Care Home: Felbrigg House

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What the care home does well There is a relaxed and homely atmosphere. People say that the support workers give them the assistance they need in ways that are right for them. One health and social care professional says, `there is a friendly and welcoming atmosphere in the Service with caring staff. They support clients with diverse needs and rise to challenges in a positive, professional way`. There are interesting occupational and social things that people can do. One support worker says, `in general I`m confident that each person does the social things that they want to. People are out and about in the community and no one gets bored. Some people like to be at home more than others, but in general people lead active and varied lives`. People are helped to stay in good health. This includes keeping an eye on how everyone is and then calling doctors as soon as they are needed. People are helped to lead normal lives through responsible risk taking. One support worker says, `we want to get people doing more and more things for themselves. We want them to be safe of course and not to come to any harm, but at the same time there are risks in life that are part of everyday life. We don`t want to limit people too much, we want to get the right balance`. People are served with good quality meals. One support worker says, `the food is good really. It gets eaten up and meals are a social affair`. There are arrangements to promote health and safety. What has improved since the last inspection? A number of improvements have been made in the course of the past year or so. The range of occupational and social opportunities has been extended. Picture cards have been introduced to help people decide what dishes to have on the menu. Various improvements have been made to the accommodation to make it more homely. Each person now has a written health action plan. This has been done to further engage people in taking an active interest in promoting their own good health. More support workers have completed key training courses including achieving a relevant National Vocational Qualification. All of these things contribute to the Service being better able to support people in ways that are right for them. What the care home could do better: The individual plans of support are not being reviewed as frequently as the Registered Provider intends. This might reduce the opportunity for people to have an active say in the support they receive. The way that complaints are recorded needs to be strengthened. This is so that there is a full account of what has been done to resolve each item. There are some shortfalls in the fire safety arrangements. These might compromise the level of fire safety protection provided in the Service. Key inspection report Care homes for adults (18-65 years) Name: Address: Felbrigg House St Alphege Road Dover Kent CT16 2PU     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: Mark Hemmings     Date: 1 2 1 0 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 29 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 29 Information about the care home Name of care home: Address: Felbrigg House St Alphege Road Dover Kent CT16 2PU 01304204760 01883734561 felbrigg@broadhamcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Broadham Care Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 10. 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: Learning disability (LD). Date of last inspection Brief description of the care home Up to 10 people who have a learning disability can make their home in Felbrigg House (the Service). The property is an older detached building that has been modernised. The accommodation is on three floors. Each person has their own bedroom. These are laid out as bed-sitting areas. All of them have a television aerial. All of the bedrooms also have a private bathroom. In the bathrooms there is a toilet, wash hand basin and a bath or a shower. There is also a shared use wet room. There are two main lounges, a large dining room/day room and a kitchen. Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 10 Brief description of the care home There is a large garden at the back and at the side of the building. This is level and it is mainly laid to lawn. The Service is in a residential street that is quite close to the centre of Dover. There is no through traffic and so the road is quite quiet. There is a bus stop nearby and there is plenty of on-street and off street car parking. There is a general store only a short walk away. The Service has its own vehicle. The Registered Provider is a private limited company. The weekly fee for living in Felbrigg House runs from £1300.00 to £1700.00. Care Homes for Adults (18-65 years) Page 5 of 29 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: The quality rating for this Service is 2 Star. This means that the people who use this Service experience good quality outcomes. We arrived unannounced at the Service at about half past eight in the morning and we were there for about eight hours. It was a thorough look at how well things are going. We took into account information provided by the Registered Provider in its self assessment. This is called the Annual Quality Assurance Assessment (the Assessment). We received this on time and it is adequately detailed. Further, we considered any other information that we have received about the Service since our last Key Inspection. During the inspection, we spoke with four of the people who currently live in the Service. We spent time in the company of another four of them while they were in the day room and in the lounges. We spoke with the Area Manager. He is a senior manager Care Homes for Adults (18-65 years) Page 6 of 29 who oversees a number of the Registered Providers services in the area. We also spoke with the Manager, with four support workers and with a visiting health and social care professional. We looked around parts of the accommodation and the grounds. Also, we looked at a