Care Home: Elsworth Residential Homes Limited

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What the care home does well People living in the home have their own personal plans of care so that staff know all about them and how to support them in the way that they want. People can be confident that no matter how diverse their needs are, staff will know the right things to do to keep them safe and help them do what they want with their lives. People can make choices about how they live their lives and the things they want to do each day. They are supported to take part in lots of activities that they have chosen. They go to day centres, colleges and pursue lots of different leisure activities. People are supported in the development of their close personal relationships and their families and friends are welcomed at the home. People benefit from having a stable staff team and being supported by staff that know them well. Staff make sure their health care is properly monitored and any problems dealt with. People know they can talk to staff if they have any worries and that staff will listen to them. They can be confident that staff understand them and will help them communicate their needs with other people too. People are supported by staff that are well trained, which means that they can be confident that staff know how to look after them in the right way. The providers have shown their commitment to developing the home and diversifying the service that they provide. They have consulted with other professionals to make sure that the best interests of the people living in the home are at the forefront of what they do. What has improved since the last inspection? They have encouraged and enabled people to attend groups where they can speak out and have their views heard. They have offered people lots more choices of activities both in the community and indoors to help them continue to develop their life experiences. They have kept the home looking attractive and safe. They have made a slope to the lower ground floor, so that it is safer and easier for people with disabilities to go out into the community. They have redecorated some more bedrooms and bought some new carpets. People have been involved in choosing their own colour schemes. They have continued with their staff training programme and sent staff on lots of courses. This helps to make sure that staff have the knowledge and skills to support people and keep them safe. What the care home could do better: We have made one requirement in this report. As they have re-registered as a limited company, there must be a person appointed to manage the home. That person must be qualified, competent and experienced to be in day-to-day charge of the home. They must then make an application to be registered to comply with the law. They must also make sure that they notify us about any events in the home that affect the well being of the people living there. The provider that has taken the role as responsible individual for the company must carry out formal monthly visits and write reports that are kept available at the home. This is to make sure that all the company directors and the manager are kept informed about the standard of care provided at the home. The results of the visit should then be used to make sure that any improvements necessary are made. They also need to make sure that the staff files contain all the information required in the regulations. This is important to show that their recruitment process is safe and that they have vetted staff properly before allowing them to start working at the home with the people living there. They have said they will do this by 30th September 2009. Key inspection report Care homes for adults (18-65 years) Name: Address: Elsworth Residential Homes Limited 108 Grange Road Ramsgate Kent CT11 9PX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Christine Grafton     Date: 1 9 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Elsworth Residential Homes Limited 108 Grange Road Ramsgate Kent CT11 9PX 01843596164 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Elsworth Residential Homes Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 25 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: 25 The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learnind disability (LD) Date of last inspection Brief description of the care home The home comprises of three properties linked together at nos 110, 108 and 106 Grange Road. It is known as Osborne House, which is the name of the middle property. There are 17 single bedrooms and 4 doubles. Accommodation is on three floors, with separate stairways to access the upper floors. It is joined at lower ground floor level only, where the lounge, dining and kitchen areas are situated. There is no lift to upper floors so people need to be able to manage the stairs. There is a large well laid out garden to the rear. The home is conveniently situated in a residential area of Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 25 Brief description of the care home town, close to shops and local amenities. The home provides care for people with varying degrees of disability. The six Elsworth family members (registered providers) are fully involved in the running of the home and work some care shifts. There are three staff on duty at night with one person sleeping in at each house. The registered providers have owned the home for many years and it is now a limited company. Some of the people who live at the home have lived there a long time. The weekly fees range from £355.47 (preserved rights) to £402.34 (contract price). Information on the homes services will be detailed in the statement of purpose and service users guide, which together with copies of our reports are kept available at the home. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This report takes account of information received since the home was re-registered as a limited company on 20th April 2009 and included a visit to the home. We visited the home without telling anyone we were coming so that we could see what it is like for people living there on a usual day. We arrived at 10.00 hours and left at 14.00 hours. We spoke to two of the providers, the trainee manager, staff and some of the people living in the home. We saw the communal areas of the home and a sample of bedrooms. We observed what was going on, the home routines, staff practices, and what activities were taking place. We looked at some of the homes records. We also used the homes annual quality assurance assessment known as an AQAA for short. This is a document that all homes have to send us once a year to tell us how they think they are meeting the national standards, how they have improved in the previous year, what they aim to do and lets Care Homes for Adults (18-65 years) Page 6 of 30 us know when they have completed important environmental safety checks. At the time of our visit there were 24 people living in the home. A number of them were out pursuing activities in the community, but seven people were involved in the inspection. There is currently a senior staff member who has the title of trainee manager and works as manager, but does not intend continuing in this role. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? They have encouraged and enabled people to attend groups where they can speak out and have their views heard. They have offered people lots more choices of activities both in the community and indoors to help them continue to develop their life experiences. They have kept the home looking attractive and safe. They have made a slope to the lower ground floor, so that it is safer and easier for people with disabilities to go out into the community. They have redecorated some more bedrooms and bought some new carpets. People have been involved in choosing their own colour schemes. They have continued with their staff training programme and sent staff on lots of courses. This helps to make sure that staff have the knowledge and skills to support people and keep them safe. Care Homes for Adults (18-65 years) Page 8 of 30 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. 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 30 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 30 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. People moving into the home benefit from having a full assessment and can be assured that their needs will be met and they will be supported to achieve their aspirations. Evidence: The home has a statement of purpose and service users guide that is written in simple language to help people to learn about the home. They have been developing this, using a Widget programme, which has pictures and symbols. They plan to introduce this soon to make it easier for people to understand. They have also updated their contract of residency and given a copy to all of the people living in the home. There have not been any new people admitted to the home this year. They have an admission process that includes the person making a number of visits to the home to meet the people living there and staff, before deciding whether to move in. They carry out a thorough assessment of the persons needs to find out about them and what they aim for in the future. This is important so that staff can help the person settle in Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: and support them in what they want to achieve. We looked at two peoples care records, including their assessments, and saw that they had worked closely with the local social services team. They had obtained written information from the care manager and other people that had been previously caring for the person. They had then drawn up a detailed plan of care that is individual to the person and provides staff with the information they need to support them in the way that they want. Some of the people living in the home are currently having their needs reassessed to identify their wishes for the future and the type of service they need and would like. The home has supported them with this and made sure they have had access to independent advocacy. Care Homes for Adults (18-65 years) Page 12 of 30 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 benefit from having their own individual person centred plans that make sure their needs are fully understood and met. They are encouraged to make their own decisions and choices, with risk being managed in a positive way to develop life experiences and address safety risks. Evidence: We looked at two care plans in detail and also looked at parts of two more peoples care records. They have been introducing new support plans and we saw that people have been involved in writing their personal profiles in their own words. They have been able to say what they like and the things they dislike, which have been recorded so that plans revolve around the things they like. The plans contain guidance for staff on such things as, how the person likes to be supported with their personal hygiene, if they have any mobility problems, their vocabulary and level of understanding, best ways to communicate with them and signs to be aware of when the person is becoming anxious or distressed. They have Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: started to develop communication passports. Care plans cover equality and diversity issues. Age and disability needs have been well considered and sensitive arrangements put into place to make sure that peoples needs are fulfilled in a safe way. Peoples sexual needs are covered in their care plans with specific plans put into action where necessary, to help them achieve their wishes. This might also involve the support of specialist health care professionals. Staff were seen encouraging people to make decisions, for example, making choices about their daily activities and meal options. One person told us they had chosen to stay in and have a quiet day today, rather than go out on an activity with a group of people. Care plans and peoples daily records show lots of evidence of them making decisions, such as making purchases when out shopping. People are supported to manage their own finances with support from staff. Risk assessments are completed where an activity might be considered risky, for example where a person has been assessed as capable of using a kitchenette independently within the home. This might involve making hot drinks, cooking, using a washing machine and doing their own ironing. Other risk assessments are in place for people who have such conditions as, epilepsy or diabetes, or where specific behaviours might need to be managed. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home benefit from being offered a wide range of opportunities for personal development and are enabled to experience activities that enrich their lives. They are supported to maintain contacts with families and friends and enjoy a balanced and healthy diet. Evidence: People take part in a variety of activities, including attending day centres, work activities, colleges and various clubs. They do things individually with their key worker indoors, or go out, either on their own, or with a staff member. They also go out together in small groups. People are enabled to take part in a wide range of community based activities, including, swimming in small groups, visits to local shops, bus trips to local towns, trips to pubs, cafes, a local bowling alley and the local library. They can attend a Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: monthly disco if they wish and one person spoke of their enjoyment of this. Indoor activities take place each day and we saw staff sitting with people on a one to one basis playing cards and other games. A staff member spoke about accompanying four people on a recent trip to Canterbury to an event where they could experience a variety of different sports. Two staff recently accompanied another person to Folkestone for a relatives birthday party. They make sure that people with diverse needs do not get left out, for example, someone who is partially sighted gets films from the Blind Association and talking news tapes that include the local news. They also make sure that people who are profoundly deaf do not get left out. We saw that staff can communicate with them and were told that when a group musical activity takes place, they join in by playing a xylophone, using a set of headphones that have been bought especially for them. The home has a wide variety of different musical instruments for people to choose from to play. People are supported to develop personal relationships with people of their choice. One person spoke to us about a close personal relationship and of going out with their girlfriend. Another person told us that their friend can come for a meal, or have overnight stays with agreement. We saw in the care plans and daily records that people have contacts with their families and friends, either by telephone, postal correspondence, or visits to the home. People are involved in choosing the food they eat. They discuss food choices at residents meetings and the menus are changed accordingly with favourite meals regularly incorporated into the menu, whilst making sure that they have healthy options. Special diets are catered for. They have two choices at each meal, one main meal and one alternative. Some people help with the food shopping and there are weekly opportunities to participate in supervised food preparation. One person spoke of their enjoyment in taking part in a cooking for fun activity the previous day when they had made cakes and gingerbread men. Care Homes for Adults (18-65 years) Page 16 of 30 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 living in the home benefit from good personal support and health care provision with safe medication storage and procedures. Evidence: Care plans contain lots of details about peoples health care and the personal support that they need. The plans set out in detail how each person likes to be supported with emphasis on the promotion of dignity, privacy and independence. Staff that we spoke to demonstrated a high regard for ensuring that peoples dignity is maintained at all times. People have developed good relationships with their key workers and we saw how this has helped people to develop their confidence and self esteem. Medical conditions, such as diabetes and epilepsy are being well managed with support from health care professionals. Staff demonstrated a good understanding of the relevant health matters and the signs that would indicate people with these conditions being unwell. People have routine health screening and care plans cover contraception and visits to Well Man Clinics and Well Woman Clinics. Peoples changing Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: needs with regard to disability have been closely monitored and addressed. They have started to create communication passports in Widget format with pictures, symbols and photographs. We saw one that contained excellent information that had been written in the persons own words. They include things like how the person communicates, if they can follow simple instructions, if they might need things repeated, and signs that they might be feeling unwell, or in pain. Once these are completed for everyone, they will provide a useful tool, when attending hospital and doctors appointments, to aid in diagnosis. We looked at the way peoples medicines are managed. They use a blister pack medication system that is provided each month from the pharmacist. Staff keep records showing that they have administered the prescribed medications (MAR sheets) and if not, the reason why. They have previously made changes to improve their medication storage. Whilst this is adequate, they have recognised that the current medication storage area is not in the best place. They have a future plan to create a dedicated medication room where other