Care Home: Foxlands House

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What the care home does well Every residents we met appeared clean, well dressed and well cared for. All stated that they were satisfied with the care provided. They said they had been consulted and their preferences regarding activities organised had been responded to. Residents are also involved in the recruitment of new staff. The home is cheerfully furnished and feels cosy and comfortable. The garden is attractive and colourful. Residents pictures and their arts and craft items were displayed in the small lounge. There is a good range of social and therapeutic activities for residents. This ensures that they are stimulated. Residents have a say regarding where they wish to go for their annual holiday. This five day holiday is paid for by the organisation. Staff worked as a team and there is a low turnover of staff. This ensures consistency of care.The home has a comprehensive training programme for staff. We note that staff were knowledgeable regarding mental healthcare and issues affecting the mental health of residents. Staff were attentive and respectful towards residents. What has improved since the last inspection? The service has an assessor who provides support for those doing their NVQ course. This ensures that staff doing their NVQ gain more knowledge and acquire skills to enable them to be more competent in the job they do. A new mental health `Recovery Model` is promoted in the home aimed at engaging residents in their assessment and treatment process. We were informed that this approach has helped to enhance the recovery of some of residents by a reduction of symptoms and by promoting better quality of life. We note that residents had become more alert and responsive since the last inspection. One resident had improved significantly and had moved on to supported housing service. What the care home could do better: Improvements are required in the care arrangements. The care plans of residents must address their cultural and spiritual needs.This is to ensure that the holistic needs of residents are met. Regular one to one support sessions with residents should be provided and these should be documented in the case records.This is to ensure that there is an accurate record of such sessions and of progress made. Details of any allergies that residents may have must be recorded prominently in their files. This is to ensure the safety of residents. The home must have a Mental Capacity Act 2007 policy and procedure which includes guidance on The Deprivation of Liberty safeguards and a copy of the code of practice. This is required to safeguard the rights and best interests of residents.A risk assessment on the use of the cooker with a defective handle must be carried out. This is for health and safety reasons. The home must have an effective system of quality assurance. This must include a stakeholder or consumer survey. A report following the analysis of such a survey together with an action plan in response to any identified deficiencies must be prepared. This is required to ensure that the care provided is of a good quality. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Foxlands House 1 Cranesbill Close Annesley Avenue Colindale London NW9 5RQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Daniel Lim     Date: 1 1 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Foxlands House 1 Cranesbill Close Annesley Avenue Colindale London NW9 5RQ 02082001796 02082009610 foxland.house@richmondfellowship.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Richmond Fellowship care home 6 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: 6 The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category of service only: Care Home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Foxlands House is a small purpose built care home which was opened in 1998. It forms part of a complex of six buildings developed on this site to accommodate people who were previously patients at Napsbury Hospital in Hertfordshire. The home is run by a charity called The Richmond Fellowship. It is registered for a maximum of six service users with mental disorders. Three of the service users may be over the age of 65 years. The stated aim of the home is to provide a home where service users can be cared for with dignity and where they can lead as independent a life as possible. The home is a detached, two storey modern house. It has six single bedrooms located Care Homes for Adults (18-65 years) Page 4 of 32 Brief description of the care home on the ground and first floors. All bedrooms have ensuite facilities.The staff office, lounge, kitchen and laundry are located on the ground floor. The managers office and a smaller lounge are on the first floor. There is a communal bathroom and toilet on the ground floor and a second communal bathroom and toilet on the first floor. There is a small car park at the front and a garden at the back. The home is within walking distance of Colindale Hospital and about a mile away from Edgware Hospital. It is also close to shops and public transport facilities along Burnt Oak Broadway. The fees charged by the home are based on a block contract with the local health authority. The provider must make information about the service available (including reports) to service users and other stakeholders. