Care Home: Fishermead Boulevard (104)

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What the care home does well People using the service are thoroughly assessed prior to admission and are given opportunity to visit the service beforehand to ensure it meets their needs. There is good regard for the diverse needs of the people living at the service and their requirements related to their disabilities, lifestyle choices and personal preferences are sought, recorded and met by the staff team, respecting their rights, choices and individuality. Activities are available to people using the service to provide them with stimulation and contact with family, friends and the community is supported to maintain social links. People`s nutritional needs are met through a balanced diet. The health and personal care needs of people living at the service are well met, promoting health, well-being, taking into account their preferences and individual requirements and ensuring that they receive medication in a safe and consistent manner. Procedures are in place to ensure that complaints and safeguarding are effectively managed to listen to the views of people who live at the service and reducing the risk of harm to them. The premises are clean, well decorated and adequately maintained, promoting a positive environment for the people who live there and which is suitable for the range of disabilities that people have. The service provides staff cover to meet needs and undertakes thorough recruitment procedures, coupled with effective training to ensure staff have the right skills and competencies to support the people who live there. The management and administration of the service promotes continuity and quality of care for the people who live there and ensures that risk is safely managed to reduce the likelihood of injury or harm. What has improved since the last inspection? Security of medication and people`s personal money has improved, to keep these items safe and accessible only to authorised persons. Records are being maintained of how any complaints have been responded to, so that a clear audit trail is in place. Food is being stored safely in line with good hygiene practice. What the care home could do better: No requirements have been made as a result of this inspection. The manager was advised to update the CQC contact details in the safeguarding procedure, to make sure staff have this information readily to hand whenever they need it. Key inspection report Care homes for adults (18-65 years) Name: Address: Fishermead Boulevard (104) Fishermead Boulevard (104) Fishermead Milton Keynes Bucks MK6 2GA     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: Chris Schwarz     Date: 0 5 0 5 2 0 1 0 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Fishermead Boulevard (104) Fishermead Boulevard (104) Fishermead Milton Keynes Bucks MK6 2GA 01908670234 01908670234 manager.fishermead@fremantletrust.org www.fremantletrust.org The Fremantle Trust The registered provider is responsible for running the service care home 6 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category/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 104 Fishermead Boulevard is located close to the city centre in Milton Keynes. It was providing care to six male service users with learning disabilities and a range of personal care needs. There are good shopping, leisure and transport facilities close by. The building is a large, detached property with accommodation on two floors. Each person has a single bedroom, one of these is on the ground floor and is next to a bathroom and shower which has been adapted to meet the needs of people with physical disabilities. The service has parking for staff and visitors and there is a large Care Homes for Adults (18-65 years) Page 4 of 29 2 3 1 0 2 0 0 9 6 Over 65 0 Brief description of the care home enclosed garden. Fees for the service were £553.98 per week. 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: This unannounced key inspection was conducted over the course of a day and covered all of the key National Minimum Standards for younger adults. The last key inspection of the service took place on 23 October 2009. Prior to the inspection, a detailed selfassessment questionnaire the Annual Quality Assurance Assessment, was sent to the manager for completion and surveys were sent to a selection of people living at the service and staff. Nine replies were received, four from people using the service and five from staff, and these have helped to form judgements about the service. Information received by the Commission since the last inspection was also taken into account. The inspection consisted of discussion with the manager and other staff, opportunities to meet with people using the service, examination of some of the required records, observation of practice and a tour of the premises. A key theme of the visit was how effectively the service meets needs arising from equality and diversity. Care Homes for Adults (18-65 years) Page 6 of 29 Feedback on the inspection findings and areas needing improvement was given to the manager at the end of the inspection. The manager, staff and people who use the service are thanked for their co-operation and hospitality during this unannounced visit. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: No requirements have been made as a result of this inspection. The manager was advised to update the CQC contact details in the safeguarding procedure, to make sure staff have this information readily to hand whenever they need it. Care Homes for Adults (18-65 years) Page 8 of 29 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 using the service are thoroughly assessed prior to admission and are given opportunity to visit the service beforehand to ensure it meets their needs. Evidence: Information provided in the Annual Quality Assurance Assessment showed that there had not been any admissions to the service since the last inspection of Fishermead. The manager told us the service had a statement of purpose and service users guide in place and that people using the service can have copies of these if they wish. The process of considering someone for a vacancy was described, including the person and their family being invited to look around, meet the service users and staff and a series of tea and overnight visits. We were advised that the views of the service user group are taken into account when considering admitting a new person to the service. The manager told us that a care needs assessment would need to be provided by the local authority and that information from other agencies would be obtained. The service would also carry out its own assessment. We were advised that user friendly contracts were in place. Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: People using the service who completed surveys said they had been asked if they wanted to move to Fishermead and that they had received enough information before they moved in to help decide if it was the right place for them. Written information about the service was available to see during the inspection. An up to date statement of purpose was in the hallway and contained detailed information about the aims, scope and philosophy of the service and outlined what people could expect from living at Fishermead. A pictorial service users guide was also seen, which each person had been given a copy of, and this also provided a good range of comprehensive information. Previous inspections of the service have concluded that service users had been thoroughly assessed before they moved in and that they had opportunity to visit and meet people before deciding if Fishermead was the right place for them. We are confident, therefore, that should a vacancy arise at the service that the same type of process would be used. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is good regard for the diverse needs of the people living at the service and their requirements related to their disabilities, lifestyle choices and personal preferences are sought, recorded and met by the staff team, respecting their rights, choices and individuality. Evidence: We were advised in the Annual Quality Assurance Assessment that person centred care plans were in place which focused on individuality and had been produced in picture format. The manager told us that service users can choose who is involved with their care plan and that each person had their own copy. We were advised that care plans are reviewed regularly and updated as necessary and that each person had a key worker. We were told that regular residents meetings take place and that people are fully involved in decision making and participate in staff recruitment; all had keys to their rooms and the front door. We were told that, where possible, service users chair their own reviews with support. The manager told us that risk assessments were in place. Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: During the visit to Fishermead, we were able to see that care plans were in place for each person. The manager advised that these were being revised and updated to reduce the number of folders which contained information about each persons care needs. Two peoples records that were viewed provided a good range of information about their needs. Folders contained a photograph of the person, essential information such as their name, preferred form of address, date of birth, next of kin, family members, religion and health care contacts. Any equipment that people needed was noted, as was useful background information and likes and dislikes. Peoples usual routines were noted such as what they like to do on their home days and during the evenings. Information about how people communicate was noted and needs in relation to tasks such as cleaning teeth, shaving, preparing meals, managing finances, seeing family and friends and maintaining a social life were recorded. Any support that people needed in practising spiritual beliefs was also noted. Service users had copies of their care plans with much of the information provided in plain, easy read text and use of colour photographs. Review notes were also held on peoples files; a recent review had been produced using photographs of the person at various activities. We also saw agreements in place giving staff permission to enter service users rooms under various circumstances. People using the service told us in surveys that they make decisions about what they do each day and that they can decide what to do during the day, in the evening and at weekends. This was reflected in minutes of service users meetings and review notes. Risk assessments were in the process of being updated, some still on the computer at the time of this visit. Individual assessments were seen supporting people with a range of activities, such as household tasks like using the dishwasher and vacuuming, nutritional assessments were also in place. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities are available to people using the service to provide them with stimulation and contact with family, friends and the community is supported to maintain social links. Peoples nutritional needs are met through a balanced diet. Evidence: Information provided in the Annual Quality Assurance Assessment showed that people using the service are encouraged and supported to choose activities within their local and wider communities. Examples of activities included going to college, football, using the cinema, discos, bowling, going to the pub, bike rides, walks and visiting friends and family. People using the service attend day services, with a variety of placements available to them. We were advised that service users are involved in planning menus, shopping and cooking meals and that dietary needs are supported with input from health care professionals. Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: One service user said in a survey I get to choose my own food, another said they enjoyed cooked breakfast at the weekend. One person felt the service could improve by having more staff to be able to do more activities. Another said they wanted to be supported to go on more shopping trips for clothes and to be supported on their choice of summer holiday. A member of staff said one of the areas the service did well was service users are supported and encouraged to participate in community events and to gain varied and interesting life experiences. During the visit to the service we saw that care plans contained information about supporting people to access the community, engage in a variety of activities and keep in contact with their friends and family members. All but two of the people using the service went out to various local day services on the day of this visit. One person tidied his room up during the morning and later went out to hydrotherapy, he was also seen going out independently to a local shop. The other person went into town with staff. A recent letter was seen in the complaints and compliments file, from a manager of a day service. It expressed positive comments about how staff had supported service users at a winter ball and included my team and I were very impressed by the way your staff support the residents - your staff highlighted good practice for all to see. There was a thank you card from relatives in respect of the service arranging 50th birthday celebrations recently and there was a birthday banner on the front door at the time of this visit to show that staff had also arranged celebrations for another persons 30th birthday a couple of days ago. A current menu was pinned on to the fridge, reflecting a range of meals provided for service users. One person has coeliac disease and this is well managed by the service, another service use requires PEG feeding which staff also manage well. We saw at lunchtime that a service user had his choice of foods and was involved in the preparation. Healthy eating is encouraged at the service. 