Care Home: Grandsmere Place

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What the care home does well Peoples needs are assessed before moving into the home and they are given written information about the services and facilities provided. People living at the home are involved in planning their care and there is good information about how people should be supported. People are supported to take reasonable risks so that they can lead as independent a lifestyle as possible. People living at the home make lots of choices about their everyday lives and lead fulfilling and active lives. People living at the home are happy with the care they receive. Support is given to help people to maintain links with family and friends. A healthy and balanced diet is available. People are supported to keep healthy and attend health care appointments when necessary. The home deals with people` s medication well. People know how to make a complaint and say that staff listen to what they have to say. The home has a caring and competent staff team that get on well with the people who live there. The home is clean and comfortable, and people like living there. The home is well managed by an approachable and experienced manager. People are protected from harm. What has improved since the last inspection? People living at the home are more involved in domestic tasks. Each person has had an OK health check with the nurse from the local GP practice, so that general health can be monitored and a health action plan put in place. The kitchen has been refitted, a dishwasher installed, redecorated and new flooring put down. Reinforced glazing has been fitted to the windows to avoid further damage caused by vandalism. It is over a year since the last incident of vandalism took place. 50% of the care staff are qualified to NVQ level 2. Plans are in place for the remaining % of care staff to complete this qualification. This will ensure that people continue to be supported by suitably qualified and competent staff. What the care home could do better: No requirements or recommendations have been made following this key inspection. Key inspection report Care homes for adults (18-65 years) Name: Address: Grandsmere Place 1/1a Grandsmere Place Manor Heath Halifax West Yorkshire HX3 0DP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Alison McCabe     Date: 1 6 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Grandsmere Place 1/1a Grandsmere Place Manor Heath Halifax West Yorkshire HX3 0DP 01422381775 None lmacdonald@bridgewoodtrust.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Bridgewood Trust Limited care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Grandsmere Place is owned and managed by the Bridgewood Trust, which is an organisation which specialises in providing care for adults with a learning disability, in both the Calderdale and Kirklees areas. The establishment is registered to provide accommodation and care for up to seven people. At the time of the visit there were five young men in residence. The property, a large Victorian end of terrace, is well maintained both internally and externally and provides accommodation in well furnished single bedrooms with spacious and comfortable communal areas. The accommodation is arranged over three floors, with a self contained flat being situated on the ground floor. The home is situated in a residential area with easy access to the town centre of Halifax. The weekly charge is subject to individual assessment depending on the amount of care and support needed. 7 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 27 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 two star. This means the people who use this service experience good quality outcomes. This report refers to an inspection, which included an unannounced visit by one inspector on 16/9/09, commencing at 1:30 PM, and the length of the inspection was 4 hours 45 minutes. The last key inspection on the service was completed on 13/9/07. There were five people living at the home on the day of the visit. As part of the inspection in order to provide information to help us form judgments about the quality of the service, the manager was asked to complete an annual quality assessment (AQAA) document. To enable people who use the service to comment on the care it provides, we sent Care Homes for Adults (18-65 years) Page 5 of 27 surveys to seven people living at the home, four of which were returned, ten to staff, three were returned, and five to other professionals involved with people living at the home, none of which were returned. All the responses and comments received were positive and indicate a good service continues to be offered at Grandsmere place. Some of the comments received include: We have a good staff team at Grandsmere headed by an excellent manager. I have worked here for almost 10 years and feel that we treat all our client as individuals and make Grandsmere as pleasant and homely a place as we can for them to live in. We try to ensure that all our clients eat good healthy meals, have their say in menu planning, have input regarding any new interior decorations etc. The annual holiday is chosen by the clients themselves, and we try to involve them in as many activities as possible e.g. swimming, sports, disco, outings etc. I find Grandsmere to be well run and managed, the staff team work well together, my training has been of the highest standard I hope to continue to work at Grandsmere for a long time. We treat the residents as individuals, involving them in decision-making, day-to-day running of the home and give them choices. During the week I am at my placements so I do what I have to do there. At the weekends, as long as I let somebody know where Im going, I am free to travel anywhere I want to, e.g. visit friends, family, places of interest. I enjoy bell ringing at weddings and visiting churches with friends. We focused on the key standards and what the outcomes are for people living in the home, as well as matters that were raised at the last inspection. