Care Home: Gubbins Lane

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What the care home does well The service has a comprehensive activities programme, to ensure they can meet all the needs of residents. There is a good selection of meals provided at the home. Preadmission assessments are completed before prospective residents move into the home, ensuring that the service will meet their needs and ensure that they receive a personalised service. Trial visits are offered to all prospective residents, to ensure residents have information on the services and facilities provided at the home. Care planning is very comprehensive and person centered with particular attention given to meeting residents` personal preferences and respecting their individuality. All residents can also be assured that at the time of their death, staff would treat them and their family with care, sensitivity and respect. The home has a clear complaints procedure, which includes timescales within which a complaint is to be investigated. The management of the home operate a open door culture welcoming complaints and feedback. The health and safety of staff and residents is promoted by the home`s policies and procedures and the environment of the home has been refurbished to a good standard. The service has robust recruitment procedures ensuring the safety of residents and there are enough members of staff on duty to meet the needs of residents at all times. What has improved since the last inspection? At the last inspection eight requirements were made in the areas care planning, identifying the wishes of residents in the event of their death, safeguarding adults, environment of the home, the review of staffing levels and recruitment checks. All these requirements had been complied with at this inspection. What the care home could do better: At this inspection one requirement has been made in ensuring that there are no risks or hazards posed to residents by the environment of the home. Failure to act on requirements that relate to the care provided for the people living in the home impacts on the welfare and safety of service users and may lead to the Commission taking enforcement action against the registered person. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Gubbins Lane 26 Gubbins Lane Harold Wood Romford Essex RM3 0QA     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Harbinder Ghir     Date: 1 0 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Gubbins Lane 26 Gubbins Lane Harold Wood Romford Essex RM3 0QA 01708384525 01708384525 sara@outlookcare.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Outlook Care Name of registered manager (if applicable) Ms Sara Petley Type of registration: Number of places registered: 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: 6 The registered person may provide the following category of service only: Care Home only Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability Code LD Date of last inspection Brief description of the care home 26 Gubbins Lane is a care home registered to provide care, support and accommodation to six adults of both sexes aged between 18-65 with physical and learning disabilities. The home is a one level purpose built property and gardens with car parking facilities to the front of the building. The home is located in a residential area of Harold Wood, close to shops, public transport and the M25, A127 and the A12. Care Homes for Adults (18-65 years) Page 4 of 30 care home 6 Over 65 0 6 Brief description of the care home The home employs staff, working a roster, which gives 24-hour cover. Information on the service available at 26 Gubbins lane is available in the Statement of Purpose which is available on request. Fees are currently £1,072.57 per week. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection undertaken by Regulation Inspector Harbinder Ghir. The inspection took place on the 4th February 2009 between 9.55 am and 3.50 pm. A second day was spent at the office contacting residents relatives and representatives by telephone. Their feedback has been included in the report. At the end of the inspection verbal feedback was provided to the registered manager of the home. During the inspection the inspector was unable to talk to residents residing at the home due to their complex communication needs. As part of the inspection the inspector toured the home, read records of people who use the service and examined documents in relation to the management of the home. Care Homes for Adults (18-65 years) Page 6 of 30 The inspector would like to thank everyone involved in the inspection process. The Commission for Social Care Inspection received a completed Annual Quality Assurance Assessment prior to the inspection. 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 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At this inspection we looked at standards 2, 3, and 4. The service completes comprehensive pre-admission assessments, to ensure they can fully meet the needs of prospective residents. Trial visits are offered to all prospective residents, to ensure residents have information on the services and facilities provided at the home. Evidence: Since the last inspection the home has had two new admissions to the home. The preadmission assessments for these two residents were closely looked at. It was evident that significant time and effort had been spent planning to make the admissions to the home personal and well managed. The service had completed a comprehensive preadmission assessment, which also consisted of observations and assessments undertaken by the registered manager of the home and a senior manager within Outlook Care. The assessments comprehensively covered the personal, healthcare and Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: social care needs of residents. Assessments were personalised and also included information on the life history of the individual and their likes and dislikes. Assessments clearly focused on achieving positive outcomes for people and this included ensuring that the services provided at the home met the diversity needs of the individual. For example residents religion was identified on their pre-admission assessment and whether they practiced or not. Residents with poor mobility were provided with the required specialist equipment or with wheelchairs. Meetings with family and health