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means the people who use this service experience GOOD quality outcomes. This inspection was carried out by Daniel Lim, inspector on 3rd June 2009 and took a total of seven hours to complete. We were assisted by the deputy service manager Ms Jacky Nwaoha and the new service manager, Mr Richard Erbe. A second visit was made on 11 June 2009 to view documents and interview staff not present during the first visit. Five residents were interviewed. The general impression gained was that they were well cared for. This was also confirmed in completed survey forms received from four Care Homes for Adults (18-65 years) Page 6 of 32 staff and four residents. Statutory records were examined. These included three residents case records, the maintenance records, accident and incident records, financial records, complaints records and fire records of the home. The premises including residents bedrooms, communal bathrooms, laundry, kitchen, garden and communal areas were inspected. Four care staff were interviewed regarding the care of residents and other areas associated with their work. They were noted to be knowledgeable regarding their roles and responsibilities. Staff records, including evidence of CRB disclosures, references, supervision and training records were examined. In addition, the minutes of residents and staff meetings were examined. The completed Annual Quality Assurance Assessment form or AQAA was received by CQC. Information provided in the assessment was used for this inspection. What the care home does well: What has improved since the last inspection? What they could do better: Improvements are required in the care arrangements. The care plans of residents must address their cultural and spiritual needs.This is to ensure that the holistic needs of residents are met. Regular one to one support sessions with residents should be provided and these should be documented in the case records.This is to ensure that there is an accurate record of such sessions and of progress made. Details of any allergies that residents may have must be recorded prominently in their files. This is to ensure the safety of residents. The home must have a Mental Capacity Act 2007 policy and procedure which includes guidance on The Deprivation of Liberty safeguards and a copy of the code of practice. This is required to safeguard the rights and best interests of residents. Care Homes for Adults (18-65 years) Page 8 of 32 A risk assessment on the use of the cooker with a defective handle must be carried out. This is for health and safety reasons. The home must have an effective system of quality assurance. This must include a stakeholder or consumer survey. A report following the analysis of such a survey together with an action plan in response to any identified deficiencies must be prepared. This is required to ensure that the care provided is of a good quality. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 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 32 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. Admissions are not made to the home until a full needs assessment has been undertaken by the manager. Admissions only take place if the service is confident that the needs of people to be admitted can be met. This ensures that the admissions to the home are appropriate. Evidence: The manager informed us that residents had been carefully assessed and are only admitted if the home can meet their needs. The AQAA of the homemade the following statement We carry out comprehensive agreed assessment with service users to identify the cultural and diverse needs of service users which is added up into a multidisciplinary Individual Support Plan and Risk Asessment. Equal Opportunity and Diversity is a standing item on the team agenda. Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: Three case records were examined. The pre-admission assessments which were examined were on the whole, noted to be appropriate and comprehensive. The assessments included details of the personal, mental, cultural and spiritual needs of residents. Detailed risk assessments had also been prepared for residents admitted to the home. We note from this inspection that the home had been able to meet the needs of those living there. Residents we met were clean, well dressed and appeared well cared for. Care Homes for Adults (18-65 years) Page 12 of 32 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. The service recognizes the rights of individuals to have control of aspects of their lives. Residents are consulted on how the service runs and activities they wish to participate in. Care plan had been prepared and these include appropriate risk assessments. Evidence: The AQAA made the following statement Every Service user has an Individual Support Plan. The plan incoporates every aspect of their needs such as Physical health, mental health, religion, education, cultural and diverse needs to mention a few. This has developed the recovery of some of our service users through a reduction in symptoms thereby promoting better well being. We involve service users in menu planing and shopping to provide them with choice and flexibility. Each service users has a designated keyworker who provides support in every day life as well as making contacts with family friends and other agencies.Service users families are involved and consulted in the service affair with Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: their consent. The five residents who were interviewed were able to confirm that they had been consulted regarding their care and daily routines. They expressed satisfaction at the way staff cared for them. The sample of three residents case records contained appropriate care plans and assessments. Plans of care had been signed by residents concerned and these had been regularly reviewed. There was documented evidence that residents had been encouraged to be as independent as possible and this was confirmed by the residents interviewed. Two of the residents interviewed confirmed that they had made significant progress in the home and were able to lead more active lives. One resident said he was hoping to move out soon into semi-independent living. Care Homes for Adults (18-65 years) Page 14 of 32 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. The home had sought the views of residents and considered their varied interests when planning their daily routines. Links to specialist support are facilitated when needed. Residents have