Care Home: Harmony Care Home

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What the care home does well People living at the home go out and do things in the local area.People have information about the home so they know about the home before they move in. The home knows their needs because the home does an assessment. The home plan how to care for people and care for them in a safe way. The care plans are done in a way that people living at the home can understand. Relatives are able to visit the home when they want. One person living at the home said: "My relatives visit and I can call them whenever I like."People living at the home say they can tell the manager and the responsible person what they think.Staff at the home are well trained and the manager support them to do their job well.People living at the home go out and do things in the local area.People can have different foods to eat. What has improved since the last inspection? The home fitted a new roof and a new ramp at the front of the home so people who use a wheelchair can get out safely in case of a fire.The home did all the things we told them to do at the last inspection. What the care home could do better: We have not told the home that they must put anything right. Key inspection report Care homes for adults (18-65 years) Name: Address: Harmony Care Home 91 Highgate Road Walsall West Midlands WS1 3JA The quality rating for this care home is: three star excellent 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: Loraine Dunkley Date: 2 2 0 1 2 0 1 0 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 34 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2010) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Harmony Care Home 91 Highgate Road Walsall West Midlands WS1 3JA 01922474336 F/P01922474336 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Harmony Care Home (2003) Ltd care home 6 Number of places (if applicable): Under 65 Over 65 6 6 6 0 0 0 learning disability physical disability sensory impairment 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 (LD) 6, Physical disability (PD) 6, Sensory impairment (SI) 6 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 34 A bit about the care home Harmony care home is owned by a private person. Parking is available at the front and rear of the home along with a small-enclosed patio area. Six people live at the home. People living at home have learning and or physical disabilities. All the rooms have bathrooms attached to them. Some rooms have been adapted for people who use wheelchairs. There are two large lounge/dining rooms, separate laundry, kitchen, sensory room, ball pit, a visitors room, a kitchen and adapted bathing rooms. Care Homes for Adults (18-65 years) Page 5 of 34 The home is close to shops, buses, the local park and the town centre of Walsall. The home has its own vehicles so people can go on trips out. Fees for living at the home are agreed with each person and their social worker before moving in and may vary depending on needs. Harmony Care Home strives to provide care, comfort and security for those in need of long term care, taking into account the individual needs of each person. Care Homes for Adults (18-65 years) Page 6 of 34 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 Care Homes for Adults (18-65 years) Page 7 of 34 How we did our inspection: This is what the inspector did when they were at the care home The Inspector spent the day at the home, talking to people who live there the manager and staff. The inspector did not tell the home before she went. The inspector was at the home from 10:00 to 6:50 pm. The inspector also looked at the care records of some of the people who live in the home and other records so that we can see how the home is run. Care Homes for Adults (18-65 years) Page 8 of 34 Before the inspection we asked the manager to send us an Annual Quality Assurance Assessment (AQAA). This is a form the manager fills in and sends to the Care Quality Commission telling the inspector how the home is meeting the needs of the people that live there What the care home does well People living at the home go out and do things in the local area. People have information about the home so they know about the home before they move in. The home knows their needs because the home does an assessment. The home plan how to care for people and care for them in a safe way. The care plans are done in a way that people living at the home can understand. Relatives are able to visit the home when they want. One person living at the home said: My relatives visit and I can call them whenever I like. Care Homes for Adults (18-65 years) Page 9 of 34 People living at the home say they can tell the manager and the responsible person what they think. Staff at the home are well trained and the manager support them to do their job well. People living at the home go out and do things in the local area. People can have different foods to eat. Care Homes for Adults (18-65 years) Page 10 of 34 What has got better from the last inspection The home fitted a new roof and a new ramp at the front of the home so people who use a wheelchair can get out safely in case of a fire. The home did all the things we told them to do at the last inspection. What the care home could do better Care Homes for Adults (18-65 years) Page 11 of 34 We have not told the home that they must put anything right. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Loraine Dunkley 77 Paradise Circus Queensway Birmingham W Midlands B1 2DT 01216005300 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. Care Homes for Adults (18-65 years) Page 12 of 34 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 13 of 34 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 14 of 34 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. Prospective people who wish to use this service and their representatives have the information needed to choose a home, which will meet their needs. They have their needs assessed fully in order that they can be confident about the service they will receive. Evidence: The statement of purpose and service user guide gives comprehensive information about the service offered by the home. Fees charged are based on individuals needs and are included in individual service user guide and contract for each person. The statement of purpose could benefit from including the range of fees that maybe charged by the home. The current statement of purpose was undated so it was difficult to say when it was last reviewed, it does however indicate that it is generally reviewed every six months. Each person has an individualised service user guide which is in a format which meets their needs. The records of two people living at the home were looked at this included the record of the person admitted since the last inspection. As with previous inspections the needs of people admitted to the home has been