selection of key records and documents. These included things like the individual written plans of support, medication records, the activities plan, the menu, complaints documents, the staff roster, staff training records, financial records and various health and safety certificates. Before we visited the Service, we asked all of the people who live there, their relatives, some of the support workers and some health and social care professionals to fill out a questionnaire for us. We wanted them to tell us what they think of Felbrigg House. Three of the people who live there wanted to complete them. Two relatives, one support worker and two health and social care professionals also kindly completed them for us. Later on in our report, we will tell you the main things that are being said in these questionnaires. The Registered Provider has also asked the people who live in the Service, their relatives and health and social care professionals to give feedback on how the Service is doing. Later in our Report we will tell you some of the main things that have been said. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? A number of improvements have been made in the course of the past year or so. The range of occupational and social opportunities has been extended. Picture cards have been introduced to help people decide what dishes to have on the menu. Various improvements have been made to the accommodation to make it more homely. Each person now has a written health action plan. This has been done to further engage people in taking an active interest in promoting their own good health. More support workers have completed key training courses including achieving a relevant National Vocational Qualification. All of these things contribute to the Service being better able to support people in ways that are right for them. Care Homes for Adults (18-65 years) Page 8 of 29 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 29 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 29 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 who are thinking of moving are asked about what support they need and how they want this to be done. They are encouraged to visit the Service to get a first hand feeling of what it is like. If someone wants to stay for only a short time, they will supported to go home again. Evidence: The records show that the people who are thinking of moving in are asked about what support they need and want. They are also invited to visit the Service, usually on more than one occasion. This is done so that they can be confident that moving in to Felbrigg House is the right thing for them. The Area Manager and the Manager also talk with family members and with people like care managers (social workers). All of this helps them to build up a really good picture of how the person can best be supported. There is some written information about the facilities and the support that people can expect to have when they move in. Some of this is written in a user-friendly style. In addition to this, support workers explain things to people. They do this so that people Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: have a good grasp of their rights and responsibilities if they decide to move in. Support workers say that the Manager shares with them the information he has obtained about someone who is due to move in. This is done so that they know what support they need to provide. One support worker says, we all look at who is going to be moving in so that we can get to know what support they need as much as possible before they actually move in. This is really important because its a stressful thing to live somewhere different and so the person needs to be welcomed so that they can start to fit in as soon as possible. We all make a special effort to help the person in their first few weeks until theyve gained confidence for themselves. Most of the people who move in do so with the intention of making Felbrigg House their longer term home. However, someone might only need to stay for a shorter time. This might be so that they can move on to living more independently. The Manager says that support workers will liaise carefully with care managers so that they can help the person achieve their goal. Care Homes for Adults (18-65 years) Page 12 of 29 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 receive the support that they need in ways that are right for them. People are helped to manage their financial affairs. There is a sensible approach to risk taking. Evidence: Each person has an individual plan of support. These plans are kept up to date by the support workers making daily notes. The plans help support workers provide the right support to people. Although people are actively involved in making decisions about their plans of support, this could be more developed. The Registered Provider wants each person to be invited to take part in reviews that are held at least once every six months. The records show that these reviews are overdue. Also, some parts of the plans are not written in a user friendly way. This might make it more difficult for people to know what is being said. Most of the people who live in the Service do not rely upon the spoken word to express themselves. They use a combination of things such as single words, sounds and signs. The support workers have a good understanding of how each person says Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: what they want. They also help by having photographs of things like activities. People who live in the Service can refer to these to show support workers what they want to say. In their answers to both our questionnaire and to the Registered Providers one, people say that the support workers listen to them and act on what they say. People also think that they receive the care and support they need. One person says, good, good when asked about the support workers. One health and social care professional says, there is a friendly and welcoming atmosphere in the Service with caring staff. They support clients