care professionals were also held to ensure the service could meet the identified needs of the resident. Once the residents had been admitted, weekly progress sheets were completed of the progress residents were making or of any identified anxieties, for four weeks during the transfer period. The admissions for both residents have been successful with the individuals becoming permanent residents at the home. One resident who presented very challenging behaviour on admission, has now become very settled at the home, interacting with staff and other residents. The resident allows staff to administer medication which she would not allow on admission and only ate certain foods. She has now began trying different foods at the home. It was very evident that the service has made good progress in meeting the needs of these residents and providing person centred care. Evidence was also seen of other residents consulted and involved in the admission process. The residents undertook various trial visits to the home to provide familiarity. Residents were also able to see their rooms with their family. One residents father was spoken to during the inspection who informed that they came to see the home before his daughter was admitted and that they have been very happy with the care at the home. The service is commended on meeting the needs and aspirations of new residents and working in partnership with them throughout the pre-admission process. Care Homes for Adults (18-65 years) Page 11 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At this inspection we looked at standards 6, 7, 8, and 9. There is a comprehensive care planning system in place, which provides staff with the information needed, to meet the needs of residents. The right for residents to exercise choice and control is promoted by the service and they are actively consulted on, and participate in, all aspects of life in the home. Risk assessments are undertaken routinely, to ensure residents are supported to take risks as part of an independent lifestyle, and are always updated according to residents changing needs. Evidence: Three care plans were closely looked at. Care plans within the organisation are focused on person centred planning, which aims to identify and provide person centred care. Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: The key principle is that people who use the service are in control of their lives and they direct the service. It was evident from examining the care plans that staff are fully committed in supporting individuals to lead purposeful and fulfilling lives as independently as possible. Care plans seen evidenced that the service involves individuals in the planning of care that affects their lifestyle and quality of life. Care plans were comprehensive; person centred and clearly set out residents health, personal and social care needs. Information was found specific to the religious, cultural and social care needs of residents and how the service was to meet these needs. All residents are given the choice to attend church services once a week. The information provided in care plans was very detailed and individualised, and clearly recorded and described how residents wanted their needs met. For example one residents care plan informed how they would like to be communicated to. The care plan stated, I can communicate by gestures and sounds but cannot say any words. I make happy sounds and I cry if I am hungry or upset. Care plans were written from the residents point of view and concentrated on promoting the independence and aspirations of residents. The documents also included a document called My Life Pathway which included information in picture formats and photographs and included information on residents likes, dislikes, how they communicate and what they are able to do independently and tasks they require assistance with and their life history. A key worker system also allows staff to work on a one-to-one basis and contribute to the care plan for the individual. An advocacy service was previously put in place for residents but this ceased as the advocate had left their employment and the service has not resumed since. During the inspection it was felt that advocacy services would benefit all residents enabling them to have one to one time with an independent external individual and this would also contribute to building relationships between residents. Advocacy services would in particular greatly benefit one resident who presents a level of verbal communication and can express her wishes. It is recommended that advocacy services are provided for all residents to ensure that they can express their views and wishes to an external individual who can work with them on a one to one basis. Care plans were working documents and are reviewed on a six monthly basis or as and when required. Evidence was seen of reviews taking place also involving the resident and their representatives and family. If professionals such as the General Practitioner were not able to attend the review, the service obtained written feedback from them to contribute to the review. Reviews focused on asking what has worked for the individual, where progress is being made, achievements, and concerns and identified action points. Minutes of reviews held by the funding Local Authority were also obtained and placed with the care plan. Relatives spoken to as part of the inspection process all informed that they are invited to attend the reviews held at the home and Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: spoke very positively about the service. I am very satisfied with the care provided at the home. I have been to all the meetings held there and Sara (registered manager) lets us know of any problems, they discuss everything with us said one relative. Another relative informed I have known Sara for several years and we are quite happy with the care. I always get invited to review meetings. The home lets us know of any developments. When X was in hospital they called me. I have never made any complaints to the home said another relative. All health and care planning documents were signed by each member of the staff team to evidence that they had read the information. This is very good practice ensuring that all members of the staff team were aware of residents changing needs. Risk assessments were completed for residents and identified risk