of the focus for care planning and reviews. The manager has noted in the AQAA: Providing individuals with the opportunity to advocate choice has seen a remarkable decline in more negative behaviours and which has resulted in a calmer service. Clearly listening to people works. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Those using the service can be assured that the home provides opportunities for them to engage in activities both within and outside the home, utilising local community resources, and to adopt a lifestyle best suited to them as an individual. Relatives and friends can expect a positive welcome from the home, within the context of respect for each persons own choices and decision-making. Links with each persons own home or roots are encouraged, to ensure that support from this source, and with external contacts are maintained. People using the service can expect to receive a good standard of nutritious and wholesome food to their preferred choice, meeting individual dietary needs, and in an atmosphere that seeks to ensure that mealtimes are a pleasant and enjoyable time. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: People are supported to take part in activities and skills developments engaged in prior to entering the home, if they still wish. The focus on training and education, at whatever level may be suitable, enables people to maximise their skills and independence. People attend centres for a number of sessions each week, and most are enrolled at Sutton College of Learning for Adults (SCoLA) for courses of many and varied natures. People are also encouraged to engage with local community resources, both learning disability-focused and specific and also mainstream. Attendance at the Mencap social club & Discos, Swimming, Gym, addresses the social and physical aspects or needs, contributing to each persons fulfilment and potential. As far as individual capacities allow, all those using the service are encouraged to engage in meaningful and fun activity at the home, and to lead a fulfilling lifestyle within the peer group context of the home, as all those using the service are within a roughly similar generational age group. The service positively encourages appropriate social and interactive engagement with staff, with those outside the home, and with each other. The level of a social skills base of an individual does not obstruct the right of anyone to actively engage with the community, whatever their specific needs or abilities. The home also encourages spiritual concepts - through some people attending religious Services, with staff or families as appropriate. The on-site house vehicle allows for trips to local venues such as visits to parks, cinemas, pubs, shops and the local countryside. People really enjoy sharing the trips arranged - even, perhaps, to take another person to their parentsal homes, going as company - just for the pleasure or enjoyment of the trip, and also the associated refreshments. The home encourages the maintenance of family links and friendships inside and outside the home. Four of the people using the service have regular contact with at least one of their parents, and visit them away from the service itself. Some parents collect their relative from the home - and staff members drive some to their parental home base. Some find it difficult to stay at their parental home, positively preferring to return to their own space at 33, Egmont Road. All people using the service now, commendably, have a Yahoo internet address to access the intranet for themselves, and even to remain in contact with people they wish to contact. Those using the service sit down with staff and plan the next week menu, personal favourites being tempered by staff encouraging service users to think of sensible and healthy eating. A weekly takeaway, however, is a popular opportunity to try out new Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: culturally mixed cuisines. The home encourages everyone to engage or assist in the preparation and cooking of food, as far as practicable; staff members offer advice and support regarding food hygiene and nutrition. The kitchen continues as a central hub of the home. Staff members also use the mealtime opportunities to discuss activities and peoples feelings about a variety of things over meals. People using the service thoroughly enjoy providing hospitality to visitors through making drinks and sandwiches available. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be assured that their personal, health care and emotional or psychological needs will be recognised and met by the assessments of the service and through the care planning programme, with appropriate specialist support being accessed as appropriate. Medication systems used ensure the safety and consistent treatment and support for each service user. The systems and relationships formed with other medical professionals ensure a high standard of input. Evidence: The observed personal care and support of individual people using the service, provided by staff members was appropriate, friendly, and sensitive to their needs. Routines were flexible, and guidance, observation and support offered were generally second nature to staff, working alongside people, whilst providing any necessary assistance. Service users clearly choose their own clothes and initiate their own activities of choice; they are supported in activities and day-to-day routines by all staff, whilst having a more focused relationship with their keyworkers. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: Those using the service receive support and advice from appropriate health care professionals - firstly from the local and very supportive GP, and also including specialist psychological and psychiatric input, as may be required. Service users are offered annual health checks, and records of all healthcare related appointments or visits are appropriately maintained. Fully completed Health Action Plans are in place for each person at the home; they are updated annually or more frequently, based on the individual history - and taken along when GP appointments arise. The plans are an excellent summary of identified need, and involve people in making decisions about their own healthcare, being signed off by the GP. The manager also is focusing on ensuring that Well Women and Well Men clinics are accessed for all people using the service. The home uses the monitored dosage system of medication administration, through the use of blister packs, having Boots the Chemist as supplier. The systems for recording were examined by the inspector and found well maintained throughout. Records seen at the time of the inspection were comprehensive and well maintained. A caution is raised that the crossover of information between Health action plans and medication profiles, for instance, could lead to duplication of recording and care will have to be taken to ensure both are properly and consistently maintained. Each service user generally benefits from the continuity of support through having a designated keyworker at the home. The keyworker is principally responsible for ensuring that the users individual needs and preferences are explored and met, being responsible for the monthly summary reflecting the health and care plan achievements and aspirations. