Care Home: Green The (3)

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What the care home does well The home is strongly focusing on enabling people who use the service to live fulfilling and active lifestyles, the service making new and concerted efforts to secure a programme of consistent occupational and recreational activities for each individual, whilst also ensuring a comfortable and relaxed home life. Staff members handle what is sometimes a difficult and challenging job, with good humour and focus, and hold a genuine concern for the individuals who live there. The home has recently gained new senior staffing - both manager and deputy are new - and this enables the home to begin a new phase of review and consolidation of the home`s purpose and operation. What has improved since the last inspection? The home is now setting out on a new pathway, with the arrival of the new manager and deputy manager in late April 2009. Clearly, before this there was a breakdown of confidence in the management of the home and reports of the Representative of the Registered Provider proved this situation to be at a significant crisis point. It is good to report that this change in leadership is now providing the impetus for a thorough review of the approach The Green has adopted in the more recent past, and the organisation is seeking to involve people using the service in developing the home, once again, as a centre of excellence. The process of monthly and six monthly reviews for each person who lives at the home was being maintained; ensuring renewed continuity of reporting which assists managerial overviews and the annual reviews of each individual. The premises were generally being well maintained, with a replacement programme for furniture and furnishings in service user`s bedrooms in place, with a plan for future redecoration of the premises. Exposed radiator surfaces have been covered, ensuring safety at all times for people who like to reorganise or rearrange their rooms, and thermostatic valves are being renewed. Office furnishings have also been replaced or improved; this accompanying the move of the principal office accommodation from the coach house into the main building. As well as the new manager having his NVQ in Care Management at Level 4, the deputy manager has a degree in Health & Social Care and the staff group are now over 50% qualified at least to NVQ Level 2 in care, with three new-start staff undertaking their training currently. It is important that the newly reformed staff team now take the opportunity to reclaim the best practice that had been a feature of the home. What the care home could do better: The Statement of Purpose for the home and the associated Service User Guide now clearly require refreshing, with new information and to express the new management approach, and then subsequent republishing. Whilst it is acknowledged that the new manager is working on rectifying the issues, both a proper Person Centred Focused approach to care planning, and the revision of individual health action plans for each person, must be considered a priority. Risk Assessment is also an area which needs to be reviewed, brought up to date and consolidated. Key inspection report Care homes for adults (18-65 years) Name: Address: Green The (3) 3 The Green Sutton Surrey SM1 1QT     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: Sian Jordan-Jones     Date: 0 1 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 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Green The (3) 3 The Green Sutton Surrey SM1 1QT 02086419348 02086445399 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.caremanagementgroup.com Care Management Group Ltd (trading as CMG Homes Ltd) Name of registered manager (if applicable) Mr William Mallon Type of registration: Number of places registered: care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 7 The registered person may provide the following category of service only: Care Home Only (CRH - 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 Date of last inspection Brief description of the care home 3, The Green, Sutton is owned, managed and staffed by the Care Management Group Limited (CMG). The home currently provides a residential care service for up to seven male adults with learning disabilities and associated challenging behaviour / mental health problems. The home is a large detached Victorian property situated just to the north of Sutton Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 7 0 1 0 7 2 0 0 9 Brief description of the care home Town Centre, close to local and central shops, transport links and many social, commercial and educational amenities. There is limited parking on site at the front and side of the house, and on street spaces available on The Green, directly outside the house, itself. The main house has six single bedrooms, and communal space comprising a main lounge and conservatory, a separate dining room, and a kitchen. There are sufficient bathrooms and toilet facilities located throughout the home for the resident population. Across a courtyard there is a small laundry facility, a games room with pool table - and a storeroom / office, located beyond this well-used feature. Upstairs, in this coach house block, there is a bed-sitting room, which acts as a separate self-contained flatlet, used for the encouragement and development of one service users independent living skills. Care Homes for Adults (18-65 years) Page 5 of 31 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 inspection visit, which was unannounced, was conducted by the assigned inspector on an ordinary working day. We were assisted by the manager, Liam Mallon, and the deputy manager, and also a number of staff members. Documentation was examined, as were the premises, alongside exploring the outcomes of previous requirements and recommendations set at the last inspection visit. We also considered information received, or asked for, since the last key inspection. This included the annual quality assurance assessment (AQAA) that was sent to us by the manager and completed in June 2009. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service, and it also gave us some up-to-date numerical information about the service. We also looked at notifications sent to us concerning incidents occurring at the home, and also reflected on the outcomes of issues which had been handled within the London Borough of Suttons Safeguarding provision. The manager also provided copies of Regulation 26 Care Homes for Adults (18-65 years) Page 6 of 31 reports for early 2009. The inspector also met with the majority of the people using the service at the home, a number inviting him to see their bedrooms and engaging with him throughout his time in the home. We are grateful for the time and attention - and hospitality - afforded during the inspection of the service. Quality Assurance questionnaires were received back from both those using the service, and from a number of staff members. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Adults (18-65 years) Page 8 of 31 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 9 of 31 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 31 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. Prospective newcomers and people currently using the service can be assured they will have their needs thoroughly assessed, recognised and appropriately recorded by the service. Evidence: The organisation has a dedicated Assessment Team that ensures that all necessary information is accrued prior to considering an admission to the service, and the senior staff members are involved in assessment and familiarisation visits prior to admission for a prospective person who may use the service. No new people had been admitted to the service users for the past year. Each individual at the home is recognised for their own individuality; all are male, with six of white British extraction, and one of black African background. Staff members are both male and female, and of varying ages (from 20s up to 60s). Placements have been made at The Green currently by Medway Council and the following London Boroughs: Bromley, Croydon, Greenwich and Southwark. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: Five people using the service have been resident for more than five years and two for almost two years. This consistency of the home population has remained fundamental to the progress of the wellbeing of some; the individual life skills programmes being constantly reviewed and refined thanks to the stability this long-term aspect of community brings. One previously identified dilemma that such stability at a home brings, is a developing distance from the need to ensure that the Statement of Purpose and Service User Guide are kept up-to-date, and reflect the actual evolving purpose of the service. The new manager has accepted the recommendation that these two familiar documents both required by Regulation - be revisited, and reviewed or updated in the near future. Service users are in regular contact with both health and social care-based professionals, including GPs, Care Managers, and community based mental healthcare professionals, all of whom are able to check that the ongoing assessed need of each individual is being met. The Lead Inspector has been involved in a number of meetings regarding individuals from The Green over the past twelve months or so, and in all respects the service has been noted for the individualised and concerned focus of the care provided. Care Homes for Adults (18-65 years) Page 12 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home creates and maintains basic care plans and assessment documents designed to ensure that the needs of service users are realistically met in an individual and focused way. The person-centred approach should now be fully adopted to ensure that the focus put the person using the service at the centre. Service users can be assured that their rights to individuality and self expression are protected, whilst acknowledging the community and supportive aspect of living at The Green. Service users can be assured that risk-taking will be an integral part of the support and protection plans put in place by the home, though such documented issues need updating or entire renewal. Evidence: During the inspection visit, one persons care plan and daily records were tracked and noted to be comprehensive and active in content. There is a need to ensure that all plans are devised from a person centred approach to ensure the individual is located at the centre of the strategy. Care plans are reviewed and updated after the collation Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: of a monthly review, which is created by the dedicated keyworker involving the individual concerned, which seeks to reflect on achievements and changing needs. The six-monthly review process was in process and up to date. Care plan meetings are timetabled into a cycle of structured reviews, though some local authorities are more reliable in fixing and keeping to appointments than others. The manager and staff continue to be commended, in both this section and the next, for their engagement, optimism and tenacity in encouraging the people they work alongside to source opportunities with regard to both occupation and enjoyment. Active engagement with the local community is notable. Activities within the home are also provided, including enjoying books (a number visit the library), board games, arts and crafts and computers. A pool table is housed in the coach house at the rear of the main building. Resident Group meetings are held, this providing an opportunity for planning, comment and discussion of issues requiring agreement within the household. Trips out from the home include visits to the cinema, bowling, swimming and restaurants or pubs. No individual, except one, has expressed a religious affiliation of any kind; however the service is aware of local resources. Potential general risks and hazards are assessed (under broadly identified headings such as: Relationships / Community access / Aggressive behaviour / Electrical hazards / Fire precautions / etc.), and are