Care Home: Freshfield Cheshire Home

What the care home does well All of the people living in the home told us that they enjoyed a lifestyle in keeping with their personal choices. They were particularly appreciative of the variety of activities available and of the staff members themselves. Comments included, "always something to do" and "the staff are excellent". The staff are supported by large team of volunteers, which means that there is always someone available to support people who live in the home to undertake individual activities Throughout the visit staff demonstrated a genuinely warm and caring attitude to the people that they support. This was most noticeable at mealtimes when a calm atmosphere was evident and staff supported people to eat in an unhurried manner. The building is adapted to maintain the independence of people who live in the home. This includes a variety of adaptations and equipment that help people to have a comfortable and safe environment to live in. Several of the bedrooms viewed contained kettle`s fridges and microwaves. Some people had larger rooms which they had furnished like a bed sit. Some had smaller rooms with en suite showers and some had flats. In general the home presents as a clean comfortable spacious place to live. What has improved since the last inspection? The service has undertaken and achieved an external quality assurance scheme that helps them identify the strengths and areas of development of Freshfield Cheshire. Freshfield Cheshire have introduced more individual training e.g. Three member of staff has successfully completed the Team Leader course. A further Three staff have completed moving and handling assessors training and three staff have completed risk assessment training. The catering department has completed a review and the catering staff shift times have been altered to fit in with the new mealtimes that were requested by the people who live in the home. Several areas of the home have been refurbished and redecorating including "easy open" fire doors, coffee bar, the function room and several bedrooms. What the care home could do better: The service has undertaken a lot of work on a new care planning system. Staff spoken with did not think that these were useful written records. When we looked at them we noticed that they were not always fully completed, kept up to date or accurate. Examples included nursing needs that did not have specific instructions available to the staff. Records did not always help the staff to be able to support and monitor the people living in the home. Medication records were also in need of improvement in particular records for people admitted for respite care, people needing their tablets when out for the day, medications as per required need and external creams. A requirement regarding the correct storage of medications from the last site visit had not been fully addressed atthis visit. We have since been contacted by the manager who informed us that appropriate action has now been take and described additional plans that will also provide better practice regarding medications. People living in the home and staff told us that they thought that the food available could be improved. We noticed that there was no information to people who lived in the home, relatives or staff that supported people with special diets to be offered a choice of meals. Staffing files were viewed in the majority of cases proper checks had taken place before the staff member started work. In one case the staff member had not been safely recruited and the homes own policy and procedure had not been followed. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Freshfield Cheshire Home College Path Freshfield Formby Merseyside L37 1LE     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: Julie Garrity     Date: 1 2 0 3 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 30 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 30 Information about the care home Name of care home: Address: Freshfield Cheshire Home College Path Freshfield Formby Merseyside L37 1LE 01704870119 01704834408 julie.perry@LCDisability.org 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) : Leonard Cheshire Disability care home 35 Number of places (if applicable): Under 65 Over 65 0 0 learning disability physical disability Additional conditions: 3 32 Maximum no. registered - 35, of which up to a maximum of 30 PC (personal care) and up to a maximum of 12 N (nursing). Service users to include up to 32 PD and up to 3 LD. Date of last inspection Brief description of the care home Freshfields is owned and operated by the Leonard Cheshire Disability. It is registered to provide nursing and personal care for adults with physical and learning disabilities. Accommodation in the service is provided in a variety of settings. Single rooms are available in the large section of the building whilst double and single self-contained flats are available in the extensions that are linked to the main building. There is a variety of different communal space in the building that includes dining facillities, quiet araes, activities araes and outside garden space. Freshfields is located in a highly popular residential area of Formby. Local shops, pubs, Care Homes for Adults (18-65 years) Page 4 of 30 Brief description of the care home and other facilities are within walking distance of the home. Public transport links are also easily accessible. The home is close to the local railway station of Freshfields, Formby. A copy of the commissions last visit is normally displayed in the main foyer of the home. Fees vary depending on the assessed need of people the service supports. These range from 450 pounds to 780 pounds per week. Care Homes for Adults (18-65 years) Page 5 of 30 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 visit was carried out over a period of one day. We arrived at the home at 10:30 at and left at 19:50, the site visit was a total of 9 hours and 20 minutes. We looked at many areas of the