with diverse needs and rise to challenges in a positive, professional way. Support workers know how to use the plans to make sure that people are supported in the right way. One health and social care professional says that one person is being helped to make good progress towards appropriately expressing themselves. Another health and social care professional says that the Service provides, a stable environment which is enabling (the person concerned) to continue to develop to their full potential. As necessary, the Registered Provider helps people to manage their financial affairs. This is done to make sure that people have the money they need to support themselves. The Assessment emphasises that sensible steps are taken to support people to lead everyday lives of their own choosing. This includes support workers helping people to take sensible risks and to avoid situations that might be harmful. For example, some people like to help out in the kitchen. Support workers assist them to do this. As necessary, they check out that there are no hot pots and pans that might be tipped over. One support worker says, we want to get people doing more and more things for themselves. We want them to be safe of course and not to come to any harm, but at the same time there are risks in life that are part of everyday life. We dont want to limit people too much, we want to get the right balance. Care Homes for Adults (18-65 years) Page 14 of 29 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. There are interesting occupational and social things for people to do. People are free to receive visitors and to spend the day as they wish. Good quality meals are served. Evidence: There is a range of occupational things that people can do if they want to. These include doing household tasks and helping out with the shopping. There are also social things to do such as doing arts and crafts, taking part in games and going out to places of interest. When we were in the Service, one person was helping around the kitchen, three people spent time in the garden, someone else went out into town on their own and two others went out with a support worker. Support workers say that the range of things that people can do has been increased in the past year. They also say that they are kept under review so that new opportunities Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: can continue to be offered. One support worker says, in general Im confident that each person does the social things that they want to. People are out and about in the community and no one gets bored. Some people like to be at home more than others, but in general people lead active and varied lives. In their answers to our questionnaire people say that they are happy with what they do each day. One person says, I go out and with staff to do things. Thats good. When replying to our questionnaire most relatives think that the activities offered in the Service are good or excellent. People are helped to keep in touch with members of their families, if this is necessary and if this is what they want. This includes helping them to write letters and to use the telephone. Family members and friends are welcome to call to the Service at any reasonable time. In their replies to the Registered Providers questionnaire, most relatives say that the Service reliably keeps in touch with them so that they know how things are going. People are encouraged to make their bedrooms their own private space. They are helped to arrange them as they want them to be. People can use their bedrooms whenever they want. They can choose to have private time on their own or to be in company. Support workers help people to deal with any mail they get. The records show that there is a varied menu. In their answers to both our questionnaire and to the Registered Providers one, people who live in the Service say that they like their meals. When asked about their meals three people smile with approval. Recently, picture cards have been introduced. This has been done to support people to have a greater say in what dishes are included on the menu. One support worker says, the food is good really. It gets eaten up and meals are a social affair. Care Homes for Adults (18-65 years) Page 16 of 29 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 are helped in ways that are right for them. They are helped to stay well. There are safe systems to manage medicines. Evidence: Support workers are relaxed and informal in how they are. They help people to organise themselves without being bossy. People are helped to wear neat and clean clothes so that they can look how they want. One support worker says, the people here do get a really good life. Things are relaxed and its like home should be. People can and do choose when to go to bed and some like to stay up later to watch television and generally to be part of things. Others like to go to the privacy of their bedrooms in the evening. Its up to them. People are helped to keep healthy. Support workers keep a tactful eye open so that a doctor can be called if someone is becoming unwell. Each person now has a health action plan. These are written in a user friendly way. They are intended to support people to promote their own health. This includes things such as watching their weight and trying to follow a lower fat diet. Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: Support workers manage medication for people. There is a system to check that the correct medicines are received from the chemist. Once in the Service, medicines are stored securely. The Assessment says that all members of staff who give out medication have been trained so that they know what they are doing. There is a procedure for administering medicines. This is designed to double check that the right medicines are given to the right people at the right time. There is a record that is completed on each occasion that a medicine is given. These are being completed correctly. The Manager says that people will be supported to manage their own medication when it is safe for them to do so. Care Homes for Adults (18-65 years) Page 18 of 29 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. There is a user friendly complaints procedure. The way some complaints are recorded needs to be strengthened. People are kept safe. Evidence: The Registered Provider has a written procedure for dealing with complaints. This states that all complaints should be recorded so that there is a clear account of what has been done to resolve them. One complaint that has been received recently has not been recorded in the correct manner. However, we understand that it has been investigated and sorted out. There is a user friendly complaints procedure. This uses pictures and straightforward words to help people who live in the Service know what rights they have. In their answers to our questionnaire, people say that they do know how to make a complaint. People who live in the Service are confident that they are safe and that their wellbeing will be promoted. The support workers are confident that people are being kept safe. One support worker says, all of the people are treated really well here. This is their home and they get lovely treatment really. Another says, the residents are very well cared for. Were here to make sure that they are safe and have good lives The Assessment commits the Registered Provider to promoting diversity in the Service. This means respecting each person who lives there as an individual who is Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: inherently valuable in their own right. One of the Registered Providers written policy documents states, we believe that all persons regardless of their perceived disability or their behaviour have the right to a valued lifestyle and to be respected as citizens. We will attempt to create a positive environment for people of all cultures. The records show that support workers receive training about the need to guard against any form of prejudice or discrimination. The Manager says that this commitment to promoting diversity is also expressed in practical terms. For example, in the way that each person receives individualised support that recognises their abilities, preferences and wishes. Support workers help most of the people to handle their personal spending allowance. The records show that this is being done in a reliable and proper manner. The Manager says that when it is safe to do so, some people will be encouraged to become more independent in managing their money. Care Homes for Adults (18-65 years) Page 20 of 29 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 accommodation is very well presented and provides a comfortable home. There is a modern fire safety system that is being checked regularly. The kitchen is well equipped. There is a suitable laundry. Evidence: The building provides a suitable range of facilities for the people who live there. These are in line with what the Registered Provider has committed itself to deliver in its Statement of Purpose. This is a legal document that describes in some detail the facilities and services that are available in Felbrigg House. The building is well maintained on the outside. The garden is well maintained. Recently some new garden furniture has been provided. On the inside, the accommodation is very well decorated and furnished. In the course of the past year various improvements have been made. Some of the communal areas have been redecorated or have had new carpets. Various new pieces of furniture and equipment have been purchased. One of the private bathrooms has been remodelled so that it better meets the needs of the person occupying that bedroom. There is a modern automatic fire detection system. This has been assessed to make sure that it continues to meet the national standard. In addition to this, support Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: workers do regular checks to make sure that it is working in the right way. The kitchen is clean and well organised. Some of the fascias are becoming worn. The records show that the refrigerator and the freezers keep foods cold enough. There is also a system to make sure that foods are used promptly once they are opened. The support workers know about good food hygiene practices. For example, they know about the need to make sure that hot foods are well cooked through. The most recent report from the Department of Environmental Health says, everything is satisfactory and there are no issues that require attention. The laundry has a commercial washing machine and a dryer. The area is well organised and clean. Care Homes for Adults (18-65 years) Page 22 of 29 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. There are enough support workers on duty. Support workers have the necessary skills to support people in ways that are right for them. Security checks are completed on new support workers. Evidence: The records show that there are six support workers on duty from early in the morning until later in the evening when the night time support workers come on duty. There are no house-keeping staff and there is no cook. This means that support workers have to undertake these roles. There are three vacant support worker posts. The shifts that these members of staff would normally complete are being done by agency staff. They are people who are employed by an outside company and who are not based in the Service. The Manager says that he hopes to recruit to the vacant posts in the near future. This is so that an established staff team can be developed that does not rely so heavily upon the use of agency staff. Support workers think that this is good idea. This is because it will further promote good team work. Support workers in general say that there are enough members of staff on duty. One Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: support worker says, in the ideal world its always nice to have more staff but in general we manage okay. Most days people are out and about in the community without too much limitation. However, the reliance on agency can sometimes be