opportunity to develop skills and are encouraged to be as independent as possible. The arrangements for the provision of meals take into account the preferences of residents and their dietary needs. Evidence: The AQAA made the following comments We recognise the important role activities play in service users recovery and ensure that they are provided with structured day centre and in-house activites. Activities held in the service addresses every individual need. There are also activities for high needs service users which is held at the Richmond Fellowship Barnet Employement Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: Service. These activities include arts and craft, cooking, cinemas, sports, sight seeing and community activities on Thursdays. Service users have been consulted about all activities. Service users always go on annual holidays. They are consulted about holiday venues and provided with 5 days paid holidays. Residents and staff who were interviewed were able to provide confirmation that the home has a varied programme of social and therapeutic activities. These include an annual holiday to a place that residents had chosen. In addition to regular attendance at a day centre, we note that there is a documented weekly and appropriate programme of activities for residents. These include picnics and outings to the park, museums, bowling and shopping centre. Residents also have access to the gymnasium which is located at Meridan House. Residents informed us that they had been treated with respect and dignity. We observe that staff were responsive to the needs of residents. We were also informed by residents that they had been in contact with family and friends and some had visited them at the home. The arrangements for the provision of meals was discussed with residents. They informed us that they were satisfied with the meals provided. The kitchen was noted to be clean. Daily recorded temperatures of the fridge and freezer had been kept. These were satisfactory. A fire blanket was in place. The menus examined appeared varied and balanced. The chef who was interviewed was aware of special diets for some residents. Staff informed us that residents had been consulted regarding their likes and dislikes and their cultural dietary observances had been respected. Care Homes for Adults (18-65 years) Page 16 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents living in the home have access to healthcare services in the local community. There is evidence in the case records that residents personal and healthcare needs are monitored and appropriate intervention taken. Further improvements are however, required in the care arrangements and in the administration of medication. This in required to ensure the welfare and safety of residents. Evidence: The homes AQAA made the following statement Every Service user has an Individual Support Plan. The plan incoporates every aspect of their needs such as Physical health, mental health, religion, education, cultural and diverse needs to mention a few. This has developed the recovery of some of our service users through a reduction in symptoms thereby promoting better well being. We involve service users in menu planing and shopping to provide them with choice and flexibility. Each service users has a designated keyworker who provides support in every day life as well as making contacts with family friends and other agencies. Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: Service users families are involved and consulted in the service affair with their consent. The sample of three residents case records contained detailed care plans and assessments. Plans of care had been signed by residents. The care plans of a resident who has challenging behaviour was examined. We noted that the risk assessments and care plans were appropriate and comprehensive and contained guidance to staff on caring for this resident. All residents we met were cleanly dressed and looked well cared for. Staff were responsive and polite to residents. The deputy service manager quoted an example of good practice. She stated that one of the residents had been able to improve sufficiently in his mental stated and daily living skills and would soon be moving to semi-independent accommodation. She attributed this to the help and care provided by staff. This was confirmed by the resident who was interviewed. We note that two of the care plans examined were comprehensive and well prepared. The case records of the third resident, did not have care plan addressing the cultural and spiritual needs of the resident concerned. This was brought to the attention of the manager and deputy service manager and service manager. They agreed to ensure that the required care plans are prepared. This is to ensure that the holistic needs of this resident are attended to. The deputy service manager informed us that regular one to one support sessions had been provided. We note that one to one sessions had been documented. However, in two of the case records, these had only been documented once since January of this year. The deputy service manager stated that some one to one sessions had been held since, but may not have been documented. To ensure that there is an accurate record of such sessions and of progress made, one to one sessions should be documented. We examined the administration of medication. There is a photo of each resident in the Medication Administration Record, MAR folder. Three MAR sheets were examined. They were appropriately signed. There was evidence that staff had been provided with training in the administration of medication. Medication was stored in a locked cabinet which is secured to the wall. The home has a policy and procedure on medication. The daily temperatures of the room where medication was stord was examined and noted to be satisfactory. Allergies that residents may have were not recorded in the MAR charts or noted prominently in their case