service including bedrooms. People who lived in the home and their relatives were offered the opportunity at the visit to discuss their opinion of the care and support provided. On this occasion we spoke with seven people who live in the home, seven members of staff, three relatives and the deputy manager. Additionally questionnaires were sent to people who live in the home and staff. The service told us that these had been completed and returned to us. However we are unable to include reference to this surveys in this report as replies to our surveys were not available. The service was sent an Annual Quality Assurance Assessment known as an AQAA. This asks them to let us know how they have improved the quality of the service that they Care Homes for Adults (18-65 years) Page 6 of 30 provide in the last 12 months. A number of areas of support were reviewed and this involved us looking at records such as how the staff found out peoples needs and care plans (called ISP) that showed how the staff will meet their peoples needs. We also reviewed the health and safety arrangements to maintain safety such as managing medications and identifying and reducing any risks. Observation of how the staff provide care and support was also undertaken. We reviewed the training, support and monitoring of staff skills. Feedback was given to the deputy manager throughout the visit and at the end of the day. Additionally we spoke to the manager following the visit and were given additional information that has been included in this report. The arrangements for equality and diversity were discussed during the visit and are detailed throughout this report. Particular emphasis was placed on the methods that the staff in Freshfield Cheshire used to determine individual needs, promote independence and support to make informed decisions in line with individual choices. What the care home does well: What has improved since the last inspection? What they could do better: The service has undertaken a lot of work on a new care planning system. Staff spoken with did not think that these were useful written records. When we looked at them we noticed that they were not always fully completed, kept up to date or accurate. Examples included nursing needs that did not have specific instructions available to the staff. Records did not always help the staff to be able to support and monitor the people living in the home. Medication records were also in need of improvement in particular records for people admitted for respite care, people needing their tablets when out for the day, medications as per required need and external creams. A requirement regarding the correct storage of medications from the last site visit had not been fully addressed at Care Homes for Adults (18-65 years) Page 8 of 30 this visit. We have since been contacted by the manager who informed us that appropriate action has now been take and described additional plans that will also provide better practice regarding medications. People living in the home and staff told us that they thought that the food available could be improved. We noticed that there was no information to people who lived in the home, relatives or staff that supported people with special diets to be offered a choice of meals. Staffing files were viewed in the majority of cases proper checks had taken place before the staff member started work. In one case the staff member had not been safely recruited and the homes own policy and procedure had not been followed. 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 30 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 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who move into the home have information availiable to them that helps them decide if the home can meet their needs. Evidence: The AQAA for the service told us that, all people wishing to move into the home and their families are encouraged to visit the home. Individual assessments are carried this is done to make sure that the service can meet individual needs. People living in the home told us that they had received sufficient information to enable them to make a choice about moving into the home. One person who had recently moved to the home was case tracked. When we case track we look at the persons experience of living in the home in more detail. When we looked at the records for this person we noted that staff have access to assessment information within the record. The information provided gave a clear overview of the persons needs. Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: We looked at he information available to people living in or wishing to move into Freshfields. Each person was given a document called a service users guide, that explains the support the service provides. Discussion with the people who live in the home confirmed that they had access to this information. one person told us I dont want one in my room so its not there. The deputy manager told us that most people are known to the service as often they have been staying at the home for respite care. The service also has an on-site day centre that provides support. People who access the daycare often also access the service for respite as well. The majority of people living permanently or for a short time in the home are aware of the services that Freshfields provides before they move in. A relative told us I Knew all about Freshfields before (their relative) moved in. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home feel in charge of their lives and are actively encouraged to make the home their own. Evidence: We spoke to people living in the home as to how they were included in the records that the staff kept about them. The service has care records called ISP (Individual Service Plan), this is meant to detail to staff the support that they need to provide. People spoken with confirmed that they are regularly consulted about the care that they recieve and that they have been shown the documents. One person told us that the staff come and discuss my ISP with me. I have been involved in helping them write it. The AQAA for the service told us that Individual Service Plans (ISP) are developed for all residents. The ISP is based on the social model but includes health and nursing needs. We looked at four records of care. Three of the peoples plan we looked at had Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: a nursing need. In one case the plan to meet that need did not reflect what actions the staff were taking. In another there was no plan in place that described how a need was to be monitored or what nursing interventions were needed We spoke to staff about their point of view of the ISP in place. All told us that they did not find it helped them to support the people living in the home. Comments included cumbersome, not user friendly and a load of red tape. Staff told us that they did not read the plans as they were far too big. Staff need clear, accessiable and up to date instructions on how to support people. We spoke to people as to how they were supported to make decisions. The service has a commitee for the people who live in the home. One person on the commitee told us that they meet regularly with the manager and discuss different aspects of the service they recieve. These discussions are minuted and the minutes are shared with all the people living in the home. This action supports people living in Freshfeilds Leonard Cheshire to discuss their ideas and provides them with information as to how these ideas are actioned in the home. Care Homes for Adults (18-65 years) Page 14 of 30 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 majority of people living in the home are offered a lifestyle in keeping with their individual choices. Evidence: All people living in the home spoken with during the visits agreed that there is a good variety of activities on offer. The AQAA for the home told us that The Activities Organiser is full time and he arranges for residents to go out on trips, pub lunches, shopping etc and he also arranges in house activities. Records viewed showed that people living in the home take part in a variety of activities inside and outside the home. A day centre is run from the same site as Freshfields Cheshire, which has its own staff team. The deputy manager and staff told us that people living in the home can go and do any of the activities happening in the day centre if they want. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: We where shown a large room that has a portion set aside for computer usage. Two of these computers are dedicated for two people as they have a number of special adaptations such as a raised keyboard. We spoke to three people who use the computers. One said its great I can surf the net whenever I want. Staff from Hugh Baird College visit the home once a week to provide training to people living in the home. Menus were viewed within the home and a mealtime was observed. A calm atmosphere had been promoted and staff had made sure that the dining room was equipped with condiments etc and presented nicely. Staff provided support in a dignified manner. We spoke to people in the home regarding their opinions of the food. These varied one person told us, the food is very nice another told us I buy a lot of my own food as I dont like the way they cook. There was a menu board available in the main dining area that detailed what choices of meal were available that day. The menu board did not identify the choices for special diets such as a diabetic diet or softer diets. Further examination showed that there were limited options for people needing a softer diet. Touring the environment showed that several people had fridges, microwaves and tea/coffee making facilities in their rooms. Throughout the building there are separate opportunities to obtain snacks, do some cooking and make hot drinks. Visitors told us its a bit like going and visiting them in their own house. After all when I visited (their relative) at home I didnt have to wait for staff I just made us both a drink. Observations over the day showed that people living in the home were supported to maintain relationships with their relatives. A variety of relatives visited during the day and either spent time in the home with their family members or went outside the home. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are given personal support in line with their individual preferences. Evidence: The AQAA from the home told us that, Key workers and Residents work together to identify personal support needs and this is then documented within their ISP files. We looked at four peoples care records, three of these had nursing care needs of which there were no up to date instructions or care plan to inform staff as to how to meet an assessed nursing need. Discussions with staff showed that they had appropriately contacted external professionals such as doctors, dieticians and tissue viability nurses when needed. Nursing staff spoken with were able to describe with knowledge how they meet individual healthcare needs. Other staff spoken with were also aware of medical needs such as a diagnosis of diabetes for individuals. People living in Freshfield Cheshire were confident that any healthcare need would be dealt with appropriately. They told us, I am always supported to go to any medical appointments. Often a member of staff comes with me, I have needed an ambulance Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: and one was here in minutes, the nursing staff are very good. I have lived here so long they know if Im a bit of colour and call the doctor and If I need a doctor I get one. Its never a problem. We looked at how the home managed medications. The majority of medicines were evidenced as being given in the correct manner to people living in the home. There were two cases in which medications could not be fully accounted for. As an example one person had seven too few tablets availiable and another had twelve tablets that could not be