Care Home: Elysian Villas

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What the care home does well The service provides a really good level of support and opportunities for residents with very complex leaning disabilities and mental health needs. The service is really good at fulfilling its aims and objectives. The aims of the service are to provide intensive support for the residents who live there. Residents live in home that is well run and they are well supported with their complex needs. Care plans help to show in a really good way how residents are supported while they stay at the home. Residents are really well encouraged to be a part of the community. Residents are provided with a well cooked and varied diet. The environment works really well to help to keep residents safe and also to offer them some independence. Staff do a good range of training in subjects that are relevant to the needs of the residents. There are really good systems in place for monitoring the quality of the care and the overall service. What has improved since the last inspection? Medication records are now being signed by staff when residents are given their medication. This demonstrates that residents get the medication they need given to them. What the care home could do better: Fire alarms must be tested regularly to make sure that they work properly. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Elysian Villas 21a King Street St George Bristol BS15 1DL     The quality rating for this care home is:   two star good 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: Melanie Edwards     Date: 2 2 0 3 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 © (2009) 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: Elysian Villas 21a King Street St George Bristol BS15 1DL 01179619977 01179619933 Telephone number: Fax number: Email address: Provider web address: admin@aspectsandmilestones.org.uk Name of registered provider(s): Type of registration: Number of places registered: Aspects and Milestones Trust care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Manager must be a RN on parts 5 or 14 of the NMC register May accommodate up to 13 persons with learning disabilities aged 18 and over who are ambulant and may have a mental disorder. StaffingNotice dated 28/08/2001applies Date of last inspection Brief description of the care home Elysian Villas is operated by Aspects and Milestones and comprises three houses accommodating thirteen residents needing social or nursing care. The residents have learning difficulties or a dual diagnosis including mental disorder. The villas are set in secure grounds and the home is situated in a residential area that is close to local amenities and a main bus route. Each house has four or five single rooms including one bed sit, a lounge and dining room, bathroom, kitchen and laundry. The fees are around 1900 pounds each week. Extra charges are levied for hairdressing, chiropody, Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 13 Brief description of the care home toiletries, holiday trips, transport, hobbies and reflexology. 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: 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: Due to their different needs, some of the residents are not able to easily make their views known. We were able to meet and see residents. We spoke to three of the residents who live at the home. We met the registered manager Mrs Saunter, one registered nurse and seven care assistants. We looked at a range of different records relating to the running and management of the service. We saw two care plans, two assessment records, medication records, staff duty records, supervision information, staff training records, employment files, accident records, fire records and menus. Care Homes for Adults (18-65 years) Page 6 of 31 We saw the most of the environment. The only parts we did not see were a small number of bedrooms. We have referred to the AQAA (an annual quality assessment document that all homes are required to complete) in the report. We found the home was operating within the required conditions of registration set down by us. The conditions of registration set out the type of care and the needs of residents as well as the numbers of residents who may stay at the home. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 8 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 9 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of residents are being assessed and are well met. People can get hold of good up to date information to help them to understand the service provided. Evidence: We read a copy of the statement of purpose and service user guide to see if people can get hold of a good level of information about the service. Both documents have been recently reviewed and updated. They have in them, up to date information for residents, or people who may represent them, to make a decision about the home. We saw that there was information in the statement of purpose and the service users guide about the service. We also saw information about the qualifications of the staff employed and the accommodation. The philosophy of the home and how the service aim to meet residents needs is also included. The complaints procedure is in each service users guide so people know how to complain. It says in the AQAA document that the home do the following to meet residents Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: assessed needs and also to make sure they can get hold of up to date information about the service:The home has annually reviewed the statement of purpose, quality audit and service user guide, with pictorial support and symbols. All service users have had a care management review by social services which have identified that, at this time all service users residing at Elysian Villas require the intensive support in place by the team and its specialism. All service users records are reviewed regularly at monthly meetings, or sooner if need dictates and an annual general assessment of need and a health check compiled. We read one of the residents assessment record to see how their needs had been assessed.We saw detailed information about the persons mental health needs. The assessment clearly identified what the persons range of needs are and how to try and meet those needs. The assessment record had been reviewed and updated on a regular basis. Care Homes for Adults (18-65 years) Page 11 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. Residents care plans show really well how their needs are being met. Residents are being well supported by the staff to make decisions (as much as is possible) and to take risks in their day to day living. Evidence: In the AQAA document it says that the home do the following well to ensure that residents need and choices are well supported and encouraged:All risk assessments, care plans are available with regular reviews and endorsements in all service user records. Records of monthly residents meetings are available, with outcomes in service user diarys. The home liaises regularly with the homes capacity act, rights of attorney and care application all documented so promoting the independence of all individuals within decision making and choice. All policies and procedures being developed within the home are placed