areas in care plans included risks areas that were pertinent to each resident that may be presented by the building, mobility, falling and wandering, use of the homes transport, presenting challenging behaviour. Assessments included clear guidelines for staff to follow in managing risks posed to people who use the service. Risk assessments were reviewed regularly and amended. Daily case recording notes were examined which were linked to the care plan and focused on the specific needs of residents. Each resident has a personalised case recording sheet which may focus on their challenging behaviour, their diet or the risks they are posed to, which provided specific information about each resident which is used to monitor their care needs or their behaviour on a on-going basis. Information was also found on the times residents actually got up or went to bed and their moods during the day. Due to residents high level of care needs their abilities do not allow them to participate in all of the daily running of the home. However, the service has developed skills teaching within the home where they work with each resident on a one to one basis to support each resident to complete daily living tasks step by step. For example one residents focus was on putting laundry into the washing machine with the support of staff. The residents progress is being recorded and reviewed. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At this inspection we looked at standards 11, 12, 13, 14, 15, 16 and 17. Residents are provided with support to maintain their independence and in areas of personal development according to their needs and wishes. Residents are engaged in community life, promoting their opportunities to be part of the local community. Residents are offered meals that promote their choices and respect their individual preferences. Residents are supported to maintain family links and relationships inside and outside the home. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: The service has a strong commitment to enabling residents to develop and maintain their skills, including social, emotional, communication, and independent living skills. Individuals are supported to identify their goals, and work to achieve them. Two residents have recently been supported to go and see Kylie Monogue in concert and were supported to stay at a hotel overnight. Residents are supported to go out on a daily basis in the homes mini bus to the local shops or sight seeing. Some residents also attend local day centres and one resident attends a cookery class once a week. The home also provides a music and movement class once a week, massages and manicures. Residents are also given a choice of visiting church services once a week and are also given the opportunity to participate in festivals and celebrations throughout the year. During the inspection residents were observed being involved in a game of skittles and then watched a music DVD. Some residents were observed looking at magazines, whilst others watched television. One resident was seen listening to music in her room. Another resident was going out with her family for the day. There was a range of activities residents could participate in and had the freedom and choice to wander around the home as they liked. Residents also had the opportunity to develop and maintain important personal and family relationships. Residents were supported to see family at the home and visit them. Evidence was seen of residents supported to visit and stay with family. Compliments received by the home included the following comments We are so pleased to know X is being cared for by a great bunch of people. A relative making a formal compliment to the home stated Myself and my family are very happy with the care my daughter receives at 26 Gubbins Lane. The home provides meals, which are varied and nutritious and meet the dietary needs of residents. There was plenty of fresh fruit and vegetables at the home. Staff were seen preparing the lunch time meal, which was Pattie sandwiches. The food smelt and looked appetizing. Residents were joined by the inspector at lunch time and all residents were eating different varieties of sandwiches and salads. Some had brown bread whilst others had white bread and one resident had toasted bread. Some residents were supported to eat their lunch with the support of staff. Staff were calm and relaxed with residents helping them to eat at their pace. Residents chose their meals from an extensive folder of pictures of foods, meals and ingredients and staff supported residents to devise the weekly menu. Residents can also refuse their choice of meal on the menu on the day and staff prepared alternative meals specified by the resident. Care Homes for Adults (18-65 years) Page 16 of 30 Care Homes for Adults (18-65 years) Page 17 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At this inspection we looked at standards 18, 19, 20 and 21. Residents receive personal support and care in the way they prefer and require. Medication practices always ensure the safety of people who use the service. The ageing, illness and death of service users are handled with respect and as the individual would wish. Evidence: Residents at the home receive personal care and healthcare support using a person centred approach with support provided based upon the rights of dignity, equality, fairness, autonomy and respect. Each resident has a devised health plan which identifies the healthcare needs of residents including specialist health, nursing and dietary requirements, which are clearly recorded and act as an indicator of change in health requirements. The plan also identified residents daily routines including the type of support they need in relation to personal hygiene and according to their level Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: of care needs. For example whether residents prefer a shower or bath. One resident liked to have a manicure which was provided by the home on a regular basis. Residents are supported by staff to attend appointments with healthcare professionals and their health is closely monitored and prompt referrals are made. There was evidence of staff taking female residents to well women checks and the involvement of multi-disciplinary healthcare professionals where required were made to dentists, chiropodists, General Practitioners and community psychiatric