recorded within each individual service user care plan. It is evident from the individual care plans seen, that based on an assessment of acceptable risk and safety criteria, staff members encourage people using the service to take reasonable risks, whenever possible and to live their lives to the full. Many risk assessments seen were noted to be signed off with a review date, but had not been revisited and fully updated for some length of time. It is essential that risk assessment documents be renewed on an ongoing basis to ensure the best possible currency of the plans. Risk management strategy guidelines for people assessed as likely have challenging behaviour or to self-harm have also been drawn up, with, where appropriate, the involvement of specialist care professionals. Such guidelines were generally more contemporary in form. Staff members have training in dealing with challenging behaviour through the company having a specific training strategy for dealing with behaviour that challenges. The home maintains a good financial record-keeping process, with a transparent financial auditing system being used. The home remains very keen to encourage those Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: people who are willing and able, with support (where appropriate), to manage their own financial affairs. Care Homes for Adults (18-65 years) Page 15 of 31 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 can expect their lifestyles at the home to be individually focused, and aimed at personal development. Activities provided and pursued ensure, as far as is practicable, positive engagement both within the home and especially outside in the local community, whilst acknowledging and respecting each individuals needs and capacities. Relatives or friends can expect a positive welcome from the home, within the context of respect for personal choice and decision-making. People can expect to be involved in the provision of a good standard of nutritious and interesting food, whilst acknowledging the right to their own stated choice, with an aim to ensure that mealtimes are pleasant and enjoyable. Evidence: The manager and staff show their ongoing optimism and tenacity in encouraging residents in sourcing opportunities with regard to occupation and enjoyment. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: Everyone is encouraged / assisted to undertake educational or occupational activities. SCOLA, NESCOT and Merton Colleges are used for vocational focuses. The closure of the Cheam Centre has provided a challenge to find alternative placements for people who have more specifically focused needs. Part-time jobs have been held by some - such a being a pot-man at a local pub. Some currently do, or have, worked at a charity shop and within other vocational projects. Staff members consistently seek out opportunities which could be taken up one of the users of the service. Physical activity in general is positively encouraged, though with greater success with some than others. A number of residents go to the gym to keep trim, and swimming, bowling and shopping are common social activities. The home has a people carrier, which can take a maximum of seven people (including staff) on trips out. Holidays are planned for each individual according to their expressed wish. Some people travel abroad for trips, whilst some prefer to remain in the UK. Some people also have holidays or breaks with family members. People make a part-contribution to the funding of holidays. Family involvement is recognised as vital to promote self-identity and to encourage contact with the outside world. In almost every persons respect, visits are either enjoyed to their parent / relatives homes, or they visit The Green. Those without direct face-to-face contact have telephone communication. Visitors to the home are enabled either to spend time in their relatives own room, or the conservatory can be made available to them. The service can provide transport for visits where necessary. One person at the home is encouraged to cook their own meals in their self-contained flat, and others are now being actively involved in the cooking for themselves and their peers at the home. Care Homes for Adults (18-65 years) Page 17 of 31 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 can be assured that their personal, health care and emotional needs will be recognised and met by the homes daily input and through longer-term assessment and care planning programme. The systems adopted by the home regarding medication ensure the safety and consistent treatment and support for each person using the service, provided that tight attention is paid to all relevant records. Evidence: Staff members provide appropriate and sensitive care and support to the need of each individual, encouraging self-help as much as possible. Routines are flexible, and guidance and support is second nature to the staff - who try to live alongside them, integrating support and assistance. Each person is evidently treated as an individual, sharing goals with keyworkers who are responsible for the encouragement of engagement with fulfilling and enjoyable pursuits. People clearly choose their own clothes and initiate their own day-to-day activities; staff support people in their daily routines, keyworkers in particular. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: All people using the service have access to local community health services, including local GPs, and other medical services - as appropriate and preferred. Local community opticians and dental surgeries are used. People are encouraged to take control of their healthcare needs (e.g. arranging their own appointments), this promoting privacy, dignity and independence. A number of service users are supported with psychiatric visits (either in house or clinic based) on a regular basis. The home has good liaison contact with mental health services and also the professionals associated with learning disability services in Sutton. Health Action Plans are in place, but need some focused work and updating (some originating from 2007) to remain useful. One action plan is being devised in symbols format to meet the needs of one specific person. Medication records were examined and found to be generally in good order, with just a singular query arising during the inspection about items which were due for return to the pharmacist. Care Homes for Adults (18-65 years) Page 19 of 31 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 using the service and their advocates can be assured that their comments or complaints will be taken notice of, investigated and acted upon within the registered providers stated procedural timescales. The home provides support to people to ensure that they are protected and safeguarded from harm, neglect and any form of abuse. Evidence: The Complaints Procedure is openly displayed and available in symbols and large print formats. Relatives have previously indicated they were well aware of the Complaints Procedure. People using the service also indicated they knew who to approach if they were not happy about the service or wished to make a complaint. Adult protection issues raised in the past twelve months - with the Commission being involved in monitoring the homes conduct in relation to these issues - have shown that they have been handled and progressed with competence and a sound knowledge of dealing with the individuals concerned. The manager is clearly conversant with the Sutton local authority - as host Borough - procedure and processes. All safeguarding incidents have been handled well, being fully recorded and notified to the local authority, the Commission and all significant others. The Registered Provider provides training for staff on PMCB - the Prevention & Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: Management of Challenging Behaviour course. This is being rolled out for all staff within the home. This approach stresses that people are only ever restrained when absolutely necessary, and even then treated with respect in such challenging situations to avoid issues of potential harm / abuse. A specialist company is used to train staff, and also to audit, where appropriate, challenging behaviour guidelines. Most residents handle their own financial affairs - whilst others may have their monies managed by their funding local authority, or be subject to Power of Attorney. The home maintains a good financial record-keeping process, with a transparent financial auditing system being used, which is externally checked by the external Regulation 26 monthly visit audits. Care Homes for Adults (18-65 years) Page 21 of 31 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. People can expect to live in a clean, warm and comfortable environment designed to meet their needs, providing adequate communal services and domestic facilities. People can be assured that, once the bedrooms have been further refurbished with adequate fittings and furnishings, the home will be a comfortable, safe and hygienic environment in which to live, without unnecessary risk. Evidence: The house, which is a detached Victorian building, stands in its own grounds overlooking a green leisure area at the very north end of Sutton town centre. This provides those using the service and the assisting staff to easily access a myriad of resources: leisure, shopping, transport and other facilities. The house has again been generally well maintained - with the staff accessing the handyperson team to address general maintenance issues, or accessing appropriate service engineers for the specialist equipment in the home. All maintenance certificates and records showed servicing routines to be up to date. The coach house now has a drainage gully along the front of the ground floor opening, to ensure proper drainage, this avoiding any further flooding problems. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: The main lounge is spacious and comfortably furnished, and the conservatory is a popular place to meet visitors. The dining room is also of a good size, and the coach house and the garden provide space for sporting and social pursuits. It was good to see pots of vegetables growing outside the kitchen window, which were being zealously supervised by one of the people using the service. The garden area is also much improved and attractive. The premises were in generally good repair, with little damaged furniture evident; this can be an underlying problem with the fabric of the house, in that challenging behaviour can severely compromise the standard of the premises. Two bedrooms were due a complete refurbishment within days of the inspection visit, and this was the start of a concerted effort to upgrade the premises; especially the individual private areas - but also including the landings, hallway and stairs. Plans are also afoot to replace the thermostatic heating valves on radiators to make heating more localized and controllable. This programme reflects the quality argument of the previous inspection report which stated: whilst respecting the right of people who use the service to control over their own space, the issue of maintaining quality surroundings for all should not be lost or compromised. A shower room facility on the ground floor continues to be a useful resource for the home, providing a variety of bathing opportunities, alongside the main formal bathroom upstairs. The house was clean and odour-free during the inspection. People are encouraged to help with house cleaning chores and their own private room cleanliness - though staff intervention can still be invoked if the situation becomes too difficult / challenging for a service user. The quality rating for this section is awarded in the light of work committed to, to begin within weeks of the inspection visit; it is important that a rolling programme of continual refurbishment is committed to in the future, to ensure ongoing quality surroundings. Care Homes for Adults (18-65 years) Page 23 of 31 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 can rely on the home providing adequate staff in sufficient numbers and being competent to provide a service that aims to meet individually