records. This must be done to ensure the safety of residents. Care Homes for Adults (18-65 years) Page 18 of 32 Care Homes for Adults (18-65 years) Page 19 of 32 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 arrangements for responding to complaints and for adult protection were satisfactory. The home has an open culture that allows residents to express their views and concerns in a safe environment. This ensures that residents are well treated and protected from abuse. Evidence: Residents who were interviewed by us indicated that they were well treated and satisfied with the care provided. The home had an adult protection procedure. It included information on examples of abuse and guidance to staff on reporting allegations of abuse to Social Services and CQC. The manager and his staff who were interviewed were aware of the homes policy and procedures for the protection of vulnerable adults. There was evidence that staff had been provided with the required training. The local authority guidelines were available. No allegations of abuse regarding this home had been received by us. No complaints had been recorded. The deputy manager stated that none had been received. Three out of four residents who returned their completed survey forms indicated they knew who to complain to if they needed to make a complaint. With one exception, all residents who were interviewed knew who to complain to. Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: We note that there had been concerns expressed during strategy meetings that the previous registered manager had not properly handled allegations of abuse in Meridan House. The organisation had responded promptly to concerns expressed and the action plan drawn up had been carried out. Care Homes for Adults (18-65 years) Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a physical environment that is aimed at the specific needs of the people who live there. It is clean, tidy and on the whole, well furnished. The manager had ensured that the physical environment of the home provides for the individual requirements of people who live there. Residents are allowed to personalise their bedrooms. Overall, the home provides a pleasant and comfortable environment to live in. Evidence: The premises felt homely and cheerful and the chairs and sofa were comfortable. During our visit, we note that the bedrooms inspected had been personalised by residents with their own pictures and ornaments. These bedrooms were well furnished. Arts and crafts items of residents were on display. There were also photos of residents and staff along the corridor and in the lounge. The gardens were attractive and seating had been provided. No offensive odours were detected in the home. The two residents we spoke to said they were satisfied with the accommodation provided. Safety inspections had been carried out on the gas and portable appliances. The manager stated that no specialist equipment was required as all residents were independently mobile and did not require any specialist equipment. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: We however, noted that the carpet on the stairs had become worn in some areas and there was an area where it was threadbare and may present a safety risk. This was brought to the attention of the manager. The manager promptly arranged for this area to be taped over. He further reassured us that the home is due for redecoration and the carpet would be renewed. Care Homes for Adults (18-65 years) Page 23 of 32 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 has a good recruitment procedure that is followed in practice. Management recognizes the importance of training and is able to deliver a programme that meets statutory requirements. Staff are being supported to meet the needs of residents. Evidence: The AQAA made the following statement All staff are competent and knowledgable. Staff are aware of their roles and responsibilities as detailed in the job description. Staff receive regular supervision and opportunities to develop more skills to give quality care to service users. We have thorough and fair recuritment process. We ensure all staff have satisfactory Enhanced Criminal Record Checks before resuming employment. We ensure all staff receive mandatory training such as 4 days First Aid, Equal Opportunity and Diversity, Induction, Fire training, Challenging behaviour, Mental Health and Recovery to mention a few, to ensure that staff are trained to support service users towards the journey of their recovery. We have staff who have National Vocational Qualification and who are currently participating in the NVQ. We always have adequate staffing level and contingency plans in place to cover shifts when the need arises. Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: The five residents who were interviewed indicated that staff were responsive to their needs and had treated them with respect and dignty. The duty rota was examined. It indicated that in addition to the manager, there was normally at least three staff during the morning shift, 2 staff during the afternoon and evening shifts and one staff on sleeping duty during the night shifts. Staff interviewed were of the opinion that this staffing level was adequate for them to attend to their responsibilities. The two staff who were on duty were interviewed on a range of topics associated with their work. They were noted to be knowledgeable regarding their roles and responsibilities. There was documented evidence that staff had been provided with essential training. The staff records examined indicated that the required recruitment standards and procedures, including obtaining satisfactory CRB disclosures and references had been followed. Staff were aware of the need to treat all residents with respect and patience and to encourage residents time to remain as independent as possible. Staff further stated that they worked as a team and communication in the home was good. Four