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Adults (18-65 years) Page 6 of 27 What the care home does well: What has improved since the last inspection? People living at the home are more involved in domestic tasks. Each person has had an OK health check with the nurse from the local GP practice, so that general health can be monitored and a health action plan put in place. The kitchen has been refitted, a dishwasher installed, redecorated and new flooring put down. Reinforced glazing has been fitted to the windows to avoid further damage caused by vandalism. It is over a year since the last incident of vandalism took place. 50 of the care staff are qualified to NVQ level 2. Plans are in place for the remaining Care Homes for Adults (18-65 years) Page 7 of 27 50 of care staff to complete this qualification. This will ensure that people continue to be supported by suitably qualified and competent staff. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 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 are assessed prior to them moving into the home to ensure that their needs can be met. Evidence: The AQAA states that there have been no new admissions in the last 12 months. It states that before people move in they would have a full assessment by social services, and that their views, those of their family and Bridgewood Trust staff would be taken into account. Compatibility of people living at the home and the ability of the Trust to meet identified needs is reported in the AQAA as being very important. The AQAA states that visits and overnight stays are offered and that once funding is agreed a three month trial period is offered. Records for two people were looked at and each had an individual assessment, including a Care Management Assessment. Care Homes for Adults (18-65 years) Page 10 of 27 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 are involved in the care planning process, are supported to take reasonable risks as part of an independent lifestyle, and make choices about their lives. Evidence: Two care plans were seen, and both had detailed information about how individuals needs should be met. There was evidence in the records to show that the care plan had been agreed with the individual and they had signed to this effect. Daily records provided evidence that care plans were being implemented as agreed, and people spoken to at the time of the visit confirmed that this was the case. There was evidence that care plans are reviewed and six monthly review meetings take place where people are encouraged to invite family and care professionals involved with them. Minutes of these meetings were in the records. Individuals are supported to make decisions about their lives. For example, how to spend their time, what to spend their money on, what to eat etc. Examples of this Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: were seen during the visit and people spoken to confirmed this. The AQAA states the service users are supported to make choices and have a say in the running of their home. Residents meetings are held regularly and minutes of these meetings are kept. Four surveys have been returned from people living at the home. Two said that they always make decisions about what they would like to do each day and two said they sometimes make these decisions. All four indicated that they can do what they want during the day, evening and at the weekend. Detailed risk assessments had been completed for a range of identified risks relating to individuals, and these are regularly reviewed. These provided evidence that people are supported to take reasonable risks as part of an independent lifestyle. Two of the risk assessments examined needed further clarification about what steps should be taken to minimise the identified risks. This was discussed with the manager at the time of the visit and she agreed to address this matter as soon as possible. One risk assessment described restrictions on an individuals choice and freedom. The home manager was able to explain a clear rationale for these restrictions, however it was not clear from the records who had been consulted or that the individual had agreed to these restrictions. The manager agreed to clarify this further in the records. Care Homes for Adults (18-65 years) Page 12 of 27 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. People living at the home lead active and fulfilling lifestyles, are provided with support to maintain relationships with family and friends and have a healthy and balanced diet. Evidence: People take part in a wide range of meaningful activities during the day, evenings and at weekends. One person has no formal day placement however the manager explained that the Bridgewood Trust was in the process of arranging the necessary support and funding for this person. Only one person living at the home requires support to go out into the community. A vehicle is available for the homes use, which everybody contributes towards the cost of. The home manager explained that people are encouraged to use public transport; the Bridgewood Trust covers the cost of this. During the inspection visit people were observed to come and go from the house freely to participate in a range of activities. Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: Everybody living at the home has contact with their families, and there was evidence in the records that people are supported to keep in touch with family and friends. An individual was observed to use the house telephone to speak to his family and the manager reported that the necessary support is given to people to visit their families and friends. Evidence of this was seen in the records and people spoken to confirmed this. The daily routines and house rules promote independence, individual choice and freedom of movement. Staff were observed to enter bedrooms and bathrooms only with individuals permission and everybody is offered a key to their bedroom and the front door, which most people have. People were observed to choose whether to spend time alone or in communal areas of the home. Interactions between staff and people living at the home were respectful and inclusive. The home manager said that a support worker was responsible for planning the menus with input from the people living at the home. Healthy eating is encouraged and evidence of this was seen in the records and confirmed by the people living at the home. The manager said that staff usually cook the evening meal and that although several of the people living at the home are capable of cooking with support, often they are reluctant to get involved. A semi-independent flat is on the ground floor of the building. The manager reported that the people living in the flat do some of their own shopping and cooking. People spoken to said that they had a choice of meals and that they enjoyed the food provided. Most people prepare their own breakfast and lunch. Care Homes for Adults (18-65 years) Page 14 of 27 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. Peoples health and personal care needs are well met. The home deals with peoples medication well. Evidence: The AQAA indicates that everybody has a personal support plan saying how and when support is to be given. These were seen in the files looked at and were clear, detailed and current. Times for getting up, going to bed, meals, baths and other activities are flexible, and there was evidence in the records, and through discussion with the manager and people living at the home, that sensitive guidance and support is offered. Evidence of this was observed at the time of the visit. People receive specialist support and advice as needed from psychologists, psychiatric services, social workers, community nurse etc, and this was recorded in the records and confirmed by the manager. Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: The AQAA states that full health checks are completed and people are registered with a GP, optician etc. An OK health check was in place for everybody and from this information health action plans had been developed. People spoken to confirmed this and said they were supported to attend health care appointments. Each persons file has a healthcare section and the records showed that health and welfare are monitored. Weight is monitored, and detailed records are kept of appointments attended, any changes in peoples health needs and any significant events. Medication systems were looked at. All medicines tallied with the records kept. The home uses a monitored dose system, and all staff have received medication administration training from both external and internal trainers. Each member of staff is assessed annually to check competence in this area. Evidence of this was seen in staff training records. Clear guidance was in place in files looked at describing in detail under what circumstances an individual should be given an as required medication. A copy of this was also kept in the medication folder. Additionally, detailed information is in place in each persons file and the medication records about the medicines they are taking, including: what they are taking it for, side effects, the protocol to follow in the event of a dose being missed, the start date of the medication, review date, dose, and the form the medicine comes in. Nobody at the home is currently self-medicating, however steps are being taken to support an individual with this. The manager explained that a self medication assessment would be completed with the individual to establish whether they can safely administer their own medication with appropriate support. Medication was stored securely and at the correct temperature. There are good procedures in place for auditing medication. A list of staff responsible for administering medication is kept in the medication folder, along with the signature they would use on the medication administration record (MAR) . Care Homes for Adults (18-65 years) Page 16 of 27 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 at the home can be confident that their complaints will be listened to, taken seriously and acted upon. People are protected from abuse. Evidence: Information from the surveys and discussion confirmed that people know who to talk to if they are not happy, and how to make a complaint. Individuals have a copy of the complaints procedure, in easy read format. The AQAA states that no complaints have been received in the last twelve months, and this was confirmed in the complaints log. Clear procedures are in place about how to safeguard vulnerable adults. The home manager was clear about her responsibilities to refer any allegations of abuse to the local authority, and contact details about who to contact were displayed on the staff notice board. All staff have received training in the protection of vulnerable adults and evidence of this was seen in the staff training records. All staff who completed a survey said that they knew what to do if they had concerns about the home. The AQAA states that since the last inspection visit no safeguarding referrals or investigations have been conducted. Notifications received from the home in the last 12 months indicate that two incidents occurred that may have been safeguarding matters . This was discussed with the manager at the time of the inspection visit and she clarified that upon the advice of the safeguarding lead officer from the local authority neither the matter had been referred. Care Homes for Adults (18-65 years) Page 17 of 27 Evidence: Care Homes for Adults (18-65 years) Page 18 of 27 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. Grandsmere place offers people a homely, comfortable and clean environment. Evidence: Grandsmere place provides comfortable, homely accommodation. As part of the inspection visit, a tour of most parts of the premises took place, with the assistance of two of the people living at the home. All areas seen were clean and hygienic. Since the last inspection visit the domestic assistant has resigned. The manager said that an advert had been placed locally to replace her. Staff and people living at the home are therefore taking responsibility for all housekeeping in the interim. The AQAA stated that the kitchen has been completely refitted in the last 12 months, a dishwasher installed, redecoration and new flooring. The new kitchen looked clean and fresh and people living at the home reported being pleased with the new look. Due to a spate of vandalism in March and April of 2008, reinforced windows have been fitted to the home. The manager reported that there have been no further incidents of damage being caused. People living at the home who completed a survey said that the home is always clean and fresh. The home was free from offensive odours. Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: Care Homes for Adults (18-65 years) Page 20 of 27 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. People are supported by a competent and caring staff team. Robust recruitment procedures protect the people living at the home. Evidence: Staff were observed to have positive, respectful relationships with people living at the home. All those who completed surveys and spoken to described having good relationships with the staff. The duty rotas and staff training files were inspected and there was evidence to suggest that the staffing levels and skill mix were sufficient to meet the number and needs of people living at the home. Including the manager, five staff work at the home. During the week there are two staff on duty every afternoon from 3 PM to 9 PM, one staff member sleeps in, and one staff member is on duty from 7 AM to 9:30 AM. The manager said that at weekends depending how many people are at the home one or two staff members are on duty. The home manager explained that if people were not attending day services for any reason, staff support would be provided during the day. A number of people do not require staff supervision in the home at all times. Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: Three staff completed surveys as part of of this inspection, and all stated that there are usually enough staff on duty to meet the individual needs of the people who live at the home and they had enough support, experience and knowledge to meet the different needs of the people living at the home. Of four care staff, two have NVQ 2 or above in care, one is registered to commence training on the next intake and one is still in the process of completing the Learning Disability Qualification induction programme. Staff training records showed that staff had also received training in fire safety, infection control, first aid, medication, food hygiene, risk assessments, mental capacity act, adult protection and physical intervention. Clear records are kept of training that has been received and training that is required. All staff receive induction training and each has an individual training plan. Recruitment records for all staff were examined. These were well organised and clear. Each had a completed application form, two satisfactory references, (CRB) Criminal Records Bureau check and evidence of an interview. Recruitment policies and procedures are robust and if followed correctly will ensure that the right people are employed for the job and people living at the home are protected. People living at the home said that they are involved in the recruitment of new staff, and have an opportunity to meet candidates, ask them questions and give their views and impressions to the manager. Care Homes for Adults (18-65 years) Page 22 of 27 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 home is well managed by an experienced, competent manager. The health, safety and welfare of people who live at the home are protected. Evidence: The manager has worked at the home for many years. She is in the process of completing the Registered Managers Award and NVQ level 4 in care and reported that she expects to complete this in November 2009. The manager has completed a number of training courses relevant to her role, including, fire safety, safeguarding adults, first aid, challenging behaviour, food hygiene, medication management, mental capacity act and health and safety. The manager presented as organised and competent . People living at the home reported that she is approachable and supportive. Staff who completed surveys told us the home is well managed, and some of the comments include: in my opinion the home is well run in all aspects, with a strong staff team and manager, with a very good understanding of all the residents needs; the home staff and manager have Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: regular meetings to ensure the home is run to the highest standards and discuss if there are any areas that may need improvement; we have a good staff team at Grandsmere headed by an excellent manager; Grandsmere is well managed and a professional place to work, respecting the dignity of the residents. The team is friendly and hard-working. As part of the inspection in order to provide information to help us form judgments about the quality of the service, the manager was asked to complete an annual quality assessment (AQAA) document. This she did, and the document provided the Care Quality Commission (CQC) with a lot of information about the way the home is run, and what they hope to achieve in the future. The AQAA tells us that quality assurance systems are in place at the home and internal audits take place at least twice yearly. Feedback is always sought from people living at the home and their family and friends. Evidence of this was seen in the records, and people spoken to confirmed this. The AQAA indicates that health and safety checks are carried out at the required intervals, and evidence of this was seen in the records. Health and safety policies and procedures are in place and staff are expected to read and sign the policies and procedures every six months; records showed that this had been done. No concerns around safe working practices were seen on the day of the inspection. Care Homes for Adults (18-65 years) Page 24 of 27 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 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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