identified needs. The homes recruitment and staff support mechanisms are organised so as to ensure the safety, protection and wellbeing of service users, with staff training now ensuring adequate professional knowledge to a level providing informed best practice. Evidence: Staffing levels have been problematic over the past year or so, and are now being resolved through the new manager rebuilding the homes ethos and structure. He is now managing a team where at least a third of the staff are relatively new, the deputy and himself included. There is clearly a fresh start atmosphere in the air, and the manager is using this opportunity to encourage some new beginnings. Preemployment checking, and the subsequent induction of staff to the service - have both been properly maintained since the last inspection report; documentation seen evidenced this to the inspector. Staff questionnaires also confirmed a rigorous recruitment and induction process. As well as the manager having his Registered Managers Award at NVQ Level 4, and the deputy holding a degree in Health and Social Care, one support worker has a NVQ Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: at level 4, one at level 3 and one at level 2; and three further staff members are undertaking their NVQ at Level 2 currently. The care team of eleven staff therefore now achieves the standard inspection requirement that at least 50 of them should be qualified to (minimally) NVQ Level 2. Audits of staff records (which are securely kept) showed staff induction and supervision in place, and the manager is clearly getting to grips with these tasks now that staffing levels have improved. Care Homes for Adults (18-65 years) Page 25 of 31 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 management systems for the service ensure that people using the service benefit from an organised, competently managed and safe environment. People can be assured that their rights and interests are well served and protected, through the homes improved approach to record keeping, policies & procedures, and the day to day conduct of the home. People can be assured that their welfare, health and safety is safeguarded through the homes adherence to appropriate guidance and regulatory framework concerning best safety practices. Evidence: The new manager, Liam Mallon, has adopted an approach wherein he has become the strategic person with the guiding role: auditing and directing, rather than so much actively being hands on and participating in the day-to-day activities of the home. Management responsibilities are now being clearly shared / cascaded and delegated through to the new management structure, to the deputy manager and then beyond Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: to other senior staff. The manager, who has 20 years care and voluntary experience has his NVQ at Level 4 in Management and Care and his approach to the operation of the home is robust and he is well supported by senior management within the CMG organisation. Quality assurance measures adopted by the registered provider include unannounced visits by representatives of the registered provider which are thorough, and being carried out on a reasonably regular basis. Quality Assurance surveys are periodically sent out by CMG to relatives, friends / representatives or advocates of service users, to encourage feedback about the quality of the service provided. The responses are received centrally and collated, then overviewed prior to being sent on to the service itself. Feedback from those using the service, both in person and through the CQC questionnaire revealed a generally positive regard for the service provided in almost every aspect. In the main dissatisfactions expressed related to interpersonal issues which were being managed and negotiated by the service staff. A Company-wide consultation Forum for service users meets regularly, and CMG publishes a resident/staff magazine to encourage interest between different service locations. The home also has a substantial Quality Assurance file - which requires focused work and challenges the management to assess such issues locally. CMG has a comprehensive set of policy and procedures which cover the broad spectrum of needs identified for care services; they have a clear focus and the guidance provided by these documents is invaluable. All maintenance and servicing contract issues were up to date, and evidenced by certification produced on request on the day of the inspection visit; health and safety monitoring and recording was also being generally kept well - e.g. fire drill and fire alarm testing records; they were being consistently kept. Reports concerning incidents within the home or relating to those using the service have also been efficiently reported to the Commission in a timely fashion. Care Homes for Adults (18-65 years) Page 27 of 31 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 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 2 6 The Statement of Purpose and Service User Guide for the home must be revised following the management review of the service. in order to ensure that the information is up to date and reflects the purpose and intention of the service provider. 02/02/2011 2 6 15 The care plans relating to individuals living at the home must be developed in a person centred format. To ensure that the individual benefits from the best care planning process and is seen to be at the centre of the care process. 02/02/2011 3 9 13 Risk assessments created to 02/02/2011 relate to individuals living at the home must be regularly and actively reviewed and updated. To ensure that any areas of risk are understood Page 29 of 31 Care Homes for Adults (18-65 years) 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 and actively addressed by staff who support the individual. To ensure that any areas of risk are understood and actively addressed by staff who support the individual. 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 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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