Care Home: Flint House

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What the care home does well From information obtained through this inspection the people who use the service can be confident that they will obtain a good standard of care and support. They also can expect to receive the treatment they require to enable them to either return to work or maintain a good standard of health and fitness. The can be certain that the environment they are provided with during their stay is kept to a very high standard and will be pleasant, comfortable, and well equipped to meet their needs. Staff are friendly welcoming and supportive and have be provided with the training and knowledge to care for them well. Information from the whole inspection process shows that the service is managed well and effectively. What has improved since the last inspection? The service has implemented changes to improve the control of infection measures in place. They have continued to enhance the training, skills and knowledge of the nursing staff to provide holistic complementary therapies. What the care home could do better: They should look at developing the quality of some of the record keeping tools for care planning, some risk assessments and recruitment practices. This is to ensure that sufficient information is kept to support the decision making staff undertake of how they are going to meet individuals needs and the administration of the service. Key inspection report Care homes for adults (18-65 years) Name: Address: Flint House Police Rehabilitation Centre Reading Road Goring Oxfordshire RG8 0LL     The quality rating for this care home is:   three star excellent 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: Ruth Lough     Date: 2 8 0 4 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: Flint House Police Rehabilitation Centre Reading Road Goring Oxfordshire RG8 0LL 01491874499 01491875002 surgery@policerehab.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Board of Trustees, The Police Rehabilitation Centre Name of registered manager (if applicable) Mrs Sarah Allen Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 past or present alcohol dependence past or present drug dependence physical disability Additional conditions: The maximum number of service users to be accommodated is 5 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender; Either whose primary care needs on admission to the home are within the following category: Past or present alcohol dependence (A) Past or present drug dependence (D) Physical disability (PD) Date of last inspection Brief description of the care home The Police Rehabilitation Centre at Flint House is managed by a charity and is set in 19 acres of Oxfordshire countryside near Goring. Flint House has very comfortable accommodation and communal facilities and offers convalescence facilities for eligible Care Homes for Adults (18-65 years) Page 4 of 29 5 5 5 Over 65 0 0 0 Brief description of the care home sick and injured police officers from 28 police forces in England and Wales, serving or retired. The Board of Trustees manages Flint House and the Chief Executive has responsibility for the day to day running of the centre. Departmental managers have responsibility for staff and services within their area, and the registered manager is responsible for the management of the nursing department. Service users are admitted for 12 day therapeutic stays and return home after that time. Facilities include a physiotherapy department, hydrotherapy and gymnasium. Other therapeutic services include massage, acupuncture and workshops designed to meet individual psychological needs. Registered nurses care for the service users admitted to the nursing department. There are no charges payable as many of the guests donate 85 pence per week to the charity. 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: three star excellent 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 key inspection process generated from the excellent findings identified at the last assessment of the quality of the service by the commission in March 2008. This inspection process included reviewing information provided by the service in the Annual Quality Assurance Assessment and any returned surveys to the commission before a one-day visit to the centre. An annual quality assurance assessment (AQAA) is a self assessment and a dataset that is filled in once a year by all providers whatever their quality rating. It is one of the main ways that we will get information from providers about how they are meeting outcomes for people using their service. The Annual Quality Assurance Assessment from this service was returned within the Care Homes for Adults (18-65 years) Page 6 of 29 required timescales and had been completed satisfactorily. The registered manager was present when we visited the service on 20th April 2010, between 10:50 and 17:45. During the day the records for care planning, recruitment, and administration of the service were assessed. Two people who were currently using the service were involved with the inspection process. We met with 4 staff who were present at various times during the visit. Because of the infrequency of people using the nursing service at the centre we sought information about peoples opinion about what is provided through using the centres own quality monitoring process. Four staff completed surveys to the commission before the visit to the centre. From this visit it could be seen that the service continues to be run to ensure the best outcomes for the people who use it. There were a small number of good practice recommendations that were given at the time of the inspection to continue and develop the service and can be found in the body of this report. 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: 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 8 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 9 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. The people who use the service will have their needs identified before they are offered a place in the centre. Evidence: We looked at the information provided to new or prospective users of the service about what they can expect if they go to Flint House for treatment, rehabilitation, convalescence or a respite stay. This was to see if they are provided with sufficient information to support determining that the services on offer are appropriate to their specific needs. Details of what is on offer are included in the services website, leaflets or brochures, and within the Statement of Purpose. The accompanying video available off the website gives a good pictorial or verbal description to support the documentary information. The Statement of Purpose that was made available during the inspection holds the required information, although some minor amendments to protect confidential personal information were recommended to be carried out. Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: The service provides a very specific programme of support within a planned timescale. Stays usually are for short periods from one week for respite and or nursing care to 12 days for treatment and rehabilitation. The service is provided only to current and retired police officers within the strict criteria set by the charitable trust and they are unable to access a place in the home through any other means than a personal application which is supported by a police welfare officer. No admission to the home is made without the information from an assessment of a medical practitioner. For those with a more significant nursing and care need this information is reviewed by the senior nursing staff as to establish if they will be able accommodate and provide the appropriate care that they may require before they are offered a place in the centre. Following arrival the nursing staff carry out a further assessment of all new admissions. We were informed that the depth of information that is sought is variable in accordance to the intervention required to be carried out by nursing staff. For most of the new admissions this entails a brief outline of the purpose of stay, any significant healthcare issues identified and some baseline screening such as blood pressure, temperature, and pulse. For the small number of people who use the service for respite stays or have a greater nursing need the assessment looks at key areas for achieving personal care, any medication usage, continence, and emotional well being. We looked at the nursing and care records for one person currently in the home for a repeat respite stay. The information from the formal referral was not made available but those used for the assessment carried out by the nursing staff were reviewed. From what could be seen information had been sought although there could have been greater detail included about the medical needs of the individual. Recommendations were given in regard to developing the assessment document tool to provide space to quantify and qualify the information obtained which would assist with the care planning for the individual concerned. Care Homes for Adults (18-65 years) Page 11 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. A care plan is put in place to assist with ensuring individuals needs will be met. Evidence: We looked at the care planning records for the one previously identified service user in residence and another record was partially reviewed to see what is recorded for those admitted for less complex care. These were sampled to assess the quality and detail of the planned care in place of how they intended to meet the individuals needs. From what could be seen the nursing care plans summarised the key areas of need for the person concerned. However, there was only brief information or specific instruction of how the aims of care were to be delivered. Much better information had been included in the nursing notes from any interaction or intervention that the nurse had when carrying out the task with the individual. A moving and handling risk assessment had been implemented for the individual on a respite stay in the home. From information given by the Registered Manager these are Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: not carried out routinely by nursing staff on all the people who are in the centre for treatments or therapys. The physiotherapy department carry out their own risk assessment if the person is receiving support from them. The assessment we reviewed highlighted key areas such as using the hoist and the persons mobility. However, the document tool does not enable that much detail of the actions to be taken to rectify identified concerns to be recorded. This was discussed with the Registered Manager. Care Homes for Adults (18-65 years) Page 13 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. The people who use the service are provided with opportunities to relax and enjoy their stay in the centre as part of their rehabilitation and treatment. They are also enabled to continue with their relationships and supported to keep in contact with their families. They are provided with suitable nutritious meals. Evidence: From looking at the facilities, information on display, and what the Registered Manager informed us, there are a few activities that they can participate in whilst staying in the centre. Although a more formal programme is not in place residents are encouraged in their free time to enjoy assessed or planned escorted walks in the local area, visit the nearby village or enjoy the company of others in the main lounge with a bar, watch TV and relax. In the grounds there are areas were they can participate in games or sports. The main focus of activity during their short stay is for each person is following their planned programme of treatment, including physiotherapy, Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: hydrotherapy, aromatherapy, and acupuncture. The level of which is dependent on the reason for admission to the clinic. Information given in the AQAA indicates that there is encouragement and support given for the involvement families or friends during the individuals stay at the home. Where there is a particular need for the individuals own carer, partner, or dependant children to accompany them during their stay the centre can accommodate this within the limitations of the availability of the facilities to do so. We did not look in depth at the provision of meals, nutritional assessment or specialist diets that are in place. From information given by the Registered Manager, the feedback from the people who use the service and observation of a mealtime, the meals are very much enjoyed and are an integral part of the rehabilitation or treatment programme. Menus are left on display in the central entrance of the main building for all to view and can offer choices of a wide variety of meals which can appeal to most people. Any specialist diet can be catered for should it be required. From information given by the Registered Manager it is very rare that a nutritional assessment is required to be carried out due to the limited period people stay in the centre and their level of dependency needs. However, they will do so if someone is seen to be at a particular risk. The document tools for this were not reviewed during this inspection. Meals are provided in the restaurant in two sittings as to the volume of people staying in the centre at one time. Care Homes for Adults (18-65 years) Page 15 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who may require personal care and health support can be assured that their needs will be met. Evidence: The resident currently in receipt for support for personal care expressed great confidence in the nursing staff meeting his needs. He particularly emphasised that there were a consistent team of staff who had cared for him previously and who understood what was required. The service appears to have a very good working relationship with the local GP practice who over see any healthcare support the people staying in the centre may need. Two surgeries are provided in the centre by them during the week where the residents can consult with the GP or receive treatment. The surgery will also provide support outside of the surgery times if required. Nursing staff undertake a number of nursing tasks including some basic health screening, dressing or wound care, and medication administration. For most of the clinical activities, including catheterization they liaise with the local District or