nurses. Steps have been taken to find out the wishes of residents in the event of their death, including contacting relatives or representatives where the resident is unable to express their views. There are policies and procedures for staff to follow in the event of a death; to ensure the death of a resident is handled with respect and as the individual would wish. This information was included in each residents care plan document. One resident had chosen the music she wanted played at her funeral, whether she wanted her guests to wear black or coloured clothes and where she wanted to be buried. Medication administration records (MAR) were closely examined and the registered manager was observed administering the lunch time medication. All medication was safely locked in a wooden medication cabinet. Medication was blister packed and no controlled or temperature controlled drugs were at the home. Medication records were fully completed, contained required entries, and were signed by members of staff. The medication file contained photographs of each individual, a medication pen picture and information about each medication. All of the residents have regular medication reviews conducted by the General Practitioner, which is very good practice. All medication practices were found to be in good working order. Relatives of residents spoken to all made very positive comments about the service and spoke highly of the care provided at Gubbins Lane. One relative said The care at the home is fine. They look after my daughter well, we are very satisfied. I recently sent a letter to the Head Office to say how pleased I was with the service informed another relative. Care Homes for Adults (18-65 years) Page 19 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At this inspection we looked at standards 22 and 23. People who use the service can be assured their views are listened to and acted on. The service records all complaints and concerns to ensure any dissatisfaction with the service is actioned regardless of source. All staff have received up to date training in Safeguarding Adults, which ensures the protection of residents. Evidence: People who use the service are supplied with a complaints procedure that they can understand. The procedure is available in picture format and has also been provided in DVD format. Residents from Outlook Care were involved in making the DVD which also has individuals communicating the procedure in Makaton signing. The service also has complaints cards which include pre-paid postage to the services head office. The complaints cards also include the contact details of the complaints officer within the organisation. A complaints logbook is kept by the home, which was viewed. No recent complaints have been received by the service. The Commission for Social Care Inspection has not been informed of any complaints. Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: All staff had attended Safeguarding Adults training which is also covered in the induction programme. The service has comprehensive Safeguarding Adults procedures and protocols in place. There was also comprehensive guidance for staff on how to record incidents of abuse, using body charts and preserving evidence. Care Homes for Adults (18-65 years) Page 21 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At this inspection we looked at standards 24 ,25, 26, 27, 28, 29, 30. Residents live in a comfortable environment and decor is of a good standard and provides a homely and pleasant living environment enhancing residents comfort, but further environmental safety checks would minimise risks presented to residents. Evidence: During a tour of the building it was identified that residents live in a physical environment that is appropriate to their specific needs. The home provides ground floor accommodation to six residents. As the AQAA informs us, since the last inspection the home has new carpets, curtains and new bedding has been provided for all residents bedrooms. This was evident during a tour of the building. Residents bedrooms were provided with aids and adaptations to meet their required needs, for example grab rails and hoists. The bathrooms also provided specialist equipment such as a high low bath in one of the main bathrooms. Each resident had been supported to choose colours and furnishings for their room. One resident who had recently moved into the home was transferred to a larger bedroom to accommodate her books and belongings at the request of her family. Residents had also personalised their rooms Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: with pictures, photographs, personal furnishings and belongings. All rooms were lockable and can be overridden by staff in an emergency. The main communal areas such as the lounge and dining area were clean and had furnishings that were homely and welcoming. These areas had also been personalised with photographs of residents. The kitchen was clean and was equipped with suitable cooking appliances and kitchen equipment. There was a range of fruit and vegetables and meats available. Food was correctly labelled with the date of opening. However, fridge, freezer and hot food temperatures had not been taken consistently as on some days the temperatures had not been taken. On touring the homes laundry room it was also identified that one of the cupboards stored household tools such as a hammer, which could place people who use the service at risk. All parts of the home to which residents have access to must be so far reasonably practicable made free from hazards to their safety and unnecessary risks to residents are identified and so far as possible eliminated, this will be stated as a requirement. Care Homes for Adults (18-65 years) Page 23 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At this inspection we looked at standards 32, 33, 34, 35 and 36. Recruitment practices are robust and ensure residents are in safe hands at all times. Comprehensive staff training is provided to all care staff, to ensure they are equipped with the skills and are competent to do their jobs. The service has a good skill mix of staff, ensuring adequate numbers of staff are on duty to meet the needs of residents. Staff are supervised at least six times year to ensure they are equipped with the skills and knowledge to meet the needs of people who use the service. Evidence: Two staff files were