Care Home: Garden House

What the care home does well Residents benefit from living in a well run service. It is run in their best interests and their views matter. Residents are involved in numerous projects and forums and are invited to join in the recruitment of support staff. Staff have a very good understanding of the residents` needs and quickly recognise individual personal achievements. A staff member explained the progress made by a resident; we heard how the resident is now confident in going out in the community after many years of not engaging in community activities. The stable staff team provides continuity and consistency, and gives reassurance to residents. Residents are enabled to achieve their goals and develop confidence and selfesteem. The environment is sensitive and supportive. People living at the service feel included and valued as individuals, comments such as this are representative of comments from residents, "I enjoy going out but I love coming back home too, staff always make me welcome". Residents benefit from the support received and lead full and meaningful lives What has improved since the last inspection? All new residents receive written confirmation that the home is able to and can meet their assessed need. Inventories are also made of all property brought to the home. Information is available on prescribed medication so that for staff to consult and explaining the effect of the medication. Copies of the complaints procedures are made available to residents and friends also any relatives that require them. What the care home could do better: The service has an effective quality assurance process in place that recognizes and plans for continuous improvements in the service. This should enable the home retain the excellent service. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Garden House 127, Friary Road London SE15 5UW three star excellent service The quality rating for this care home is: 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: Mary Magee Date: 1 5 0 1 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. They reflect the things that people have said are important to them: 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. 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. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Garden House 127, Friary Road London SE15 5UW 02077320208 02072776043 kevin.parkes@lcdisability.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Leonard Cheshire Disability Name of registered manager (if applicable) Mr Kevin Parkes Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 10 0 care home 10 learning disability Additional conditions: 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: Learning disability - Code LD The maximum number of service users who can be accommodated is: 10 Date of last inspection 3 0 0 1 2 0 0 7 A bit about the care home Garden House is registered to provide care and accommodation for ten people with learning disabilities. The home is located in a residential street in Peckham close to public transport routes. The home is managed by Leonard Cheshire - South East London Learning Disability Homes, and the building is owned by a housing association. 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 How we did our inspection: This is what the inspector did when they were at the care home One inspector completed this key unannounced inspection over two days. We met with the registered manager, the senior support worker, and three key workers. Throughout the visits we spoke with all nine residents. Prior to the inspection we received the information requested in the AQAA. Residents were assisted with completing surveys, seven surveys were received. Case tracking was used to evaluate the service provision. We examined personnel records for residents and staff members, other records relating to individual support plans were also viewed. What the care home does well Residents benefit from living in a well run service. It is run in their best interests and their views matter. Residents are involved in numerous projects and forums and are invited to join in the recruitment of support staff. Staff have a very good understanding of the residents needs and quickly recognise individual personal achievements. A staff member explained the progress made by a resident; we heard how the resident is now confident in going out in the community after many years of not engaging in community activities. The stable staff team provides continuity and consistency, and gives reassurance to residents. Residents are enabled to achieve their goals and develop confidence and self esteem. The environment is sensitive and supportive. People living at the service feel included and valued as individuals, comments such as this are representative of comments from residents, I enjoy going out but I love coming back home too, staff always make me welcome. Residents benefit from the support received and lead full and meaningful lives What has got better from the last inspection What the care home could do better The service has an effective quality assurance process in place that recognizes and plans for continuous improvements in the service. This should enable the home retain the excellent service. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Mary Magee 33 Greycoat Street London SW1P 2QF 02079792000 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 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 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home has excellent admission arrangements with each individual given the opportunity to sample life at the home before they decide to move in. No resident is offered a place unless the service is confident that it has the capacity and is suitable to meet the person’s needs. Evidence: The service has produced a new brochure outlining the services on offer. The guide is available in picture form that is accessible to all residents. We viewed the admission process and found evidence of the assessments always completed first. The person most recently admitted came to the home prior to admission, and had spent time there meeting residents and staff before she moved in permanently. She had her needs fully assessed by senior staff. She was consulted about the areas where she needs support, also on her likes dislikes and social history, communication methods. This information is recorded and held with personal support plans. We saw on other files viewed too details of pre admission assessments. Prior to admission the resident is encouraged to be involved in choosing her key worker. By the time of admission they are then familiar with many people in this community. A letter is sent from the home to the prospective resident to confirm that the home usable to meet all the support needs. Copies are held on care file. We found that every effort is made to support individuals in testing out the services and become acquainted with residents and staff first. A placement review is carried out after 8 weeks, at this time is considered if the home is meeting the needs of the new service user. Prospective residents visiting the home make the decision if the home is suitable and Evidence: able to meet their needs. Residents also have the support of an advocacy worker who assists with the admission and maintains links thereafter. The home demonstrates that it is meeting the needs of all those living at the home. There is consistency in the management and staff team. The home has a skilled and experienced diverse staff team that receive a good training and development programme. We found that all eight residents spoken to are very happy with service in their home, the rapport is good among individuals and there is an inclusive feel. Individuals were observed to be completely involved in pursuing activities and hobbies they like. They lead busy and meaningful lifestyles. Each resident is issued with a contract. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living at the home are consulted on and participate in all aspects of life in the home. The service has excellent care arrangements in place to make sure that individuals receive the necessary support to achieve personal goals. Staff respect individuals rights to make decisions and provide the assistance required to do so. Evidence: The home develops support plans for each resident. These are recorded in person centred plans. We used case tracking to evaluate the care arrangements for two residents. One was more recently admitted. The home use a person centred approach. Initial care and support plans are developed from the needs assessment. All areas of support are considered including health care. In house reviews are undertaken every six months with residents. All plans are reviewed and updated to reflect changes. The review is thorough and covers any changes to support from staff within the team or in the community. Individuals are supported with communication needs, pictorial guides and objects of reference are available for those that require them. One of the non verbal residents was present during our visit; we observed how at ease she appeared when interacting with staff, and how her communication means are fully understood by staff. The manager and staff team at all levels have a good understanding of risk assessment processes which is underpinned by promoting independence, choice and autonomy. Risks are identified at the pre admission assessment and reviewed six monthly or as change occurs. We found that people are supported to lead meaningful lives in the safest way possible without placing too many limitations. Evidence: The service considers all areas where risks are identified and have plans in place to minimize and manage the risks appropriately. The risks range from those associated with emotional and challenging difficulties to environmental factors. The home promotes user participation. Residents are actively encouraged to be involved in recruitment and selection of staff. At recent interviews the resident developed her own question to ask. The residents are involved with a communication group. This is facilitated by the regions communication officer and the service user support team link person. We viewed the methods used to support individuals manage their money. The procedures are good, receipts are in place and records are held of each transaction. We observed how residents are enabled to use their money for purchasing items, also provision for savings accounts. The home has plans to refine this area further and have more consultation with residents on finance management. The home is good at working together with residents and enabling them set goals and objectives. Daily records are maintained of each persons progress. This are quite detailed and records information appropriately, and this reflects if relevant support plans are followed. Monitoring reports are completed monthly for each resident showing the progress and participation in events. The service has introduced a more professional approach to record keeping. Staff record with greater detail the observations made of each residents well being. The residents participate in all aspects of life at the home. We observed residents completing the usual household tasks setting tables, and washing up, and doing personal laundry chores. Residents confirm with us that they have input into the running of the home. We observed this during both visits. Individuals also feel more empowered through attending monthly residents meetings. The meetings are used to discuss issues of general concern with residents and act as a forum for residents to raise their own issues. In addition to the in house consultation systems Leonard Cheshire Foundation has a Service Users Support Association and details of how to contact representatives are available in the home. 