Practice Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: Nurse. They have ensured that they have the clinical skills and equipment for resuscitation should the need arise. The nursing staff are able to provide additional care through the use of complimentary therapies including aromatherapy, stress management and counselling. Health promotion, including dietary advice is incorporated in the services on offer from the nursing staff. We looked at the medication administration practices including the policies and procedures in place to see if there are safe processes in place. From information given by the Registered Manager the majority of the people who use the centre do not have a requirement for support with their medications. For a small number that responsibility may fall on the nursing staff. Usually if there is a need it is identified in the assessment process and staffs intervention is noted in the care plan. However, for those people who wish to but may not have the competencies to do so there is not a formal documented risk assessment process to support the decision making they may be able to self medicate. The Registered Manager was advised to look at developing a risk assessment process for self administration of medications. Looking at the facilities of for storage of medications, the usual practice is to offer a portable lockable tin to be kept in their rooms for this purpose should they request or have a need to do so. The Registered Manager was advised to look at providing a secure lockable space in the bedrooms for this purpose as to ensure that medications or other valuables cannot be removed from individuals rooms. We were informed that the nursing staff us a MAR(Medication Administration Record) to note any interventions they carry out, although these were not seen during this inspection. The nursing staff are able to provide some non prescription, over the counter medications, which have been agreed by the local GP practice, plus have available Epipens for anaphylactic shock and oxygen for the use in an emergency. The records for these non-prescribe medications were reviewed and supported that there were safe practices and checks in place for their administration. We were informed that the nursing staff as part of their supervision of practice, are observed carrying out their medication administration. However, we were also informed that re visiting training for medication administration for both the Registered Manager who is responsible for this and the rest of the nursing team had not occurred for sometime. They were advised to look at including this in their training programme for the nursing staff. Care Homes for Adults (18-65 years) Page 17 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. The people who use the service can be confident that their concerns will be listened and responded to. Evidence: We looked at the processes in place for managing any concerns, complaints or compliments received about the service. Information given in the AQAA indicates that there were no formal complaints received by the centre. The CQC (Care Quality Commission) during the last 12 months has only received one enquiry which the concerned person was referred back to the service for clarity of information. The complaints procedure is included in the information given to new service users at the beginning of their stay and is available on display in the centre. Information in the AQAA states that minor concerns are usually resolved quickly by the reception staff, duty nurse or security, although the records for this were not reviewed during this inspection. The use of the surveys at the end of each persons stay in the centre also give them the opportunity to comment or express any concerns. This could be seen in the sampled records made available. However, what actions taken to rectify them, is unknown. What could be seen was there were very many compliments made about all aspects of the services provided. From the hotel services to the care and treatment individuals received all respondents to the surveys had felt their stay had been beneficial and very enjoyable experience. Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: The information and training for safeguarding adults from possible abuse or harm were reviewed. This was to see what they had been provided with to ensure that the small numbers of possible vulnerable adults who come in contact with the service are protected. The service policy and procedure were reviewed and it was identified that the local authority procedure and protocols were not reflected in the information. The Registered Manager was able to show that they did have some supporting information for this for staff to follow. Through discussion with the Registered Manager and reviewing some of the training records for staff it appears that it is a least 4 years since any training had been undertaken for this. It was recommended that they revisit this topic as part of their ongoing training programme. Information in the AQAA state that families, including children, are allowed to stay if they wish. The need for child protection awareness should also be incorporated in the training provided to staff. Care Homes for Adults (18-65 years) Page 19 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service can enjoy a well maintained, comfortable, pleasant environment. Evidence: Flint House is situated in a peaceful setting away from one of the main roads leading out of Goring-on-Thames. The original building retains many of the period features but is still generally adapted to suit people with limited mobility or wheel chair users. Additional extensions to the main part of the centre have been made gradually since its opening in 1988. The centre provides en suite or bathroom facilities for all its 131 bedrooms. There is flexibility in some parts of the centre to provide shared accommodation to accompanying partners, carers or children if required. The nursing staff have available 5 bedrooms to use to support those staying at the centre which have been equipped and designed for people who have more dependent needs. Much of the aids, showers and baths in these rooms all can be used without the support of nursing staff if the person concerned is able to do so, supporting individuals to remain as independent as possible. The majority of the buildings have wide accessible corridors, lifts, ramps and some automatic opening doors for wheel chair users to use the building without extra support. Throughout the home consideration has been given to provide plenty of communal areas to use, including small quiet areas for people to enjoy. Equally the attention to the external areas has been made for people to sit in Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: areas around the outside of the building and the walks in the grounds. From what could be seen the footpaths and external areas are accessible to wheel chair users. The building, facilities, the hygiene and cleanliness all appear to be kept to a very high standard. The introduction of antibacterial hand gel at all entrances and exits to departments and buildings has been utilised by both staff and residents alike and has assisted with the overall infection control measures in place. Residents have access to laundry