on the notice board on each villa, in a format appropriate to the needs of the individuals in picture format. We do not routinely post Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: all policies and procedures on the notice boards specifically if they do not impact on service users in anyway, they could however be provided if required. In our discussion with the staff we met we were told that one of the main aims of the home is to actively promote the rights of the residents. The staff also told us that they try as much as they can, to encourage and support the residents to develop some independence in their daily lives and to be able to make choices about what they do. We read some very detailed and helpful information in the care plans about the potential risks the person may face and any risks from particular activities that they do. The care plan showed what approaches staff should take and was helpful and informative. We saw residents go out with staff to do different social and therapeutic activities, for example one resident went to the shops and another resident went out for a walk. This is good evidence of how residents are well supported to take risks in their daily lives. We saw a range of up to date information in the daily records that showed us that staff monitor and observe the health of people at the home and call the doctor, if they are concerned about them. We saw information that showed that people receive support and treatment from the Psychiatrist. We also saw up to date information written in the care records showing people go to regular appointments at the dentist. We saw a good range of information to demonstrate that peoples health care needs are being met. Care Homes for Adults (18-65 years) Page 13 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. Residents are very well supported to attend a range of activities that they enjoy. People go out with the support of staff on a one to one basis throughout the day to places that they enjoy going in the community. Residents are provided with a good standard and variety of food. Evidence: In the AQAA document it says that the home do the following to support the residents to live the lifestyle that they want to:The home continues to provide an additional fourty hours per week for service user social development and inclusion and integration. The allocation of these hours are under review to meet the needs of those who use from the care team and daycare service and the service user. Two service users within the home are in part time employment and four service users have Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: signed up to college courses this year. Staff have facilitated the service users to look at local college prospectus and attend open days prior to making choices. Villa three has now developed an internal service with two bedsit areas upstairs, that run independently from the rest of the villas. The service users using the service are encouraged and facilitated to build upon their independent skills eg. shopping, cooking, cleaning. The service users using this facility are supported by named staff , a keyworker system with regular reviews and ssessments. The home operates a defacto detention policy. The property is fenced with a key code panel to let people in or out. All regular staff have this code and service users are encouraged to come and go freely and independently where there is no risk to themselves eg. lack of road safety principles, personal space of individuals ad the need for it. All service users have locks on their bedroom for privacy but have freedom throughout the buildings with the exceptions of other service user bedroom, main offices, although if accompanied with staff this is o.k, laundry, slucies and kitchen. Service users do access the kitchen but only with staff to support them, with an up to date clear and consice care plan and isk assessment reviewed within the previous four week records are available to support this. All staff are aware of the need to knock on bedroom doors and await a reply and do so. All staff have received food handling training and work within the Bristol Safer Food better business standards. The home has regular contact with the dietician who reviews our menus generally and where specific diets are required. Cultural differences and preferences are considered and alternative food items are prepared for service users if required eg. alternatives to pork are purchased to meet the needs of one service user based on religious grounds. This is well documented in service user profile and food diaries. Meal times are at specified times however if service users want to eat at a different time or in the lounge, bedsit, arrangements are made to meet that request without prejudice. This information is recorded in service user records. Four of the bedsits have tea,coffee and snack making facilities available to them promoting more independence andchoice. Literature has been purchased within the home regarding diabeties management and staff have attended specific training. We looked at a copy of the current records of meals that residents have eaten over the last four weeks. We saw there are a range of dishes recorded as available for each day. We saw a varied choice of meal options available for the residents. Meal choices included a range of traditional, nutritional meals. The lunchtime meal of roast lamb roast potatoes, gravy and cooked vegetables was tasty and appetising. Residents do a really varied range of leisure and social facilities including going to the cinema, out shopping, for meals and to local community based facilities. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: We saw in the home photos of recent holidays and social events that residents had taken part in. The staff told that the home encourages residents contact with family and friends. Some residents see their relatives on a regular basis if they wish to. Care Homes for Adults (18-65 years) Page 16 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents physical and emotional needs are met.Staff try and support residents in the way preferred by them. Residents medication is looked after and given to them in a safe way. Evidence: In the AQAA document there are really good examples of ways that residents health and personal care needs are met: (For the female resident at the home there is),female support only around personal care. Rotas have been designed with this in mind and is fully supportive of her wishes at all times. All service users are encouraged to use dressing gowns to and from the bathrooms, to lock toilet doors and have opportunity to have personal care provided to them by their designated keyworker when they are on shift so promoting familiarity continuity. Clients go to bed and get up as they with with the exception of careplans relating to any sleep disorder where clients are encouraged to stay up a litlle longer. All male service users within the home attend a barber through choice and the female service user attends the hairdressers. All service users have a health action plan which identifies what health needs they currently have and who and how they are managed. The home G.P has Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: regular contact with our service and routinely schedule blood test