difficult because quite rightly there is a policy that they do not support someone on their own when they go out. This does occasionally limit some of the trips out, because we dont have the established support workers we need. When we were there, we kept a look out for things that might give us a clue about how well the Service is being staffed in practice. We noticed that people were being supported in small groups to do a number of social activities. People also had one to one time with support workers when this was necessary. When someone spilt some of their coffee down their front they were gently encouraged to change their clothes. The Assessment says that the Registered Provider completes a number of security checks on new support workers. The records show that these checks include things such as confirming their identity, taking up references and doing a police check. This is done to make sure that they are trustworthy people to work in the Service. The records show that support workers are doing quite a lot of training. This includes introductory training for new members of staff. One person says, I got lots of training when I first came and it was very useful really. I was much more confident by the time I finished the training than at the beginning. Theres a lot to learn and the residents need to sense that you are confident and know what youre doing. After their introduction, there is ongoing training in key subjects such as first aid, health and safety, epilepsy, communication and responding to difficult situations. At the moment, there is no organised training given in how to use sign language. This is an oversight that the Manager hopes to see corrected in the near future. The records show that most, but not all, of the other training is up to date. Support workers say that they have enough training. They also say that they are confident in their work and that know what they are doing. Nearly all of the support workers have completed or are completing a relevant National Vocational Qualification (NVQ). This Award is designed to further develop support workers ability to provide people with the assistance they need. Our observations show that support workers are generally well supported by the training and guidance they receive so that they can appropriately support the people who live in the Service. Care Homes for Adults (18-65 years) Page 24 of 29 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 Service is well managed. There is a quality assurance system. There are generally suitable health and safety arrangements. Evidence: The Manager has a good knowledge of how things are going. He has been in post since June 2009. He has applied to be registered by us. This is a legal requirement. He has both of the formal professional qualifications that are required for someone in his role. Support workers say that there in the recent past morale in the staff team has not been good. They say that there have been difficulties supporting one person to decide that they wanted to live somewhere else. They think that a more focused approach should have been used to support a quicker move. However, they are now looking forward to a more settled period in the Service. One support worker says, everyone likes (the Manager) a lot. He is easy to talk to and is very knowledgeable about the needs of the people who live here. He is very popular and hopefully we will recover from the low point. Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: There are handover meetings at the beginning and end of each shift. These are when support workers discuss how things are going so that they can plan what needs to be done. There are also regular staff meetings. People who live in the Service are regularly asked what they think about their home as part of everyday life. There are also regular house meetings. These are where people who live in the Service meet with support workers to look at how things are going. The records of the most recent meeting show that peoples suggestions are taken seriously and that whenever possible they are acted upon. For example, one person identified the need for a repair to be made in their bedroom that has since been done. Earlier in the year, the former Manager completed the questionnaire exercise that we have already quoted from. The records show that careful consideration was given about how best to support people to make a meaningful contribution to this process. The Area Manager regularly calls to the Service to check how things are going. The records show that he completes a thorough review. He also prepares an action plan which lists the improvements that need to be made. There is evidence that these improvements are being put into effect. The records show that there are fire drills. It is intended that all support workers also have regular fire training. The Manager is going to strengthen the way this training is organised and recorded. This is going to be done to double check that everyone has the training that is intended for them. This development is going to be completed by 1 December 2009. The records show that all items of equipment used in the Service remain in good working order. The records also show that there have not been many accidents in the Service this year. Most of them have been minor bumps and bruises. The Manager says that he monitors the occurrence of accidents. This is so that he can see if anything needs to be done to help prevent them from happening again. The Manager completes a monthly health and safety audit. This is done to help make sure that there are no hazards that might result in someone having an accident. He says that there are no particular hazards that need to be dealt with. We did not notice any either. Care Homes for Adults (18-65 years) Page 26 of 29 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 29 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 Care Homes for Adults (18-65 years) Page 28 of 29 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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