thoroughly assessed. This includes an assessment Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: done by the funding authority as well as an assessment by the homes manager. These were very detailed assessments which included consultation with relevant parties. Due to the complex needs of the people living at the home there was also evidence of multidisciplinary capacity assessments where it was felt that people were unable to make decisions about their care. The needs assessments were kept under regular reviews. New people moving into the home have the opportunity for them and their relatives to visit the home prior to moving in. From the information seen and discussion with staff and other professionals spoken with it is clear that the home is well able to meet the complex needs of the people living there. This has been consistently demonstrated . Care Homes for Adults (18-65 years) Page 16 of 34 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. Care plans are excellent within this home, providing staff with the information they need to satisfactorily meet peoples needs, within a risk managed framework. The home takes responsibility to support people living at the home to be involved in decision regarding their care. Evidence: The records seen shows that each person has a detailed person centred plan of care based on their individual needs. All files sampled contained evidence that plans are reviewed on a regular basis and that risk assessments are in place that support the contents of each plan of care. The care plans looked at reflected the needs identified in the care needs assessments. Plans in place included those for communication, personal care, community access, nutrition, health and personal care. The records showed that staff working at the home signed up to say they had read and understood the needs of each person. Discussion with staff indicated that they understood the communication needs of the people living at the home. Staff were able to give examples of how people expressed their likes and dislikes. We spoke to one social care professional who said: Really impressed with the care provided at the home for the person using the service Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: who has very complex needs. The home has been flexible and go the extra mile. All needs were risk assessed and cross referenced to the care plans all included clear plans for managing risks as well as contingency plans. As mentioned in previous section where people have difficulty expressing their choice in areas of their care the manager ensures the correct assessments involving all relevant parties are undertaken to ensure the persons rights are protected at all times. All files sampled contained evidence that risk assessments are reviewed on a regular basis. Despite the majority of people who live at this home having potential communication needs that could impact on them being able to express choices all staff demonstrated understanding of promoting good practice in this area. All staff spoken with said they knew the people living at the home well and can tell by expressions and body language when people are happy or unhappy, this enables them to get an understanding of the likes and dislikes of each person. Care Homes for Adults (18-65 years) Page 18 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are able to participate in activities that suite their needs and that they enjoy. They are able to maintain personal relationships. Culturally appropriate meals are provided and the home ensure people are able to have choices in what they eat as far as possible. Evidence: People living at this home lead full and active lives, based on their individual needs and capabilities. The atmosphere within the home is very relaxed and welcoming with an abundance of evidence that indicates relatives and friends of people living there were welcomed by the home. One person living at the home said: My relatives visit and I can call them whenever I like. People living in the home are supported to maintain contact with friends and relatives. The home has its own transport which is used to enable people living there to access various activities within the local community. One person living at the home told us that they attended college where they do cooking and computer. They also said they go to disco, shopping, cafe, cinema and ice skating. Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: The home has its own sensory room, music therapy room and separate ball pit, all of which are used by the people living there. During the visit we observed a person being supported to use the sensory room by a member of staff. The interaction observed between the staff and the person was very relaxed. We asked the person if they were enjoying themselves and they responded by smiling and tapping their feet. All staff that were interviewed demonstrated understanding of supporting the people living at the home to maintain personal relationships. There is a four weekly menu plan which is in pictorial format for people who have this need. Discussion with the manager and staff indicated that although some of the people living at the home had restricted communication staff got to know their likes and dislikes about what they want to eat and drink. For other people their choices are included in their person centred plan. A record is being kept of all meals taken by people living at the home. Some people at the home take nutrition via alternative sources a comprehensive record of this is also being kept by the home. One person living at the home Said: I have curries and do well with the Sunday roast, I have gotten used to it and do well with it. People living at the home have access to the kitchen a portable ramp has now been purchased to facilitate this. Culturally appropriate meals are available for people who have this need. A tour of the kitchen showed that cupboards and freezers were well stocked with dry goods, vegetables and fresh fruits. During the visit we observed people being supported by staff to have their meals. Procedures are in place to ensure people living at the home are weighed on a regular basis. This should ensure that any deficit in nutritional needs are picked up quickly and can be addressed. Care Homes for Adults (18-65 years) Page 20 of 34 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. People living at the home receive support in a way that ensure their needs are met and their privacy and dignity is maintained. The health needs of people living at the home are well met with evidence of good multi disciplinary working taking place. Safe systems are in place to support people with their medication this ensures peoples health and wellbeing is maintained record keeping in this area needs to be more robust. Evidence: Staff at the home have excellent knowledge of the needs of the people living there. The manager is trained