liquids are currently stored. The trainee manager said she regularly checks the medication records and usually picks up any issues quickly and deals with them. It was discussed that by recording monthly medication audits and staff medication competency assessments, this would not only validate these checks, but the information could be used to feed into the homes quality monitoring processes. They have cared for people that have become terminally ill, or are dying, and supported other people living in the home in their bereavement. A person has died this year that had lived at the home for many years and people living in the home are missing them. Staff are skilled in listening and supporting people when they feel sad. Care Homes for Adults (18-65 years) Page 18 of 30 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 living in the home can be confident that any complaints will be listened to and sorted out. They can be assured that they will be protected from harm by good staff practices. Evidence: People living in the home that we spoke to indicated that they go to any of the staff if they are unhappy about something. Two people told us that they like living at the home and they like the staff. We saw that they have developed a good rapport with staff and saw people talking with staff about things that are important to them. We noted one instance when a person went up to one of the providers and thanked them for the lovely day out they had had on the previous day. A staff member spoke about knowing the people that live in the home well and of being able to pick up on body language and other signs that indicate something may not be quite right. We saw examples in the care plans and daily records of how they recognise and deal with situations when something might be wrong. People have one to one talk times and key workers write monthly reports that show how minor issues have been dealt with. The AQAA indicates there has been one complaint received this year, which has been resolved. The trainee manager stated that complaints are recorded and fully investigated. This year, people have been involved in a local Speaking Out Group organised through Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: the local Mencap and have attended District Partnership meetings with social services. They can also speak out at the regular residents meetings held in the home. Six staff have completed training on the Mental Capacity Act this year and the remainder are booked to complete this in September. They have considered the implications of the deprivation of liberties guidelines and each person has a check list in their care plan regarding this. There has been one incident of restraint, which has been well recorded by the home. We discussed that this should have been notified to us, but evidence seen indicates that it was handled appropriately and the deprivation of liberties safeguards considered. One staff member has just completed their National Vocational Qualification (NVQ) level 3 in counselling and plans to do a cognitive behavioural therapy course. This will mean that they will have in house skills to support the specific needs of some people living in the home. Staff say that they feel confident to approach any of the providers, or the trainee manager, if they suspect something is not right. Care Homes for Adults (18-65 years) Page 20 of 30 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 live in a comfortable, safe environment, which is suited to their needs and is clean and hygienic. Evidence: They have stated in their AQAA their future plans to diversify and provide some independent living units on land behind the home. As well as this, part of the home has already been set up for independent living and includes a small well equipped kitchenette, lounge and dining area. They have a transition plan, which they are working to, involving social services and independent advocacy services. They have continued to refurbish the building, with several more bedrooms having been redecorated with new carpets this year. People have chosen their own colour schemes for their bedrooms and those we saw are especially homely and personalised. Key workers have been instrumental in adding finishing touches, with things like throws with the persons favourite animal on, cushions, attractive curtains and matching duvets. One bedroom has a separate conservatory room that is currently being converted into a kitchenette to promote a persons independent living skills. They have had a ramped access created to the lower ground floor bedroom for two Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: people with mobility problems. This means that they now have direct wheelchair access to the outside, making it easier for them to go out. Their AQAA indicates that they have provided screens for double bedrooms and fitted locks to some bedroom doors after individual risk assessment. They have procedures in place to minimise the risk of cross infection, including the provision of electric hand driers in all bathrooms and supplies of liquid soap and paper hand towels in other areas. They have a safe system for soiled laundry. All areas of the home seen were clean and there were no odours. They have started a programme to guard radiators that is being continued on a risk based process. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home benefit from the well trained, enthusiastic and supportive staff team. Staff have a good understanding of the people living in the home and positive relationships have formed. Night staffing arrangements provide enough protection to meet the assessed needs of the people currently living in the home. Recruitment practices are adequate to protect them. Evidence: They state in their AQAA that there has been a low staff turnover and low sickness levels. There is a nucleus of long standing staff and as the providers work on shift alongside the staff team, this provides people living in the home with a stable staff team to support them. We saw that the staff are approachable, good listeners and they demonstrated good attitudes. They have good understanding of the diverse needs of people that they support. Some people living in the home have specific medical conditions that sometimes require action from staff to keep them safe. Staff are knowledgeable about these things and confident when describing what they do to keep those people safe. Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: Staffing numbers are allocated on a daily basis and shifts are planned around peoples activities to ensure full support during busy times of the day. At night there is a total of three staff on sleeping in duty on the premises, with one person sleeping in each of the three houses that are joined together at lower ground floor level to make up the one home. They have established procedures to monitor people with specific medical conditions where there is a risk or relapse. They have reassessed some peoples dependencies this year to ensure that they can continue to provide the sort of assistance that they need both during the day and at night. Staff are encouraged to undertake their National Vocational Qualification (NVQ) in care level 2 and above. The AQAA indicates that ten out of sixteen care workers have achieved their NVQ level 2, including one staff member that has NVQ level 3. Staff are enabled to attend a wide range of short courses relevant to the work that they do. This was described in the AQAA and confirmed in discussions with staff and some of the records seen. They have recently introduced a staff training matrix as a way of identifying gaps and seeing when refresher courses are due. We saw a record of induction training for a new staff member that follows the Skills for Care Common Induction Standards. They are also working through the induction standards with existing staff, using some DVDs that have been purchased as training tools. We looked at how they recruit staff to see if it is thorough enough to protect the people living in the home. We were told that there have been no new staff recently employed. The trainee manager indicated that the home carries out security checks on new staff before they start work, including references and criminal records bureau (CRB) checks. We looked at three staff files and although there was some evidence of full employment checks being carried out, the files were disorganised and some things were missing. This is an area for improvement that has previously been identified. It is important that all the information specified in the regulations is kept readily accessible in staff files. This will then demonstrate that the homes recruitment process is safe. The trainee manager indicated that she had prioritised issues relating to outcomes for the people living in the home. She indicated that this shortfall would be addressed by the 30th September 2009. Care Homes for Adults (18-65 years) Page 24 of 30 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 home is run in a manner that protects the best interests of people living there and promotes their health, safety and welfare. Evidence: The providers have run the home for many years and are experienced. However, as they have now registered as a limited company, they need to appoint a manager to be in day to day charge of the home. In order to comply with the Care Standards Act 2000 that person must make an application to be registered under the Act. The trainee manager indicated in the AQAA that she does not wish to continue in this role and that the providers are looking for a new manager. They have development plans for the home and have shown in their AQAA that they have completed a number of improvements to both the environment and the care management side of things. They have continued with their staff development and training programme. Changes have also been made that have resulted in good outcomes for the people living in the home. They have continued to develop peoples life experiences in all aspects, especially in their lifestyles, where we have seen Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: excellent outcomes. They have focussed on person centred planning, closely considering equality and diversity issues and promoting the rights of people living in the home. The AQAA was well completed and provided lots of relevant information. The things that we have tested out have verified what they have stated. Peoples views are sought informally in various ways, including, day to day contact, key working, residents meetings, staff meetings and involvement in a Speaking Out group and the district partnerships meetings. They now need to look at developing a more formal quality assurance system to include monthly reports from a responsible individual of the limited company. The AQAA indicates that the homes equipment is being maintained and no hazards were observed. The staff training matrix and discussion with staff indicates that staff are encouraged to attend training on safety things such as, health and safety, fire safety, food hygiene, first aid, infection control and moving and handling. Care Homes for Adults (18-65 years) Page 26 of 30 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 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 37 8 As the registered provider is 30/11/2009 an organisation, there must be an individual appointed to manage the home and be in day-to-day charge who is qualified, competent and experienced to run the home to meet its stated aims and objectives. The person appointed must make an application to be registered to be in compliance with Section 11 of the Care Standards Act 2000. To ensure that the home is run in a way that benefits the best interests of the people living there. Care Homes for Adults (18-65 years) Page 28 of 30 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 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. 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