eg. anticonvulsant levels twice per year as identified through the surgery review each service user has an annual Health check compiled by one of the registered nurses. Regular referrals are made to the Community Learning Disablities Team regarding accessing specific professionals to meet the health care needs of the service users. The most recent being the psychologist to support the home with some behaviour issues. We have in the past used the physio, audiologist and dietician. All other health professionals we contact via our local healthcare provider. We receive domicilliary visits by the chiropodist for four service users and a dentist for three service users. All service users within the home require their medication to be administered for them. This is administered in a trust policy and procedure. In the event of a service user requiring prn medication permission is sought prior to administration. If it is denied then it is not given. Authorisation has been given regarding one service user by the consultant psychiatrist to administer this medication in extereme circumstances covertly. This well documented in his behaviour management plan. Any service user living within the home with any failing health issues have care plans in place including manual handling risk assessments to help support that individual for the short or long term if required a care management assessment would be sought. We saw useful information written in residents care records about the preferred daily routine of the residents and particular likes and dislikes in their daily lives. This helps staff to be able to meet residents needs in the way that the residents would like them to be met. To support residents with their health needs they can use local GP practices.There is also specialist support provided from other external professionals including the psychiatrist dietitian and if needed the community learning disablites nursing team. The staff we met explained to us that they keep a really close eye on residents and observe their overall health. We saw good evidence in the care records we read that showed staff will call the doctor, if the residents health seems to be causing them concern. We checked how residents medication is looked after to see if this is done correctly. We checked the procedures for administration storage and disposal of medication.We looked at four medication administration charts. We saw a photo of residents with each record,this should ensure medication is administered correctly to the person named on the chart. The stock of medication we saw was well organised. Medication that was no longer needed was being returned to the pharmacist. We found that administration charts were legible, up to date and had Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: the signature of the dispensing nurse. This shows residents medication is administered safely. The reasons for any omissions had also been written on the charts. 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. Residents should be well supported to make complaints if they need to. There are efective ways in plcae to protect residents from abuse. Evidence: We checked the complaints records to see how complaints are dealt with by the home. There had been no complaints made since before the last inspection. All of the staff who we met explained to us in good detail how they see part of their role as being to represent the views of the residents who may not be able to direct make those views known. The staff have clearly built up very close relationships with the residents.This means if they need to make a complaint on behalf of a resident they can do so. In our discussions with staff they demonstrated an understanding of the importance of supporting residents to make their views known if they are unhappy about any aspect of life in the home. We saw a copy of the homes complaints procedure and this has our contact information as well if people need to get in touch with us. Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: We saw a copy of the homes policy relating to the issue of protection of vulnerable adults from abuse. The policy is to help to guide staff to take the correct course of action if they ever have to respond to an allegation of abuse. The staff do training courses in understanding the principle of the protection of vulnerable adults from abuse. The staff we met had an understanding about the subject of abuse and how they protect residents in the home. 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. The home is satisfactorliy maintained clean and safe. The enviromement suits the needs and tastes of the residents. Evidence: We have quoted parts of this section of the report from the last key inspection report in 2007, as the description and evidence here still apply:The home comprises three purpose built houses that are suitable for their purpose and well laid out. Each villa has a bathroom, dining room and lounge area. The villas are set in quite large and well presented grounds , which are fenced and secure to which people have unlimited access. A number of the people are able to use the keypads that secure the villas and gates. Peoples rooms are decorated and furnished individually making sure the person has individual space and ownership of that space. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: A number of people have recently acquired new bedroom furniture. Each house is appropriately furnished and decorated. There are proper arrangements in place to maintain and repair the houses and the standard of decor is generally good. There continues to be suitable laundry facilities and wellequipped kitchens in each villa. The Environmental Health Officer inspected the site prior to the inspection visit and they gave the home an excellent report for the very high standards of hygiene kept in the kitchen. There is only one dining room where smoking is allowed on villa one. No adaptations are required other than the fixed hoist fitted in one bathroom and a number of grab rails. All the people living at the home are ambulant although one person uses a rollator. All three villas were clean and in good order. People are encouraged to take care of their own rooms where they are able. All doors have locks with thumb turns and a small number of people are able to use a key. A copy of the Infection control manual is available. There are proper arrangements in place to dispose of clinical waste . 