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. The health and personal care needs of people living at the service are well met, promoting health, well-being, taking into account their preferences and individual requirements and ensuring that they receive medication in a safe and consistent manner. Evidence: The manager told us in the Annual Quality Assurance Assessment that people using the service are registered with a local surgery and have up to date health passports. She said nutritional screening is carried out for each person and that actions are taken where people are at risk of malnutrition. We were advised that medication is reviewed regularly and that people attend medical appointments as necessary. We were advised that care plans outline the support that people need with health care and that health professionals are consulted if there are any concerns about peoples well being. The manager told us that peoples privacy and dignity were respected at all times. We were advised that the provider and other organisations offer training to ensure staff are able to meet peoples health care needs. We were advised that there are policies and procedures for handling medication and that staff who handle medicines have been trained to do so. The manager informed us that people are assessed and Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: supported to manage their own medicines. Care plan folders provided information about the support people need and how they wish to be supported. One persons file contained very good information about coeliac disease and how it can be managed. We saw that health action plans were in place for each service user. A couple that were looked at were up to date and contained sections such as how the person communicates, people who help them, their name and preferred form of address, on-going health care needs, medication, and a record of different appointments such as with the doctor, dentist, chiropodist and psychologist. Peoples weights were also noted. At the last inspection, a requirement was made for the keys to medication cabinets to be kept secure. We saw on this occasion that this was being complied with. Medication cabinets are located in each persons bedroom, with a small stock cupboard in the office. Two peoples medication cabinets and medication administration records were checked and found to be in good order. There was a medication policy for staff to refer to in the operations manual in the office and staff training records showed that staff receive training before they handle medicines. 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. Procedures are in place to ensure that complaints and safeguarding are effectively managed to listen to the views of people who live at the service and reducing the risk of harm to them. Evidence: The manager advised us in the Annual Quality Assurance Assessment that there had been one complaint in the past twelve months. She said people are encouraged to raise concerns and use the complaints procedure, which is available in an accessible format. We were also advised that service users had contact numbers and addresses to report any concerns or complaints. We were advised that there is safeguarding training for staff as part of their induction and further in-house training. The manager said that the service had policies and procedures for safeguarding service users and that an open culture had been created to enable staff and service users to express any concerns. No safeguarding incidents or referrals were indicated in the Annual Quality Assurance Assessment. People using the service told us in surveys that they knew who to speak with if they were not happy and most knew how to make a complaint. Staff who returned surveys said they knew what to do if anyone raised any concerns about the service. During the visit, we saw that information about safeguarding and making complaints was contained within the statement of purpose and service users guide. There were Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: also complaints procedures in the operations manual and in the Fremantle Feedback file. Accessible, pictorial versions were also available. The one complaint identified by the manager in the Annual Quality Assurance Assessment was seen at the last inspection, when there was no evidence to show it had been responded to. A requirement was made to maintain records to show how complaints have been responded to. The manager had addressed this since the last inspection to show the complaint had been responded to and resolved. Safeguarding procedures were in place at the service. The manager was advised to update the CQC contact details within it, to make sure staff have this information readily to hand whenever they need it. We saw from staff training records that they receive safeguarding training, initially as part of their induction and then refreshed through in-house training. Peoples money was being managed well. A requirement was made at the last inspection regarding security of peoples money, which we saw had been addressed. Two peoples wallets and accompanying records were checked. Transaction sheets were in place to note expenditure and receipts were being kept to verify this. Actual balances were found to tally with recorded ones. We saw in care plan folders that budgeting plans are used to help people manage their finances effectively. We also saw clear information about which benefits people were claiming and how much they receive. The Commission is not aware of any complaints or safeguarding matters for this service. 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 premises are clean, well decorated and adequately maintained, promoting a positive environment for the people who live there and which is suitable for the range of disabilities that people have. Evidence: Information provided in the Annual Quality Assurance Assessment told us that the building is clean and homely with a safe and comfortable interior. The manager advised us that some rooms had been redecorated and there was new dining and garden furniture. We were informed that peoples bedrooms were personalised to reflect their interests and tastes. We were advised that people using the service are supported to use kitchen and laundry equipment and that a maintenance programme was in place to keep the premises safe and in good order. People using the service said in surveys that the premises are always kept fresh and clean. One member of staff said there needed to be more driers at the service. Fishermead is a detached property close to the centre of Milton Keynes. There are transport links nearby and a very good range of shops and leisure and recreational facilities to hand. The service has its own car park plus off street parking outside. Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: During the visit, we saw that the building was being kept in good order and was clean, well decorated and comfortable throughout. Communal areas were modern and spacious. Kitchen and laundry areas were well organised and kept tidy and clean. Dining and lounge areas were pleasantly arranged and homely. There is one downstairs bedroom, currently occupied by someone with physical disabilities. There is an adapted bathroom with shower next to it. Upstairs there are five further single bedrooms, two bathrooms and storage cupboards. Bedrooms that were seen had been personalised to reflect peoples interests, tastes and hobbies such as football. The service has an enclosed garden with areas to sit in and to play football and other games. A poly tunnel was seen up and ready in the garden for service users to start growing their own produce. 