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 service is committed to enabling and supporting residents develop and maintain their skills, including social, emotional, communication, and independent living skills. Individuals are supported to identify their goals, and work to achieving them. Evidence: The service respects the human rights of people using the service with fairness, equality, dignity, respect and autonomy underpins the care and support being provided. The staff team help with communication skills, both within the service and in the community, to enable residents to fully participate in daily living activities. Residents are involved in meaningful daytime activities of their own choice and according to their individual interests, diverse needs and capabilities. They are fully involved in the planning of their lifestyle and quality of life. Where appropriate, education and occupational opportunities are encouraged, supported and promoted. As part of the support arrangements activity planners are developed with each resident. Copies of these are held in each residents room. Picture formats are used describing activity plans making sure that information is accessible to all. Residents choose activities that they enjoy and find stimulating. The home promotes community participation with an increase in those engaging in the local community events. A number pursue educational classes and attend college. Others continue to develop independent living skills in the home by having responsibility for household chores. Evidence: Much progress has been achieved in this area. The majority of residents attend functions and events in the community most days. Evening time too is used to socialise at local pubs and restaurants. At the home residents choose to pursue hobbies, we observed those enjoying their own style of music. A resident told of his recent trip to the theatre and of how much he enjoyed the pantomime. Other residents display in their bedrooms their devotion to football and television series. Consideration is given to assisting residents pursue hobbies and achieve their goals. We heard how a resident is supported to maintain a personal relationship with a friend outside the home. The service has handled sensitively issues in relation to death. A resident was supported through a difficult period following the loss of his mother and obtained bereavement counselling. There has been a significant increase in the quantity and range of activities which are currently under taken by residents. The service has developed a more effective system to monitor the progress made by residents in achieving chosen goals. This information assists with future planning provision. We were present for evening meals. Mealtimes were observed to be flexible and relaxed, staff are patient and helpful, and allow individuals the time they needed to finish their meal comfortably. Residents choice of food is respected; likes and dislikes are reflected in the menu. Menus are changed frequently to reflect the individual preferences. Residents enjoy eating out at local restaurants. We observed residents assisting in the kitchen in the preparation of meals. Earlier too in the day a resident took back to share with residents a cake she had baked in cookery class. 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 residents of the home receive appropriate support with managing and promoting good healthcare. The personal support arrangements for residents are good and help to maximise independence and dignity, and the ability to take control over their own lives. Medication procedures are good with residents receiving prescribed medication that is regularly reviewed. Evidence: The home radiates a sense of warmth and an inclusiveness that is tangible when visiting. People living at the home are pleased that they receive all the personal support they need in the way they prefer. We heard from residents how they feel about the service. Flexibility is experienced by residents with services tailored to suit their needs and staffing levels adjusted accordingly. The healthcare needs of residents are promoted; records clearly demonstrate that regular check ups, consultations take place with GP and nurses. The staff team are familiar with individuals needs with designated key workers that they choose. The strength of the service is the stability of the staff team, having worked together with them for some time. Communication barriers are avoided as staff members clearly understand the likes dislikes and preferences of each resident. As a result of the good relationships that exists between residents and staff any concerns or changes to individuals well being are identified promptly and responded to appropriately. Monitoring is done discreetly by staff that are skilled and experienced. We found that in discussions with staff that they are experienced at recognising any changes in temperament, or willingness to engage. The manager informed us of the procedures adopted by the provider organisation and operated at the home. Residents have the option to attend regional days to meet and network with others across the London & Kent region. In this social environment ideas develop and are incorporated into the events within the region. This has proved to be Evidence: a very successful venture. A resident has recently attended a formal Leadership Lunch, promoting the work of Leonard Cheshire Disability, and also took part in recent tender presentations with Kent County Council. Other examples of the inclusiveness of the service were seen; the residents views discussed when flu pandemic plans were being prepared. With all residents having a main key worker and shadow key workers identified to ensure there is regular contact in the week across the shift pattern. If an identified key worker is unavailable the key worker system is reviewed and adjusted to ensure support is provided. All residents have regular contact with the advocate, who has a long standing history with Garden House and as a result knows the residents very well. Records too we found are kept up to date of the support needs and the response to this, with all changes logged clearly. A gender care record is held for each resident which means that consideration is given to providing personal support from carer of choice. Residents say that they enjoy choosing and buying their own clothes. We observed that residents have hairstyles they like and frequent hairdressers locally. Throughout the visits we found that the encouragement and reassurance given