to ensure the complex needs of the people living at the home are met. In addition the home works well with other disciplines to maintain the health and wellbeing of people living there. There is excellent documentation available for the health care management of people living at the home. Extensive evidence was seen where the home had advocated on behalf of people where it was felt that their health needs were not being met in the way that it should be. Staff sign to say the have read and understood the health action plan for each person. Some people living at the home had specific needs relating to nutrition and medication and the home ensures that staff have the necessary training to meet these needs safely. Appropriate records are also maintained to support the care of these people. Policies are available on gender specific care, peoples choices are incorporated in Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: their personalised care plan. Staff confirmed that they always provide personal care in twos due to the needs of the people living at the home. The principles of privacy and dignity is an integral part of each persons care plan. Procedures and practices with the home in relation to medicines and controlled drugs were found to be good in most areas. Gaps were observed in the medication administration recording for one person living at the home for the administration of prescribed cream. We checked with the manager who confirmed that the cream had been applied, it was also recorded on the daily record that cream had been applied but this did not state which cream had been administered. Where prescribed creams are being administered more robust records needs to be kept. No one living at the home administered their own medication at the time of inspection. Medication in the custody of the home is handled according to the requirements of legislation and records are available, of medicines received, administered and leaving the home. The homes medication system is regularly audited by the local primary care trust and the home has a contract with a local pharmacist who should also complete regular audits. Care Homes for Adults (18-65 years) Page 22 of 34 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. Not all staff at the home are aware of the complaints procedure so they may not be aware of how to take forward complaints an behalf of people living at the home. Procedures and practice at the home should protect people from abuse. Evidence: The home has the necessary complaints procedure. Information taken from the homes AQAA indicated that the complaints procedures were reviewed in April 2009. During the visit we spoke with a number of staff about their role in taking forward complaints on behalf of the people living at the home. Some staff were clear about the procedures, however one member of staff was not clear about the procedures. The manager said procedures are discussed during the induction period for new staff. It is vital that all staff working at this home are aware of the process for supporting people living at the home with raising concerns given the limited communication needs of most of the residents. The home kept us informed about any concerns they received since the last inspection these were noted to have been addressed appropriately. Previous inspections had reviewed the policies and procedures for protecting people who live at the home and found these to be appropriate. Information provided in the AQAA indicated that the safeguarding policy and the policy for handling peoples finances were last reviewed in April 2009 but some of the other associated policies had not been reviewed since 2007. Staff spoken to had good understanding of the safeguarding policy and the need for them to report any instances where they felt someone living at the home needed to be safeguarded. Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: Individual financial records are kept for each person along with receipts for all transactions. These are checked by the manager monthly. There is a safe in the home for the safe storage of peoples monies the keys are held by the senior person in charge on each shift who is responsible for ensuring monies are given to staff as necessary for peoples expenditure. It is recommended as good practice that two people always withdraws monies from the safe. This will ensure better protection for people living at the home and staff. One person at the home manages their own finances other people have relatives or appointees who have responsibilities for their financial affairs. Care Homes for Adults (18-65 years) Page 24 of 34 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. Generally the physical design and layout of the building enables people to live in a safe, well-maintained and comfortable environment. Evidence: At this unannounced visit the home was found to be clean and free from offensive odours. The rooms occupied by people living at the home are well furnished and decorated. It was observed that the corridors needed to be redecorated. The manager said that they are in the process of renovating a part of the home for staff quarters and that the rest of the home will be redecorated once this is completed. The current renovations do not have any impact on the people living at the home. One of the en-suite bathroom is being renovated to improve access for the person using the room. There are bathroom facilities on the first floor and a shower room down stairs that can be used temporarily by the person living in this room. Since our last visit the home has fitted a new roof as well as repaired the fascia board at the rear of the building. A ramp has been fitted to the front of the building to improve wheel chair access and aid evacuation in case of fire. Part of the ceiling in the upstairs corridor sustained some water damage during the re roofing and the manager has plans for this to be repaired. Door guards have been fitted to prevent paint work from becoming chipped and a portable ramp is available to enable better access to the kitchen for people living at the home. The downstairs shower room has been renovated to ensure safe access to the shower and this is now in use. The premises are in keeping with the local community, and offers access to Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: local amenities and transport. Laundry facilities are appropriate and are sited in a separate area designated for the purpose. Equipment provided ensures foul laundry is washed at appropriate temperatures, and the washing machine has a sluicing facility. Laundry facilities do not intrude on the routines of people living at the home. Care Homes for Adults (18-65 years) Page 26 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained, skilled, safely recruited and in sufficient numbers to support the people who live there. Evidence: During the visit we spoke to four support