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. The service provides staff cover to meet needs and undertakes thorough recruitment procedures, coupled with effective training to ensure staff have the right skills and competencies to support the people who live there. Evidence: We were told in the Annual Quality Assurance Assessment that the majority of staff had achieved National Vocational Qualification at level 2 or above. The manager advised us that mandatory training was up to date and that all staff receive regular supervision or key sessions and annual reviews. We were advised that all staff have undertaken an induction and that job descriptions were in place. We were advised that there are regular staff meetings and that service users were actively involved in staff recruitment. In statistical information, the manager confirmed that there is a staff development programme which meets the National Minimum Standards for the service and that satisfactory recruitment checks had been received for any new staff who had started in the past twelve months. People using the service said in surveys that staff and managers always treat them well and that they listen and acted on what they say. One said there were kind and friendly staff. Another said the service could improve by having more male staff. Staff who completed surveys said they are given up to date information about the Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: needs of the people they support. They said their employer had carried out checks before they commenced work, such as uptake of references and Criminal Records Bureau clearance. They felt their induction had covered the areas they needed to know about and that they received training which was relevant to their role, helped them to understand the individual needs of people, kept them up to date with new ways of working and gave them enough knowledge about health care and medication. Staff said they received regular support from their manager and meet to discuss how they were working. They considered the ways in which information was shared worked well and that there were usually enough staff to meet the individual needs of service users. Staff also felt they had enough support, experience and knowledge to meet the different needs of service users, such as those relating to equality and diversity. Areas where staff considered the service worked well included support and enhance the people who live at Fishermead in all that they do, the needs of service users are always priority, cater for all clients to the best of our ability, offer lots of choice to the service users, always has an open door, a great team spirit among staff, good at fund raising, very flexible in the shifts that you can work, great training. One member of staff felt the service could improve by having designated admin days. Other comments by staff were staffing levels are sometimes inconsistent, offer 37 hours full time posts not 20 hours, making sure that we have drivers on shift, having more staff on at evenings to offer service users more choice. Two care staff plus the manager were on duty when we arrived at the service. Rotas reflected there are at least two people on duty each morning and afternoon, with one person sleeping in at night. The manager advised that there had not been any use of agency staff at the service since the last inspection and no new staff had started. Three relief workers were in the process of being recruited and the manager said they would not be permitted to start until their full Criminal Records Bureau clearance had been received, and was satisfactory. Staff on duty were respectful to service users, engaged with them and were knowledgeable about peoples needs. Training records were looked at and found to be in good order. As well as mandatory courses, staff had also attended specialised training to meet the range of needs that service users have, such as basic skin care, epilepsy awareness, foot care, PEG care, dysphagia, introduction to autism, managing challenging behaviour and sex and sexuality. 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 management and administration of the service promotes continuity and quality of care for the people who live there and ensures that risk is safely managed to reduce the likelihood of injury or harm. Evidence: We were advised in the Annual Quality Assurance Assessment that the manager has the necessary experience and qualifications to run the service. We were told that there are annual consultation meetings involving relatives and people using the service and that a quality assurance audit takes place each year. The manager said there were policies and procedures to refer to and an administrator who works at the service once a week to assist with financial matters. Statistical information showed that equipment such as the electrical circuits, portable electrical appliances and gas appliances had been serviced as recommended and that there were assessments for handling of hazardous substances. The manager said there was an action plan to deliver best practice in the prevention and control of infection and that six staff had received training in this area of practice. We were told that seven staff had received training in safe food handling. Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: A member of staff said in a survey Sue the manager is always a call away if you need her. The manager was on duty at the time of this visit and assisted throughout. She had addressed issues raised at the last inspection, with all requirements now being fully met. The certificate of registration was displayed in the hallway, alongside current employers liability insurance. There were records of regular monitoring visits by the provider. The manager said there had been a quality assurance audit shortly after our last key inspection. The report could not be located at the service and she agreed to obtain a copy from the provider and email a copy of it to us; this had not been received before our report was written. Health and safety was being well managed. A sample of servicing records and certificates showed gas appliances, electrical hard wiring and portable electrical appliances were safe. The fire officer visited the premises in June last year and found fire safety to be satisfactory, with a recommendation to update the fire based risk assessment at least annually. The service was awarded four stars/very good from the environmental health department in 2008 and we saw that Legionella testing had been carried out in 2009 when no cultures were found. Hoists had been serviced since the last inspection and the emergency procedures file was up to date. The operations manual contained various health and safety policies such as food safety, fire, moving and handling, control of hazardous substances and accident and incident reporting. We saw that staff training on health and safety related areas was well maintained and included infection control. Food storage had also improved since the last inspection. 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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