by the staff has helped residents to develop confidence and self esteem. Residents are supported to manage their healthcare effectively; health action plans are developed alongside support plans with each resident. We examined two of these as part of the case tracking. Residents are registered with a local GP practice, a good relationship exists with the practice and the pharmacist. Access is also enabled to other healthcare practitioners such as dentists, opticians, counsellors. Staff aware of policies and procedures regarding accessing health care. Staff support individuals to access all professionals in the community. Care records show that any changes in residents conditions are reported and appropriate medical advice requested and followed. Good communication exists with the local pharmacist who supplies prescribed medication in a dosset box. The medication procedures we found to be good. According to observations made of procedures medication is administered at times prescribed and records are made on medication administration sheets. Medication audits are undertaken regularly to identify any area of shortfall. One resident is currently assessed as competent to self administer; the home has procedures in place to support the resident to do this safely. Information is available for staff to consult on all medication prescribed for residents. Each resident has a medication profile. According to records medication is reviewed every six months. All staff trained in medication procedures. A specific member of staff has been allocated the responsibility of ordering medication, instead of the senior support worker. The service experienced the death of a long stay resident. This was dealt with sensitively; it has provided support and assistance for residents during a bereavement experienced by all at the home. The manager has included plans to develop further with residents the support arrangements for end of life care. The service has also set out plans to encourage and support more residents to develop capacity in setting future goals to self administer medication. 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 home operates robust procedures that safeguard and protect vulnerable people from abuse or neglect. The views of people using the service are promoted and incorporated into how the home operates. An easy and accessible complaints procedure is available for residents with an open and transparent approach adopted. Evidence: Residents are familiar with the complaints procedures. A transparent process is fostered with residents confident at raising issues informally with management and staff on a day to day basis. The rapport that is witnessed between residents and staff demonstrates that individuals feel at ease in talking about any issue they are unhappy with. All receive a copy of the Leonard Chesire form, this is Have your say leaflet, this is also available in a user friendly version. Residents have a known advocate that is familiar to them for many years. During discussions we found that residents feel confident in raising issues with advocate. At annual review the advocate is attends. A monthly resident’s forum takes place giving residents a forum as a group to raise issues. Minutes of these meetings are recorded. Residents met with catering focus group to discuss likes and dislikes and any changes they would like to see in the menu. Any familiar thems are also identified as part of the annual resident’s surveys. All staff are trained in POVA /POCA as part of induction. Along with grievance, whistle blowing and complaints and concerns. We found that staff recruitment and employment procedures are robust and help to safeguard vulnerable adults from abuse or neglect. When new residents are admitted an inventory is completed recording all possessions at time of admission. There were no concerns raised since the last inspection in relation to any resident at Garden House. 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 . Residents live in a safe environment that is comfortable and homely. Ongoing refurbishment and improvements take place to keep the building in a good state of repair both internally and externally. Plans are in place to address ongoing refurbishment. Evidence: The home is well located and convenient to local shops and leisure facilities. The building includes three terraced period houses adapted and interconnected on the ground floor. The premises are owned by a housing association. The home offers spacious accommodation that meets resident’s individual and collective needs. Two lounges on the ground floor at either end o the building are comfortably furnished and provide relaxing space for residents to enjoy leisure time. The main kitchen is located off the dining room. Meals are served through a serving hatch. There are plans in place to adapt this and make a doorway through to enable wheelchair access. Ongoing refurbishment retains the premises in good condition. Records show that repairs are responded to by the housing association within reasonable timescales. All bedrooms were viewed, they were suitably furnished and comfortable and clean. A number of bedrooms were replaced. There are plans to recarpet the lounges in 2009. Residents have personalised their bedrooms with personal effects, and display hobbies and interests. The accommodation on the ground floor is wheelchair accessible. One bedroom on the ground floor is en suited. There are appropriate numbers of bathrooms and toilets located on the first floor for residents. The manager spoke of plans to convert a first floor bathroom into a shower room. How water temperatures in the bathrooms are monitored weekly to make sure they are within safe limits. The standard of hygiene maintained is good. Care is taken to monitor the temperatures of freezers and fridges and store food appropriately. Evidence: Improvements continue to be made to the rear garden so that it offers ore pleasure to residents, and is more accessible to people with mobility issues. 