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by a sufficient number of competent qualified staff. Residents are cared for by staff who are well supported and supervised in their work. Evidence: It says in the AQAA document when writing about the staff team and ways that staff are trained to do their jobs well :All staff have an up to date terms and conditions issued to them two years ago. All new staff attend a weeks trust induction but also build a profile induction within the home scheduled over a six month period. The home has a robust training schedule regarding positive behavior management with trainers within its workforce ensuring its therapeutic and safe application. Staff turn over is low, with only one staff leaving within the past twelve months. We have a waiting list of staff who wish to join this team held within the office. The majority of bank is covered by our own staff so providing continuity of care, however where we do require bank or agency we use regular staff ( who know the residents). Each villa has a team day per year plus the home has one big one also per annum. These are always well received and attended. We checked three of the staff recruitment records to see if the home carry out the Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: required employment safety checks on all staff before they start work.The staff records demonstrate the necessary checks before employing new staff are being carried out. Specifically there were two written references taken up for all new staff before they start work. Although these are kept at the Trust head office. We do checks on the files that are kept there on a regular basis. We saw there are criminal records bureau disclosure checks and protection of vulnerable adult first checks carried out on all of the staff. This demonstrates to us that people are protected by the homes recruitment procedures. We checked the number of staff on duty for four weeks of March of this year. We saw that there are is always a qualified registered learning disabilities nurse on duty and at least eight or nine support staff on duty for a day shift. There is one registered nurse who works at night and three support staff. Ms Saunter works additional to the nine staff on duty each day. There are on call managers outside of these times,who offer support and advice. Based on the evidence from the inspection the number of staff on duty at any time meet residents needs. We saw a sample of three staff training records to find out if staff do regular training to help them keep up to date in their knowledge. The staff do a range of training and the Trust provides much of this training directly to them. We could see from the training records that staff do training relevant to the needs of residents. This should help residents if staff are well trained and knowledgeable. Staff reported that the manager and senior staff provide them with regular structured supervision sessions to assist them in their work. We saw written information that also demonstrated staff are well supported and supervised. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a well run home with good ways for their views to be listened to and represented. There are mostly effective systems in place to protect peoples health and safety However there needs to be a tightening up of fire alarm testing in the home. Evidence: As written in the last inspection report: the registered manager Ms Sarah Saunter has many years of experience managing a nursing home for people with learning disabilities and has attained several additional qualifications each villa has a team leader and designated staff team. One of the three villa managers will deputises in her absence and this makes sure that the management is consistent . In the AQAA document there is a really useful information about the way that the home is run:The home manager has eighteen years experience in management eleven years of that managing large teams within a registered nursing home setting. The manager manages the home using her skills and experience to the fullest Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: ensuring the welfare of all service users and staff are always fully considered. The team is a strong one with shared aims and objectives across site. There is an open and inclusive culture within the home where peoples opinions and contributions are sought frequently. The manager has the relevant qualifications required to act as the registered manager nd in addition ongoing profession, appropriate training including positive behaviour management trainers award. The home operates a quality assurance policy seeking opinions from others, and circulates annual questionnaires to service users,relatives and peer professionals. The home has its own business plan to work toward each coming year. These identified areas have been reused within the staff meetings for inclusion onto the plan prior to its formulation. The home has twice yearly finance audits ensuring the home and staff are following policy and are knowledgeable about budgets and budgeting. Each service user has a contract and tenancy agreement which we meet monthly, and on occasions sooner as need dictates, reviews of service user care and support take place ensuring we offer the fullest support to service users the home can, but can also identify shortfalls for individuals of which we then problem solve and amend a care package. Records are comprehensive across site and inclusive of medication administration, care plans and risk assessment, personal records, finance records, policies and procedures, local and trust wide, health and safety and staff training, attendance and rotas. Staff turnover within the home is small, two staff left during the past twelve months and for personal reasons, indicating a generally happy and content team which is reflected with the general culture and atmosphere of the home and adds to the homely feel of each villa. The reputation of the home within the trust and other agencies has improved immensely, we are now viewed very positively and our services sought after. The Trust has a system for carrying out detailed quality audits in their homes. We looked at the recent audit done to assess the overall quality of service. We could see that the views and outcomes for the residents who use the service are used as the main way of judging the quality of care. We saw residents records are kept securely in the office and care plans are available in a secure cupboard. The care records and records relating to the running of the home were satisfactorily maintained up to date and in order. This helps to demonstrate confidentiality is being protected. This also demonstrates to us legal records required for the running of the home are kept properly. We saw that the environment looked safe and satisfactorily kept up together in all areas that we saw. We saw in the staff training records that staff do a good range of training in health Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: and safety matters including first aid and moving and handling practises. This should help protect safety if staff are knowledgeable and well trained. All of the staff do regular training in food safety. This is a really good way for staff to help residents to prepare and cook food in a safe way. This should help protect residents if staff are knowledgeable and well trained in health and safety principles and practises. We saw records that showed staff check the temperatures of all high-risk cooked food before it is served to people to make sure it is hot enough and safe to eat. We saw the fire logbook record and it showed the required weekly and monthly tests of the fire alarms and the fire fighting equipment are done. However we saw three gaps of time when the fire alarms had not been tested on a weekly basis. 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 1 42 23 Fire alarms must be tested on a consistently regular basis Health and safety 25/03/2009 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation 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 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. 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