completed staff surveys were received. These indicated that staff had been provided with a period of induction when they started work at the home and they are being supported by the manager. Care Homes for Adults (18-65 years) Page 25 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is planned to be user focused and take account of equality and diversity issues. It works well in partnership with residents and their representatives. Staff supervision is in place. The service manager is aware of areas that are deficient and is working to improve the care provided. Further improvements are needed in the area of quality monitoring and in Health and Safety. Evidence: The AQAA made the following statements Service users are involved in recruitment exercise and have opportunities to express their opinions in the way they want the service to operate. We have a service user lead who attends forums and cascades information to service users within and from the service. Service users families are involved and consulted in the service affair with their consent. We will learn from best practice to improve our service. We will build our success and be conversant with new changes by regulators and government agenda for mental health. We will work in line with Richmond Fellowship policies and Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: procedures which are monitored through the Quality Audit Visits and Financial Audits. We will evaluate and review our service in cosultation with service users together with staff through outcome from Quality and Financial Audits. The service manager informed us that he is committed to improving the management and care provided at the home. He was appointed recently. He informed us that he has experience of working with people living in local authority sheltered housing. He has not applied for registration with us, but reassured us he will be doing it soon. He is supported by an experienced deputy service manager who has worked in the home for several years. An administrator is now in post. The service manager informed us that she will also provide administrative support for Meridan House which is located nearby. The issue of effective quality assurance and monitoring systems was discussed with the manager and deputy manager. We were informed that there are regular consultation meetings with service users. However, we were not provided with evidence of any consumer surveys carried out in the past twelve months. The home must have an effective system of quality assurance. This must include a stakeholder or consumer survey. A report following the analysis of such a survey together with an action plan in response to any identified deficiencies must be prepared. This is required to ensure that the care provided is of a good quality. A current and appropruate certificate of insurance was available for inspection. The financial record of three residents were examined. The records were well maintained and contained appropriate signatures for money withdrawn by residents from their accounts. The fire logbook was examined. The weekly fire alarm tests, emergency lighting checks and fire drills had been carried out and documented. There is an updated fire risk assessment. The required health and safety inspections on the portable appliances, gas and electrical installations had been carried out. We noted that a minimum four fire drills carried out over the past twelve months. One was carried out after dark. We also note that there is a record of fire training for staff. Window restrictors were fitted and engaged. However, we found that the gas cooker was defective as the handle was damaged. The service manager stated that this had been repaired but became damaged again. For safety reasons, repairs must be carried out again or a new cooker purchased. The manager stated that he was aware of the problem and a new cooker was in the process of being purchased. The home has a range of policies and procedures. However, we were not provided with a policy and procedure to provide staff with guidance on the Mental Capacity Act 2008 Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: and The Deprivation of Liberty safeguards. This is required to safeguard the rights and best interests of residents. The service manager agreed to ensure that the required policy and procedure is provided. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 32 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 19 15 The care plans of residents must address their cultural and spiritual needs. This is to ensure that the holistic needs of residents are fully met 03/08/2009 2 20 13 Details of any allergies that residents may have must be recorded prominently in their files. This is to ensure the welfare and safety of residents. 07/08/2009 3 39 24 The home must have an 18/08/2009 effective system of quality assurance. This must include a stakeholder or consumer survey. A report following the analysis of such a survey together with an action plan in response to any identified eficiencies must be prepared. This is required to ensure that the care provided is of a good quality. Care Homes for Adults (18-65 years) Page 30 of 32 4 40 12 The home must have a Mental Capacity Act 2007 policy and procedure which includes guidance on The Deprivation of Liberty Safeguards and a copy of the code of practice. This is required to safeguard the rights and best interests of residents. 24/08/2009 5 42 13 A risk assessment on the use of the cooker with a defective handle must be carried out. 10/07/2009 This is for health and safety reasons. 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 18 Regular one to one support sessions with residents should be provided and these should be documented in the case records. This is to ensure that there is an accurate record of such sessions and of progress made. Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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