accounted for. In both cases records showed that the people had received their medications at the times they should. Some of the medications available in the home were not stored at the correct temperature. The manager told us after the visit that this had now been addressed. There were minor issues with some documentation particularly were staff had handwritten medications into medication records, carrying forward medications left over from the previous month and instructions for as needed medications. The service has made available medicine cabinets to go into each persons bedroom in order to support them to take their medications more independently and reduce any potential inaccuracies. The home is registered to provide nursing support between the ages of 18 and 65. The statement of purpose for the service made clear that people will still be supported after the age of 65. The service has been able to respond appropriately to the changing needs of people it supports an example includes a person living in the home needs had changed to nursing. Staff were able to make sure that they consulted with social services in order that Freshfield Cheshire Homes staff were able to provide the correct nursing support. Care Homes for Adults (18-65 years) Page 18 of 30 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. People living in the home are aware of how to raise any concerns they have and have confidence that these will addressed. Evidence: The AQAA from the home told us that, Freshfields has a detailed complaints procedure in place. All residents are given a copy of Have your say, Leonard Cheshires procedure on how to make suggestions or complain. All complaints are dealt with appropriately and outcomes recorded. We spoke to people living in the home who told us, if there is a problem I can ask a member of staff to sort it out and it gets done. If they could not Im sure that they would speak to (manager or deputy manager) and I bet it would be fixed, Ive never had an issue with the home but if I did Im sure that they would address it promptlyand I would tell the staff if it was really bothering me and I wanted it fixing quickly I would go to the office. People living in the home also confirmed that they had access to a written copy of the homes complaints policy and this is included in the service users guide given to them when they move in. There has been one allegation of potential abuse raised in the service in the last 12 months. The service had dealt with this in the appropriate manner and reported it to social services in accordance with their policies and procedures. Staff spoken with us told us that they had received training in the protection of vulnerable adults but were Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: not aware of the policy from social services. Records of training showed that staff receive training in recognising potential abuse. This training is also included as part of the staff members initial training when they start work in the service known as induction training. All staff spoken with told us that they would report and potential allegations of abuse to whomever was in charge of the Freshfields Cheshire at the time in order to maintain the safety of the people they support. Care Homes for Adults (18-65 years) Page 20 of 30 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. Fairfield Cheshire is a warm and welcoming environment that is adapted to meet the needs of the people who live there. Evidence: We looked at the building and noticed that Freshfield Cheshire had a number of areas available to people who live in the home to spend their time in. This includes activities areas for crafts, quiet lounge areas with television or radio, computer area that can also be used for large events, dining area and individual bedrooms adapted to peoples personal needs. Staff told us that they thought this was very useful and helped the residents do lots of different things. The service had large spacious, well-maintained gardens that are furnished with wooden garden furniture. Some of the people living in the home had access from their bedrooms to the garden. People living in the home told us that I have everything I need in my bedroom and its my personal space and I can have it how I like it. I choose the colours and how it was too look. Bedrooms looked at had a variety of equipment to help people maintain their independence, such as moving and handling equipment that they can control themselves. Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: The AQAA for the home told us Specialised equipment is purchased as required i.e. electrically controlled profiling beds, specialised shower chairs, etc. When we looked around Fairfield Cheshire we noticed that the service provides a variety of aids and adaptations to meet peoples needs. These include walk in showers, specialist baths, handrails, hoists and lowered work surfaces. All bedrooms are fitted with a call system. Records examined on the day of the visit evidenced that a fire safety, moving equipment and emergency lighting is checked regularly and well maintained. Records that showed if the call system was regularly checked were not available. Freshfield Cheshires main kitchen is situated close to the dining area. There is a smaller kitchen also close to the dining room this has recently been refurbished. This is equipped with facilities to enable people living in the home to prepare drinks and snacks. There are also other hot drink and snack facilities available in the home. Care Homes for Adults (18-65 years) Page 22 of 30 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. Staff are given the opportunity and training to develop the skills they need to care and support for the people who live in Freshfield Cheshire. Evidence: The AQAA for the home told us Residents are involved in the recruitment and selection of staff and volunteers. All new staff are given supernumerary shifts. Staff told us that all new staff are offered the chance to work and not be