closely looked at. One new member of staff has been recruited since the last inspection. These two staff files were in good order. References and Criminals Records Bureau checks had been obtained, application forms had been completed in full and two references had been obtained. All new staff complete comprehensive induction programmes and the service sees this as vital to the success Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: of staff recruitment and retention. The service has made a commitment to staff training that is focused on delivering improved outcomes for people who use the service. Outlook Care has a very comprehensive training programme in place and management prioritise training and facilitate staff members to undertake external qualifications beyond basic requirements. The service also has a internal development training, to complement formal training as part of an ongoing training plan. Staff training included training in first aid, food hygiene, manual handling, health and safety, fire training, safeguarding adults, medication, equality and diversity, mental capacity act, person centred planning, lone working and infection control. Over fifty per cent of the staff team are NVQ qualified and the AQAA informs us that two members of staff have recently commenced their LDAF qualifications. The staff rota included all the members of staff on duty. However, the registered managers working hours were not identified on the staff rota for one week. It is recommended that the staff rota is an accurate reflection of all staff on duty each day, ensuring the protection of residents and staff. The service has a permanent staff team and uses its internal system of bank staff to cover shifts when required. All staff had lone working risk assessments in place, which was very good practice. There are three members of staff on duty per shift which supports the needs of residents, activities and aspirations of residents in an individualised and person centred way. The latest supervision records were viewed for all staff. A supervision programme is in place and staff files evidenced that staff members are supervised formally on a regular basis (at least six times a year). This ensures that staff are provided with the skills, training and knowledge to perform the tasks required by their employment role. During the inspection two members of staff were spoken to who spoke very positively about the manager and working at the home. Staff were also observed positively interacting with residents and were able to communicate with residents freely and using each residents preferred method of communication. Care Homes for Adults (18-65 years) Page 25 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At this inspection we looked at standards 37, 39, 42. Residents benefit from an experienced manager who recognises their needs and adequately manages the home. The systems for service user consultation ensure the home is run in the best interests of residents. The welfare of staff and residents is promoted by the homes policies and procedures. Evidence: The registered manager has a NVQ level 3 qualification in Mental health, an advanced management in Care Award, an NVQ level 4 qualification in Care Management and has also achieved the Registered Managers Award. The AQAA informs us that her return has instilled confidence in her management ability and the staffs moral and support for her as a manager. Staff spoken to during the inspection also spoke very positively Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: about the manager, informing That she is supportive and always listens to staff. The manager is commended for her organisational skills as all documentation required for inspection purposes was easily accessible. The manger also demonstrates through her formal qualifications, robust operational systems and her professional experience and ability that she is knowledgeable and highly competent in a range of areas, which included good practice areas, understanding current legislation, and the importance and purpose of having effective quality assurance systems in place. Quality assurance systems have been developed and surveys for people who use the service have been devised in picture format. Surveys for relatives, care managers and other professionals were seen which included open-ended questions on all aspects of the care provided at the home. The results of surveys had been analysed and incorporated into the homes Annual Development Plan. The home works to clear health and safety policy. Health and Safety records were inspected. All documentation was in order and appropriately completed. Certificates viewed included certificates verifying up to date portable appliance testing, electrical installation, gas safety, employers liability insurance and records of fire drills and fire alarm testing and water temperature testing. Motor insurance certificates were also seen for the homes mini bus, which were all in good working order. Regulation 26 visit reports were examined during the inspection which are undertaken by a number of senior managers within the organisation. These reports were completed monthly and were very comprehensive and also included action points where any areas for improvement had been identified and were reviewed to check for compliance. The accident and incident records were closely examined which evidenced that all accidents and incidents were comprehensively recorded and further follow up checks were also completed by the manager of the home to ensure residents did not have any further health associated risks posed to them. A completed Annual Quality Assurance Assessment was received before the inspection and was supported by a wide range of evidence. It informed of the changes the service has made and where they still need to make improvements. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 It is recommended that advocacy services are provided for residents to ensure that they can express their views and wishes to an external individual who can work with them on a one to one basis. It is recommended that the staff rota is an accurate reflection of all staff on duty each day, ensuring the protection of residents and staff. 2 33 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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. 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