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 gets 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home employs a well vetted staff team that are trained and competent for their role. A consistent staff team that is skilled and experienced provides the support and stability needed by residents. Evidence: The staff team is made up of six permanent full time (37 hrs) and four part time (20)support workers. Any additional shifts during leave times are covered by these staff with little use of bank or agency staff. We found that the service successfully manages a low turnover of staff as well as low absenteeism. The service has great stability which residents appreciate, staff that are familiar with their needs are on hand to support them where needed. Each resident has a named key worker as well as a shadow key worker. Should the named key worker be absent then a member of staff that is familiar with their needs is present. Only one new staff member has joined the team in the past twelve months. The support worker referred to has moved from another service. The staff file was examined to evaluate the recruitment process for staff. Staff are fully vetted before they begin work at the home with full and satisfactory information held on file to verify this. We observed that the majority of staff have worked there for more than four years. It is recommended that new CRB Enhanced Disclosures are sought when staff are more than three years in employment. The service invests in the staff team. Training records are held that confirm all the necessary training and development is given to staff and that they are skilled and knowledgeable. We found evidence of this during discussions with individual staff members. Records were supplied of the staff training and development. The service has achieved the investors in People Award. The majority of staff have completed NVQ 2/3 training as well as ongoing communication skills and learning disability training. An induction programme is in place for all new staff. Evidence: We found evidence of how staff training needs are responded to and of the learning and development provided for staff. In the past twelve months it was identified that staff needed training that responds to changes in residents needs such as the ageing process, and dementia. This training has now been delivered to the majority of the staff team with plans for the whole team to complete this by the end of March 2009. We found records demonstrating that supervision is used effectively and staff receive the regular supervision and support required. Staffing rotas were viewed for the past twelve months. The home employs appropriate numbers of experienced staff on duty, during the morning there are four staff members, three cover the afternoon shift. At night there are two staff members both of whom sleep over at the home. The manager spoke of the resources available to support additional needs. The home has available an on call manager after eight o clock every night. 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 . Consideration is given to promoting the health and safety of residents and staff, they are protected by safe working practices. The service is well run, and in an open and transparent manner. The views of both people who use the service and staff are listened to, and valued. Evidence: There is evidence of a well run service that is growing in strength. Residents are becoming more confident and developing further independent living skills. We found the following evidence of continuous development. Practice and performance are discussed during supervision, staff training and team meetings. Quality monitoring systems provide management evidence that practice reflects the homes and organizations policies and procedures. The manager is qualified, highly competent and experienced. He displays good leadership skills which are respected by both staff and residents. Many aspects of the service operation demonstrate that the service is run in the best interests of residents. The service continues to foster an open and inclusive environment, residents say they like the caring and sensitive approach. Observations we made on both visits too confirm that staff make time to sit with and listen to residents views. Information supplied in AQAA was well detailed and informative. The service completes an annual self assessment, residents views are constantly sought through meetings and incorporated into service development. User surveys are conducted; the surveys are then analyzed by an external agency. We found that each resident has developed a personal plan with the key worker; this plan outlines goals they wish to achieve. Individuals receive the assistance and encouragement to realize potential. The service uses effective systems to self audit and manage information and statistics. Evidence: We viewed copies of Regulation 26 visit reports, management reports, training analysis, accident and incident reports. The home is maintained to safe standard, the servicing of equipment and the building takes place regularly. Hot water temperatures in bathrooms are monitored on a weekly basis. All portable appliances are tested annually. Regular testing of fire fighting equipment is done; fire evacuation takes place in accordance with fire risk assessment. Staff training in health and safety is kept up to date. The induction programme includes topics on health and safety in the workplace. Policies and procedures are reviewed and kept up to date. Record keeping is of a high standard. Records are well ordered with all the necessary information required kept filed neatly. Are there any outstanding requirements from the last inspection? Yes  No  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 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 Description 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 Description 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 34 It is recommended that new CRB Enhanced Disclosures and POVA checks are completed for staff after three years of employment. Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web:www.csci.org.uk We want people to be able to access this information. 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