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service and their advocates can be assured that their comments or complaints will be taken notice of, investigated and acted upon within the homes stated procedural timescales. The home provides support to people to ensure that they are protected from harm or any form of abuse - through the maintenance of robust adult protection and safeguarding policies and procedures, and the resultant practice of the service. Evidence: The homes complaints procedure is included (in symbols format) in the Statement of Purpose and Information Handbook. The procedure has clear timescales given, and timeframes for the resolution of any such complaints. A record book for all concerns or complaints made about the service at the home is kept, with records of action taken, outcomes and feedback noted as part of the resolution process. The manager evidenced that concerns raised by people using the service are recognised and recorded (an important point for some) and that a clear outcome has to be documented as well as the actual problem being recorded. The home is in possession of the most recent version of the Local Authority (Sutton Borough) protocol. The CMG Policy and procedure for Safeguarding refers issues directly to the Local Authoritys Guidelines for dealing with any incidents - and ensures that the Local authority (the lead agency in such issues) is contacted in the first Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: instance - should an issue arise. Previous adult protection issues arising at the home have been dealt with appropriately by both the home staff and the central provider organisation. E-Learning is now provided by the managing company, CMG, to ensure that all staff not only undergo training but are also tested on the subject matter before this is signed off and confirmed by the computerised process. Safeguarding is a standard item on the agenda for staff meetings and within staff supervision sessions. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Those residing at the service can expect the home to be a safe, clean, pleasant & comfortable environment to live in. Private space meets the needs of the individual service user well, and promotes the concept of privacy and the opportunity to express their own character through the furnishings, contents and decorative style of the room. Evidence: The home has been open since July 2003 and as such is regarded as new premises in National Minimum Standards terms. This is reflected in such aspects as all bedrooms having ensuite facilities, and the communal space being substantial and well planned. The general toilets and bathing facilities are additional to the en-suites provided in each of the bedrooms. Residents individually furnish their bedrooms, which are well decorated in a personalised style. They are being progressively redecorated and recarpeted where necessary in the next year or so. Each occupant is given choice of their own colours and new items of furniture. Each person has their own lockable storage space in which to keep their valuables; they are also offered a key to their bedroom. Each bedroom Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: has ensuite toilet facilities - five have a shower, and one has a bath. People living at the service were extremely keen, and proud, to show their rooms to the inspector; each clearly showing the individualism of the person living there. Communal space is also generous; there is a large comfortable lounge, a dining room, an office, a large well-ordered kitchen, an attractive upper patio area, and a large (grassed) garden. The main communal space has been developed with displays and stimulating information available. The ground floor sensory room is also available, providing a good place to chill if life gets hectic, and to provide time out for any who feel the need for such relaxation. No service users smoke - so the home has been fully non-smoking for some while. If staff members or visitors do smoke, they have to pursue this habit outside the building. The staff sleeping-in room is on the second floor. CMG operates a full and comprehensive list of policies and procedures for the control and prevention of infection within the home. The home continues to be kept very clean, and was again free from odours at the time of the inspection. The laundry facilities are located on the ground floor and are suitably positioned to ensure that soiled articles are not carried through any areas where food is stored, prepared or eaten. The room is fitted with its own hand washbasin. The washing machine is capable of washing foul laundry at appropriate temperatures, having a sluice-cycle. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Those using the service can rely on the home to provide adequate staffing in sufficient numbers, and duly competent, to provide a service that seeks to meet identified needs, through a well trained and qualified staff team. The homes recruitment and staff support mechanisms are organised so as to ensure the safety, protection and wellbeing of service users. Staff members are well supported through management oversight on a day-to-day basis, but the need for regular professional development would be enhanced by the recruitment of a deputy manager. Evidence: Staffing levels at any time run at least with three members of staff on duty both on the early and late shifts, this ensuring a minimum ratio of at least 2 to 1 staff support for service users throughout the day. One person at the service is currently funded for fifteen hours per day 1 to 1 attention in addition to the general staffing levels and the manager hours are supernumerary to this formula. At night there is always minimally one waking and one sleeping-in member of staff on duty in the house (with two awake when the 1 to 1 focus was introduced). Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: The home is staffed with the manager, a vacancy for a deputy, a senior support worker, two support worker at level 2 - and eight support workers. The position of deputy is currently open to recruitment interviews and this will be of great benefit to the service, supportive of the manager and also the staff team. Three care staff members have transferred into the home from other projects within the company. The previously identified need to recruit more male support workers, to ensure that role modeling and appropriate personal care services can be provided to the three males using the service, has been boosted to there now being three male staff available, compared to nine women employees. Over 90 of the care staff team are now qualified, nominally to NVQ Level 2 in Care. Only one member of staff is without this qualification threshold, and is in process of the training. All staff members have also completed the Skills for Care Induction training. Staff records examined at the time of the inspection visit were again noted for their clear organisation and comprehensiveness; it is good to see a service underpinning its service with the firm foundation of good recording. Records evidenced the registered provider ensuring that all appropriate checks, such as references, CRB checks and employment status are undertaken and fulfilled before staff commence. Formal staff supervision at the home has continued; the staff member file which was case tracked showing sessions recorded at least to the minimum standard. The home manager offers formal, individual staff supervision regularly, and an open door policy for emergency support. The recruitment of the deputy manager will make this process more focused, consistent and reliable. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home and their relatives and friends can rely on the service being run well, and providing a professional service with the best interests of the service user being central to the care provision. The registered providers can be relied upon to take seriously issues raised for their attention from both those using the service and their advocates, through both the quality assurance and complaints mechanisms, and embodied in the Company policies and procedures, this contributing to both the wellbeing and safety of those residing at the home. The Company ensures that health & safety issues are properly addressed responded to, to the benefit and the safety of both those residing at, and those working in, the home. Evidence: The manager, Victoria Nickless, is registered with the Commission, has a degree in learning disability care, and has undertaken and gained her Registered Manager Award Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: at NVQ Level 4 in June 2008. The manager is skilled clearly to provide guidance and leadership in this service and is heavily committed to ensuring the best possible standard of service to those who live there. Both staff and those using the service are encouraged to participate in the day-to-day operation of the home, making their views known through regular service user and staff meetings, and to voice their opinions at reviews, and through the home Quality Assurance and Complaints and Grievance procedures. Quality Assurance surveys are regularly sent out to relatives, representatives and friends or advocates of those using the service to encourage feedback about the quality of the service provided. Responses are received centrally and collated, prior to being sent on to the home itself. The home has a Quality Assurance folder - which helps focus work for the near and distant future. The home also now has an up to date comprehensive Service Development Plan for the current year, matched against the National Minimum Standards, identifying needs, projections and aspirations - reflected in an improvement plan for 2009 set against ten service management criteria. Unannounced visits by area representatives of the registered provider, or by the Regional Director are being carried out on a regular basis. The format of the documentation mirrors the format of the Commission KLORA (Key Lines of Regulatory Assessment). Such visits involve checking specific documentation and the premises, and interviewing both those using the service and staff members. Financial checks are also a routine part of the auditing process, as well as head office providing spot check audits from time to time. Care Management Group has a comprehensive set of policies and procedures that cover the broad spectrum of needs identified for care homes; there is a clear focus for guidance provided by these documents. The inspection visit included a review of all essential health & safety issues at this service, counterchecking information which had been declared in the AQAA, and checking consistency. All were found in order - and reflected the declared dates given, other than those areas where more recent work had superseded this. All were found to be in order. All maintenance, servicing and safety checks were well recorded, and adequate to ensure the homes safety and conduct. An obscure enquiry about a doubt by the inspector, relating to the mains electrical circuitry certificate, was almost immediately countermanded by the manager getting the assistant maintenance Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: manager on site to directly evidence the work undertaken on the premises. Care Homes for Adults (18-65 years) Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 20 The possibility of over recording with regard to medication profiles doubling up on the information now held in the newer Health Action Plans should be carefully monitored; it could create a problem as recording currently in this case has to be duplicated. Whilst acknowledging that the recruitment process is currently in process, the appointment of the deputy manager should be prioritised to ensure positive support for the manager, augment wider staff team support, and to share out some of the management workload, which principally falls on the shoulders of the current manager at this moment. 2 38 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: 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 © (2010) Commission for Social Care Inspection (CSCI). 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. 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