Care Home: Fernica

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What the care home does well Both the staff team and people living at the home had remained unchanged. This provides both stability and continuity in the support provided, which has contributed to the health and well-being of residents remaining stable. The advice and support of relevant health and social care professionals continues to be sought ensuring the mental and physical health of people is consistently met. Time was spent speaking with members of staff. It was clearly evident that they each have a good understanding of the particular needs of people are proactive in dealing with any issues which may arise ensuring they are dealt with promptly and effectively. We also spoke with people at the home as well as gathering feedback from the surveys. People said; `the staff look after me`, `the home is my family and I get on with the staff`, `I enjoy the food and the staff are friendly and helpful`, `help me keep my independence but know when I need help` and `they just seem to know us all very well`. What has improved since the last inspection? The providers continue to maintain and improve the home. Further redecoration and refurbishment has been carried out which has further enhanced the appearance of the home providing comfortable accommodation. A supervision system has been introduced. Records showed the that session include opportunities for staff to develop their understanding in specific areas of learning so they are equipped to carry out various duties. What the care home could do better: Care plans need to be expanded upon to show the current and changing needs of people with clear direction for staff about how their needs are to be met. The manager must seek the advice of the pharmacist with regards to the dispensing of items for people being supported to self medicating. This is needed to ensure that items are not being secondary dispensed by staff and reduce the risk of error or harm. Consideration needs to be given to the number of hours worked by the manager. Sufficient breaks should be provided and where cover is arranged this too should be accurately reflected on the rota. The manager is asked to develop a training plan with regards to the training and development needs of staff including any updates in previous training, which may now be required ensuring the team is supported in their continuous professional development. The practice of using door wedges in fire doors must cease that people are kept safe. Key inspection report Care homes for adults (18-65 years) Name: Address: Fernica Fernica 18-20 Kings Road Prestwich Manchester M25 0LE     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: Lucy Burgess     Date: 0 4 0 9 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 31 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 31 Information about the care home Name of care home: Address: Fernica Fernica 18-20 Kings Road Prestwich Manchester M25 0LE 01617736603 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Miss Marguerite Clark,Mrs Miriam Elizabeth Laventiz care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The registered person may provide the following category/ies of service only: Care home only - Code PC to service users of the following categories: Either whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia - Code DE The maximum number of service users who can be accommodated is: 14 Date of last inspection Brief description of the care home Fernica is a small care home providing accommodation and support for up to 14 people with mental health needs. The present range of fees are 365.00 to 395.00 pounds per week, however may vary dependent on the assessed needs of individuals. The home is located within the Prestwich area and is close to all local facilities. Public transport may be easily accessed for Bury, Prestwich Village and Manchester City Centre. Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 14 Brief description of the care home The home is made up of two semi-detached houses, which have been converted into one property. Accommodation is provided on three levels. The home is a family run home, offering accommodation to adults with mental health needs and is staffed on a 24-hour basis. The home caters for both short and long stay service users. All bedrooms are single however no en-suite facilities are provided. Of the bedrooms, two do not meet the spatial requirements as stated within the National Minimum Standards. This information has been detailed within the homes Statement of Purpose. 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: This was an unannounced visit to the home. The inspection was carried out over one day, between the hours of 9.30am to 4.30pm. During the visit time was spent looking at paperwork and the environment as well as observing staff interactions with residents. The inspector also spoke with people who live at the home, staff and the manager. Before the inspection, we also asked the manager to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. This was completed and provided for this inspection. Some of the information provided has been included in this report. Feedback surveys were also sent to people at the home. We received 6 completed surveys. Comments have been included in the report. Care Homes for Adults (18-65 years) Page 6 of 31 The home is registered to provide accommodation for 14 people. There were no vacancies. All the key standards were looked at during this inspection visit as well as the action identified during the last visit. The last key inspection was carried out 24 September 2007. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Adults (18-65 years) Page 8 of 31 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A thorough system is in place ensuring people placed at the home will have their needs met. Evidence: Placements at the home have remained unchanged since we last visited in September 2007. The assessment process is thorough and involves relevant health and social care professionals so that relevant background information can be sought. Assessment information, risk screening tools and care programme plans are provided giving staff at the home information about the specific needs of people. Opportunities are also made available allowing prospective residents to spend time at the home. This includes day time visits, meals and over night stays allowing time for people to familiarise themselves with the home and the people who already live there. Staff also have an opportunity to gather further information about the specific needs and behaviours of people ensuring only those people whose needs can be met move into the home. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: Information provided is them used to inform the development of a care plan. Placements are reviewed after an initial period ensuring it is suitable. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst people are supported in meeting their current and changing needs, this has not been fully reflected in their care plans. Information needs to accurately reflect their needs so that staff know what level of support is needed. Evidence: Records are held for each person. Files were orderly and included information about the person assessed needs, their care plan, risk assessments, minutes of reviews with health care professionals and correspondence in relation health appointments and benefits. Additional records are also completed in relation to diary notes, health appointments and medication. Files were examined for 3 people where issues had been identified in relation to personal care, changing health and diet and nutrition. We found that a lot of detail was found in the diary records however there was little information in the individual plans. Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: One of the files looked at was due to the behaviours of one person, which impacted on their diet. The staff had introduced food intake charts to monitor the person meals, a referral had been made to a dietician and daily supplements provided and regular weight records were being made. Another diary showed that the person had undergone tests due to continence issues. Appointments had been held with their GP and the hospital. The home had purchased aids and were offering support and encouragement to the person in addressing their personal care needs. A third diary showed that this person had been receiving on-going treatment due to their physical health. Issues had still not been resolved and the person was visiting the clinic nurse and further in-patient appointment was expected. It is acknowledge that the team is small and each know very well the support needs of people however the care plan needs to accurately reflect the current and changing needs of people along with details about these needs are to be met. Records had been reviewed in April 2009 and plans had been signed by each person. Through discussion with each of the staff it was clear that they each have a good understanding of peoples needs, behaviours and health and speak with each other regularly ensuring they are kept up to date. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to follow a lifestyle, which enables then to maintain and develop their independence both in and away from the home. Evidence: The routines and activities undertaken by people vary depending on their age and abilities. Whilst some people are quite active choosing activities away from the home others prefer to spend more time at home. People have a travel pass which enables them to access the local and wider community. The home is accessible to local transport as well being situated close to local shops, take away, post office, synagogues and church. In the main people do not take part in any formal employment or college courses, however over the last year one person has completed a maths and English course. Activities are generally more leisurely. These may include, attending a drop-in centre, Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: visiting local cafes and shops, library, craft groups, watching television and listening to music. Some of the people continue to receive support from their CPNs or outreach workers. This involves 1-2-1 sessions supporting them to increase their independent living skills. Some people are also offered additional support from staff at the home as part of their agreed care package where it has been identified that they have rehab potential. This too is to promote and enable them to develop skills so that they may move on to more independent living. People are not provided with front door keys as staff are at the home throughout the day and night however people are provided with keys to their bedrooms. The providers have recently had a new intercom system fitted. This is linked to the front door and has a camera fitted so that people calling can be seen before allowing entry to the home. This has improved security. Visits with family and friends continue to be encouraged. Two people had gone to stay with their relatives for the weekend, another person went to visit their father and a further person was planning to visit a friend the following day. Staff offer support where needed in making the necessary arrangements. Five people living at the home are Jewish. Whilst they chose not to follow a Jewish lifestyle consideration is given to their cultural and religious needs. Weekly visits take place from a member of the Jewish community as well as Friday visits from a Local Rabbi. Kosher food items are purchased although kashrut is not fully adhered to. People also spend time visiting The Fed, a Jewish day centre, taking part in groups and a monthly bagel brunch. Meal arrangements remain unchanged. The kitchen is kept locked whilst not in use. This was discussed with the manager who explained that this had previously been discussed with people at the home. The reason for this was said to be due to potential risks and hygiene. Meal times are fairly flexible and hot drinks are provided on a regular basis. The main meal is served in an evening with a lighter meal at lunchtime. Whilst a menu is in place should an alternative option be preferred this would be provided. People are supported in maintaining a healthy diet. Regular weight checks are carried out and advise and support is accessed from the dietician where needed. It was noted that supplements had been provided for one person and records were being maintained with regards to their food intake. Another person was being advised and supported helping them to lose weight. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: People were spoken with during the visit as well as comments being received in the feedback surveys. Each were happy with the support received and commented,the staff look after me, the home is my family and I get on with the staff, I enjoy the food and the staff are friendly and helpful, were well fed, I can enjoy watching television in my room in private and they help me keep my independence but know when I need help. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people are consistently met with the help, advice and support of staff and relevant health and social care professionals. Evidence: Staff at the home were proactive in accessing the support of health care professional where concerns about peoples well being had been identified. It was clear from discussions with each of the staff that they were all aware of the specific needs of people and what support was required. One person who lives at the home said they (the staff) just seem to know us all very well. As previously identified people have access to all health and social care professionals including GPs, psychiatrists, social workers, CPNs, dentists, and chiropody. Where additional concerns had been identified referrals had been made to dietician, continence services, community nurses and psychologists so that all necessary support could be provided. The team is supported by mental health professional. Those people subject to a CPA Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: (care programme plan) meet with their consultants on a 3, 6 or 12 monthly basis. Minutes to meeting are recorded and held on file and evidence that the mental health and medication received by people is being monitored. A clear record of all appointments are made and held on individual files, showing the input received by people. People confirmed that staff supported them to appointments if requested. People are generally able to manage their own personal care needs. Where necessary aids have been provided to enable people to maintain some independence when carry out tasks. Where people require support this had been recorded in the care plans. The medication system was examined. Items are provided by more then one pharmacy. Medication sheets (MARs) were looked at, these had been completed in full following the administration of medication. Handwritten entries had been checked and double signed by 2 members of staff. At present one person is learning to self medicate. It was discussed with the manager how this medication was provided. It appeared that items were being dispensed by the supplying pharmacy and then dispensed again another dosset so that only daily medication could be given as opposed to the full monthly supply. The manager is asked to discuss this with the supplying pharmacist to explore alternative arrangements so that staff are not secondary dispensing. The manager also explained that the staff office was being refurbished and a new larger medication cupboard is to be fitted. This will provide better facilities for items to be stored. 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. Systems are in place ensuring people are protected. Evidence: Systems are in place to show that people are listened too. Each person has a copy of the complaints procedure, which includes all relevant contact details for the funding authority and CQC. People are aware that they can raise issues directly with staff or their social worker/care co-ordinator/CPN. No issues were identified during the visit or on the AQAA. We noted at our last key inspection that all staff had completed training in adult protection so that they are aware of the procedure to follow should all allegations be made ensuring people are protected. Discussion was held with the manager with regards to her responsibilities in relation to the Mental Capacity Act and Deprivation of Liberty. The manager explained that she had accessed a training DVD and a course available from a distance learning provider. The manager must ensure that this is completed and that, where necessary, action is taken to ensure people are not affected. A check was carried out in relation to peoples finances. The manager is the appointee for 2 people with 3 others having their affairs managed by either the local authority or an appointed representation. Individual bank accounts are also in place. A random Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: check was made with regards to personal allowances held by staff. Records corresponded with the money held. Where people are supported with their finances this is detailed on their care plans. 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. Accommodation is clean and well maintained providing people with a safe comfortable home in which to live. Evidence: Fernica provides comfortable accommodation for people living at the home. There are 2 lounge areas, a dining room and 14 single bedrooms. None of the rooms have en suite facilities. There are also 4 bathrooms. Aids and adaptations have been provided to enable people to access facilities and maintain their independence. The providers ensure that where necessary rooms are redecorated and refurbished on an on-going basis ensuring a good standard of accommodation is provided. They have access to a handyman who carries out all general repairs and redecoration. Since our last visit one lounge has been redecorated, furniture recovered and is no longer used as a smoking room, other work has included some of the windows being replaced with new PVC, replacement carpets, new grab rails in bathroom, new bed and bedding, new digit boxes for all TVs and a new cooker. Rooms within the basement have also been redecorated and re-carpeted following recent flooding. The providers are also looking to replace the radiators throughout the Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: home and if necessary new boilers will be fitted ensuring the systems is effective. As already identified a new intercom system has been fitted to the front entrance improving security within the home. The home employs a housekeeper who carries out the majority of domestic tasks. However through discussion with the housekeeper explained that people were more actively involved and helped with certain task, for example bed changes, polishing and tidying their rooms. Looking round the home rooms were clean, tidy and free from odour. Items of protective clothing, gloves and aprons are provided and where seen to be used by staff whilst carry out domestic and care tasks to prevent any cross infection. 