workers and the manager. All had very good understanding of the needs of the people living in the home. Interactions observed between people living at the home and staff indicated that there is good rapport and that the staff know the residents well. One person spoken with said: I can tell Denise (the manager) and Simon (the responsible person ) what I think and can talk to them. The home operates at staffing levels of between five support workers during waking hours and two support worker during the night time. In addition the manager is also on shifts, a new deputy manager has recently being employed this will ensure the availability of at least one senior person at each day time shift. There is a team training plan and individual training needs analysis are in place. There was evidence of training being undertaking which relates to the needs of the people living in the home. Certificates for training provided were not always available on the records looked at and staff sometimes could not recall exactly what training they had received. Although the training records have improved since our last visit, these are now stored in individual files. New staff are inducted over a one day period and when asked about key Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: procedures such as the complaints procedure they were unable to recall. We would recommend that the initial induction period be structured over a longer period, this would ensure staff retains better information. It is also recommended that certificates are obtained and kept to support evidence of training. Information provided to us in the AQAA indicated that 70 percent of the homes staff are trained to NVQ level 2 and above. This includes staff who have a specific qualification to meet the needs of the people living in the home. The records of two staff who were recruited since our last visit were examined. These showed evidence of a robust recruitment procedure, with all key checks as required by regulations being undertaken. It was difficult to track the previous employment history on the application forms looked at, therefore these would need to be reviewed to ensure clarity. Supervision and support offered to staff is good, with all staff files sampled containing evidence that they receive formal one to one supervision on a regular basis,in addition to an annual appraisal. Staff meetings also take place regularly. Supervision records on one of the staff files looked at was undated, so it was difficult to say when these took place. Care Homes for Adults (18-65 years) Page 28 of 34 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. People living in this home benefits from a home which is consitently well managed in their best interest and where their views will be listeneed to. Evidence: The manager of the home is trained and qualified to undertake the role. Discussion with the manager and observation of practice indicated that she is dedicated to the task of managing the home and ensuring excellent outcomes for the people who live there. All records seen on the visit were organised and well maintained. The manager is aware of what improvements is needed and takes action to address any improvement in a timely way. The home works well with other disciplines and professionals to ensure the needs of the people living at the home are met. Where issues arise regarding peoples health swift and appropriate actions are taken by the home. The home continues to maintain consistently excellent outcomes for people who use the service. There was evidence of regular auditing of the homes systems by the manager, staff spoken to confirmed that the manager checks their practice on a monthly basis. The manager said the responsible person visits the home regularly although no regulation 26 reports were available. One person living at the home told us that they can tell both the Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: manager and the responsible person what they think. The home told us in their AQAA that they consult with people who live at the home by customer satisfaction surveys and involving people living at the home in monthly home meetings. There was evidence on the records looked at to show instances where the home had ensure the views of people living at the home were incorporated through capacity assessments. One social worker spoken to said they were: Really impressed with the care provided at the home, (the person they referred) has very complex needs. The home has been flexible and go the extra mile they have been a real advocate on his behalf especially with the hospital. The family is very happy he has come on in leaps and bounds. His behavior has reduced a lot whenever you see him he is always smiling. I have no concerns at all. The management of health and safety at this home is excellent, with no requirements identified. Information in the homes AQAA states, fire equipment was checked February 2009, premises electrical circuits were checked March 2009, gas appliance checked April 2009. The bath hoist had safety checks in August 2009. The manager said recommendations from fire safety reports have been actioned, water temperatures are checked weekly and shower heads are also disinfected on a weekly basis. There was evidence of fridge temperatures being monitored three times per day. Staff said they have received fire training and infection control training. Procedures and process are in place for the safe handling and storage of control of substances hazardous to health. All parts of the home was observed to be clean and safe at the time of out visit. Care Homes for Adults (18-65 years) Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 31 of 34 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 20 Where prescribed creams are being administered clear and precise records needs to be kept at all times. This will ensure that there is clear evidence to show that medicines are being given as prescribed. The manager needs to ensure that all staff working at the home are aware of the complaints procedure. This will ensure that they are aware of how to support people with communication difficulties in making complaints. That two people deal with any financial transactions relating to the finances of people living at the home at all times. Review the staff application form to ensure clarity in the employment history for new staff. That there are more formalised procedures in place for quality audits as part of the quality assurance system. This would include completion of regular reports on visits and Page 32 of 34 2 22 3 23 4 5 34 39 Care Homes for Adults (18-65 years) 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 checks made by the responsible person. Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 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 © (2010) Care Quality Commission (CQC). 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