facilities for personal items, bed and household linen is undertaken externally by a contractor. The Registered Manager stated that there were proposals, in accordance to advice from the Lead Infection Control Nurse from the local PCT(Primary Care Trust), to install a washing machine specifically for the personal items or soiled laundry used by the more dependant service users to minimise the possibility of the spread of infection around the centre. Care Homes for Adults (18-65 years) Page 21 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 people who use the service can be confident that they will be cared for and supported by a sufficient number of skilled and experienced nursing staff to meet their needs. Evidence: Comments in the surveys returned to the centre indicated that they felt all levels of staff were helpful and pleasant. From observation the nursing and other staff we met during the inspection visit interacted well with the people using the service and had developed very positive relationships with them. Specifically looking at the nursing care staff there has been a very consistent team of qualified nurses working in the centre. The last was employed over 4 years ago. From information given by the Registered Manager and in the AQAA there are 11 nurses employed either full time or part time ensuring that there is a minimum of one on duty at night. The service has not required supplementing the nursing team with agency staff, and has two bank health care assistants who are used very infrequently. The current nurses employed are supported with a training programme that incorporates personal and professional development. These have ranged from Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: enhancing their practices and reassessment for acupuncture, to updates for diabetes, Parkinsons, infection control and the prevention of cardio vascular disease. Each year they undertake training updates for using the Defibrillator and an Epipen which is provided by the PCT(Primary Care Trust). Core health and safety topics revisited include Moving and Handling and First Aid. The Moving and Handling is provided in house by the resident team of physiotherapists. Additional topics to assist with their counselling services have included cognitive behaviour and motivational interviewing. The recruitment records for one member of staff, a health care assistant who had been employed for ad hoc support within the last year were reviewed. This was to see if the processes are robust and that the service has established that they are suitable for the role they have been employed for. The centre has a specific member of staff responsible for collating and retaining the employment records of all the staff employed. We looked at the current format of the application form and it was clear that the applicant is not requested to submit their full work history and this should be amended or recorded to reflect this information had been sought. For this member of staff they had submitted a CV although they were not required to do so. References are requested and obtained from 2 referees including their current or last employer. For this individual one was a professional reference and the other was a personal recommendation. We were informed that each new member of staff is interviewed by 2 senior nursing staff. For this particular candidate brief records of the interview process had been recorded. However, they did not show that the applicants work history or any gaps in employment had been explored, the participation of the other member of staff in the interview or the decision or conclusion that the person concerned was suitable for the role they had applied for. The interview record had not been dated or signed by the participants. Copies of the persons identity had been obtained and again they were advised to date and sign who verified the original documents that were seen for this. The only photograph of this member of staff was that taken from photocopying their passport. The Registered Manager stated although advised to keep up to date photographs of the staff employed during the last inspection process in 2008 they have not obtained these. There was information that they had sought and received a Criminal Records Bureau and Protection of Vulnerable Adults list check before the individual commence working in the service. They also provided information that they had undertaken an induction programme, although there was no evidence that they had obtained documentary evidence of the training they had had previously or that which they had provided for the core health and safety topics since they had commenced employment. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: The was no supporting information that the employee had made a health declaration that they are fit for the role they had been employed for. One staff member put in a returned survey, The home cares very well for its residents(clients) and staff in all departments. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. That the home is run effectively and safely and in the best interests of the people who use it. Evidence: The registered manager has been in her role for a considerable length of time and has been integral to the development of the current service provision that the centre can offer. From information given during the inspection process it was very apparent that there has been a consistent team of senior staff leading the service delivery, who are led by the Chief Executive/Responsible Individual who reports back to the Board of Trustees and leads in the overall management of the service. What was good was the overall approach to seeking the opinion and consulting with the people who use the service. They also have good quality monitoring systems to assess what the service provides. The centre has approximately 70 new residents admitted and discharged each week and all are given an opportunity to comment about the service in a survey at the end Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: of their stay. The Chief Executive takes the lead in monitoring and collating the information and provides this back to the heads of department and the Board of Trustees on a very regular basis. The Chief Executive also undertakes regular provider visits to randomly check various areas for quality monitoring, which includes consulting with people using the service at the time. A sample of the regular safety checks carried out on the equipment used including lifts and hoists support that there is a routine programme carried out. We were informed that the Fire Service were scheduled to visit the centre the next day to carry out an inspection of the service, therefore fire safety records were not reviewed. One area that they could improve is the security, in line with Control of Substances Hazardous to Health Regulations (COSHH) 1988, of domestic chemicals which were seen in the domestics cupboard, in the near vicinity of the bedrooms where the more dependent residents would stay. The door had been wedged open and the room unattended. However, the element of risk with the current residents staying in the home was small. 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). 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