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. People are supported by a small stable staff team that have the knowledge and skills needed ensuring needs are met. Evidence: There have been no changes in the team since our last visit. The team comprises of the 2 owners, 1 of whom is also the registered manager, 2 carers and the housekeeper. Additional support from outside agencies continue to be provided as part of the individual placement arrangements for some people. As there have been no changes to the team information in relation to recruitment was not examined. No previous issues had been identified. The manager is aware of her responsibilities in this area ensuring people are protected. The rotas were examined and it was again noted that the registered manager had been working 5 sleep-in shifts each week. This was discussed with the manager and a member of staff. Whilst it is acknowledged that additional shifts had been covered due to staff being on annual leave it was felt that this was excessive with the manager not having a break for up to 72 hours. The member of staff explained that on occasion they visited the home and would provide cover to allow the manager time off. However there was no evidence of this on the rota. The manager also explained that Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: this was a short term arrangements as the second provider would be leaving her position in the health service and would therefore work more shifts at the home. Whilst this is understood the manager must ensure that she has sufficient breaks between shifts and where staff work additional hours that this too is stipulated on the rotas. Rotas should also not be written in pencil and accurately reflect any changes. Information was provided by the manager with regards to staff training. There was little evidence to show what training had been completed over the last year. The home now utilises a distance learning group. This was said to be more practical due to the difficulties in releasing staff from such a small team and enables them to study together. Courses are verified by an external assessor. The manager has identified training for all staff, this includes health and safety, medication, infection control, food hygiene, mental capacity and deprivation of liberty and nutrition. In relation to NVQ the manager has already completed level 4 and one of the carers has now progressed to level 3 having already completing level 2. The manager is asked to develop a training plan with regards to the training and development needs of staff including any updates in previous training, which may now be required ensuring the team is supported in their continuous professional development. Improvements have been made with more supervisions sessions being undertaken. These showed that staff are supported in developing their skills in particular areas, which is overseen by the manager. Shift hand overs and periodic team meetings are also held, these provide further opportunity for staff to share information about events within the home. 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. Systems are in place to ensure that the home is ran in the best interest of people so that they receive a good quality service. Evidence: Management at the home remains stable with no changes having taken place since we last visited in 2007. The manager is also one of the owners. She is a qualified nurse with the other owner being a qualified mental health nurse. Both have a lot of experience of working with people with mental health needs in various settings. Systems are in place with regards to monitoring the service delivery. As the providers work on site throughout the week, monthly monitoring reports are not completed. The providers send out annual feedback surveys to people at the home, relatives and visitors. Feedback received had been positive about the improvements made to the home. Feedback is also provided during the review meetings held with social and health care professionals. As already stated the team is very small and communication takes places on a daily basis enabling people to be actively involved in the day to day running of the service. Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: A random check was carried out in relation to health and safety. Checks were seen for gas, electric and fire safety. The gas safety check was carried out in March 2009, action identified include a replacement cooker. This had been done. A 5year electric circuit check was completed in January 2007 and was satisfactory. Further checks had been carried out with regards to fire safety including the alarm and equipment and were found to be in order. Further in house checks are made with the fire alarm, equipment and emergency lighting. The fire officer had also visited the home in May 2008, action identified included a self closing devise to one room, the removal of combustibles in the basement and the use of door wedges needs to cease. Whilst 2 areas had been addressed the manager must ensure that door wedges are not used to prop fire doors open ensuring people are kept safe. Care Homes for Adults (18-65 years) Page 27 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 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 Care plans need to be expanded upon to show the current and changing needs of people providing clear direction for staff about how their needs are to be met. The manager must seek the advice of the pharmacist with regards to the dispensing of items for people being supported to self medicating. This is needed to ensure that items are not being secondary dispensed by staff and reduce the risk of error or harm. 30/10/2009 2 20 13 30/10/2009 Care Homes for Adults (18-65 years) Page 29 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 31 Consideration needs to be given to the number of hours worked by the manager. Sufficient breaks should be provided and where cover is arranged this too should be accurately reflected on the rota. The manager is asked to develop a training plan with regards to the training and development needs of staff including any updates in previous training, which may now be required ensuring the team is supported in their continuous professional development. The practice of using door wedges in fire doors must cease that people are kept safe. 2 35 3 42 Care Homes for Adults (18-65 years) Page 30 of 31 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. 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