counted as staff for a few days. They thought this was a good idea as it helped them understand how the home worked and to be monitored for their ability. We looked at staff files and noticed that all had received the proper checks before they started. Changes to recruitment that include checking if staff have been referred to the protection of vulnerable adults list (kept by the government for staff not suitable to work in care homes) have been done for all new staff. The staff files were well organised and showed evidence that all new staff had received a proper induction. All but one of the staff files showed that all staff had the proper checks before they start working. One staff file had one reference available instead of two and the police check had not been received befote they started working. The Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: policy for the home is that all staff had two references one of which is from the previous employer in place before they start work and that staff receive constant supervision until the police check is received. We spoke to the people living in the home about the staff. All were complimentary comments included, absolutely fantastic, can not fault the staff, they are very kind and supportive, some are better than others but not everyone can be good at their job and there is always lots of staff about who look after us really well. Staff said that in general they thought there was enough staff. The staff told us that the only difficult time was mealtimes when a lot of people needed to be supported to eat and that meant that some people had to wait a bit. Staff told us that they thought they had excellent training and were always encouraged to take part in the training. They thought that the training when they start work was particularly useful. Records in the home showed that staff were kept up to date with health and safety training such as fire safety and moving and handling. They are also given other training such as national vocational qualifications in care (a qualification for staff already doing the job and specific to their job role), adult protection and infection control as examples. Care Homes for Adults (18-65 years) Page 24 of 30 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. People who live in the homes points of view are used to influence the service available. Evidence: The AQAA from the service told us, We produce our own Self Assessment Report of the home which involves asking for input from residents, staff, volunteers and other stake holders. The report is available for anyone to read. The service supports people living in the home to hold their own meetings and to influence the running of the service. Minutes of these are available to all the people living in the home. People living in the home told us that, staff are excellent, I am happy living here, the office staff are very helpful and its a good place to live in. Freshfield Cheshire has completed an external quality assurance award known as Investors in People. They also undertake their own health and safety audits and send out questionnaires to people who live in the home, their relatives and staff to find out what they think of the service. We were told that regular audits are done on areas Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: such as medications. One audit was shown to us that identified some issues within the homes in Leonard Cheshire. At this visit we noted that the areas identified such as records and secondary dispensing (were medications are put into another medicine bottle by staff in the home as an example) had not yet been addressed. The service has plans that are intended to resolve these identified areas. The manager is registered with us and has worked as the manager for several years. There was one requirement made at the last visit that was not resolved at this visit. The manager informed us following the visit that this has now been resolved and they have further plans to put into place good practice. The service has health and safety training for staff and holds regular meetings on how to recognise and resolve any health and safety issues identified. Training records showed that staff receive health and training and this is monitored to help keep staff up to date. There are a variety of policies and procedures availiable in the home. These provide staff with guidance on what is best practice. Care Homes for Adults (18-65 years) Page 26 of 30 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 30 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 1 6 Plans need to be in place that are accurate, up to date and inform staff of how to meet peoples individual needs. Consideration needs to be made to simplfying the process that is complicated and staff find difficult to use. Additionally daily records are not following NMC (nursing and midwifery council) guidelines on records and record keeping and would benefit from following this best practice guidance. Menus need to relect and offer a choice to people who need a special diet. The service needs to include up to date instructions to staff about the nursing support that they need to have. Handwritten medications need to have all the same details on them as the label on the medications. It is good practice to have these double checked in order to make sure that they are correct. Medications remaining from the previous month needs to be recorded in order that medications can be properly audited. Required need medications and creams need clear instructions available as to when to use. The service needs to investigate the discrepancies in the amount of medications noted at this visit. Review the staffing files and make sure that they comply Page 28 of 30 2 3 4 17 18 21 5 34 Care Homes for Adults (18-65 years) with CRB guidance and the homes own policy and procedure. Care Homes for Adults (18-65 years) Page 29 of 30 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. 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