Care Home: Harrington Cottage

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What the care home does well It is evident through us talking to members of staff that the emotional health of the residents is of a high priority to the home and that staff are pro-active in maintaining and supporting residents with their emotional needs in order to maintain their quality of life in accordance to their plan of care. Staff demonstrate their commitment to achieving best outcomes for residents. Staff stated they expressed job satisfaction and confidence in the management of the home. Residents who spoke to us confirmed in their own words that they receive a good quality of care from staff who are courteous, respectful, communicate well, are experienced and deliver care in a individualised and professional manner. The AQAA showed and it was evidenced that staff are dedicated and flexible and many have known the residents for many years allowing good continuity and meaningful relationships to have been built. Furthermore, good communication, trust and mutual respect are evident. Staff work hard to ensure that residents feel valued and that every opportunity is afforded them for enjoyment and development. The home itself is attractive and well maintained and provides a warm, safe and enriching environment for residents. The manager is actively involved in the day-to-day management of the home and works with staff and residents. Residents expressed a great deal of satisfaction of the care provided and the staff are very supportive of the management and have a positive ethos. What has improved since the last inspection? It was evident through the inspection process that the home is taking steps to improve the standards of care. Improvements have been made in many areas including the redecoration of various parts of the home. The manager and staff team work towards constantly trying to improve the service and see`s improvement as always ongoing. What the care home could do better: The inspection identified several areas that were in need of being addressed. The main areas that were identified were :The AQAA confirmed information with regard to ensuring that the home can meet the needs of residents. We however identified a resident who`s increased mobility needs were not fully supported by a moving and handling assessment. The Statement of Purpose states the ethos of the home is to support residents with their needs. Good outcomes were evidenced throughout this report. However on documentary evidence viewed through the care tracking of several residents this was not the case for all residents. The home is required to review the assessments to ensure that arrangements have been made for appropriate support and that documentation is in place. Care plans included limited risk assessments. Not all areas of risk were identified in the documentation viewed. Whilst outcome for the residents were evidenced as being goodthe lack of thorough risk assessment could put them at risk. Management of risk takes into account the specialist needs and age of people who use the service, balanced with their aspirations for independence, choice and normal living. Where there are limitations on choice or facilities, it is in the person`s best interest. The resident understands and agrees the limitations where possible. Any limitations need to be fully documented and reviewed on a regular basis to ensure their ongoing relevance. The manager is aware of the shortfalls in documentation and has expressed a willingness to address these as a priority. No requirement has been made at this time as the Commission is confident that such improvements will be made. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Harrington Cottage Harrington Cottage Forge Hill Aldington Ashford Kent TN25 7DT     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: Robert Pettiford     Date: 1 4 0 5 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 29 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 29 Information about the care home Name of care home: Address: Harrington Cottage Forge Hill Harrington Cottage Aldington Ashford Kent TN25 7DT 01233720814 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) : Canterbury Oast Trust care home 6 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 6 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 - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Learning disability Date of last inspection Brief description of the care home Harrington Cottage is registered to provide accommodation, personal care and support to six people. A large cottage, set in its own extensive grounds, the home is set well back from the road and is approximately 20 minutes walk from the village shop and 15 minutes from the local pub. Access into the community relies on the homes transport (the bus service is reported as infrequent) so there are two dedicated vehicles provided for communal use. There is a computer and art classroom is situated in the grounds. Communal facilities consist of a good size dining room (that is used as a staff sleep Care Homes for Adults (18-65 years) Page 4 of 29 Brief description of the care home over area at night) and a large lounge, with TV, music and computer. The kitchen (which also houses the washing machine) is freely available for people to use. WC, shower and bathrooms are situated on the 1st floor, with a separate WC on the ground floor. Harrington Cottage is owned and operated by The Canterbury Oast Trust (C.O.T.), a charitable organisation and is managed by Miss Claire Harman, who has an NVQ4 qualification. Miss Harman has been the registered manager of the home since 14th July 2005, and was previously the deputy / acting manager. Fees are according to assessment with additional costs met by the service user for hairdressing, toiletries, magazines, personal admission fees and beauty / chiropody. Inspection reports can be obtained from the home. Care Homes for Adults (18-65 years) Page 5 of 29 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: The inspection took place on 14th May 2009. We agreed and explained the inspection process with the manager present at the time of the inspection . The manager is currently on leave. The focus of the inspection was to assess the home in accordance with the Care Home Regulations 2001 and the National Minimum Standards for Younger Adults. In some instances the judgement of compliance was based solely on verbal responses given by those spoken with. We used a varied method of gathering evidence to complete this inspection, preCare Homes for Adults (18-65 years) Page 6 of 29 inspection information such as the previous report and discussion and correspondence with the registered provider/manager was used in the planning process to support the inspector to explore any issues of concern and verify practise and service provision. The home has completed an annual quality assurance assessment questionnaire (AQAA), which was received on time. This provided us with information relating to What the home considers it does well, What we could do better, What has improved within the last 12 months and plans for improvement. The judgements have been made using the Key Lines of Regulatory Assessment (KLORA), which are guidelines that enable the CSCI to be able to make an informed decision about outcome areas. Further information can be found on the CSCI website with regards to information on KLORAs and AQAAs. Documentation and records were read. Time was spent reading a sample of written policies and procedures, reviewing care plans and records kept within the home. Other areas viewed included risk assessments, pre-admission assessments, rotas, training records and recruitment records. In addition an environmental tour took place. We identified several residents for case tracking. In addition the inspector had the opportunity to speak with several of the residents and a number of staff. Additional evidence was gained to inform judgements following the observation of many of the residents and their interactions with staff. What the care home does well: What has improved since the last inspection? What they could do better: The inspection identified several areas that were in need of being addressed. The main areas that were identified were :The AQAA confirmed information with regard to ensuring that the home can meet the needs of residents. We however identified a resident whos increased mobility needs were not fully supported by a moving and handling assessment. The Statement of Purpose states the ethos of the home is to support residents with their needs. Good outcomes were evidenced throughout this report. However on documentary evidence viewed through the care tracking of several residents this was not the case for all residents. The home is required to review the assessments to ensure that arrangements have been made for appropriate support and that documentation is in place. Care plans included limited risk assessments. Not all areas of risk were identified in the documentation viewed. Whilst outcome for the residents were evidenced as being good Care Homes for Adults (18-65 years) Page 8 of 29 the lack of thorough risk assessment could put them at risk. Management of risk takes into account the specialist needs and age of people who use the service, balanced with their aspirations for independence, choice and normal living. Where there are limitations on choice or facilities, it is in the persons best interest. The resident understands and agrees the limitations where possible. Any limitations need to be fully documented and reviewed on a regular basis to ensure their ongoing relevance. The manager is aware of the shortfalls in documentation and has expressed a willingness to address these as a priority. No requirement has been made at this time as the Commission is confident that such improvements will be made. 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 9 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and health care 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 29 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. Residents can be confident that their needs will be properly assessed prior to moving to the home. Evidence: Records held showed that residents have an assessment which identifies their individual needs prior to or on admission to the home. The information is provided by the residents, their families and health / social care professionals. The assessment focuses on achieving positive outcomes for people and this includes ensuring that the facilities, staffing and specialist services provided by the home meet needs of the individual. Before agreeing admission the service carefully considers the needs assessment for each individual prospective person and the capacity of the home to meet their needs. One resident has moved in since the last inspection. Information was seen of an assessment and the Commission discussed the arrangements to ensure a smooth transition to ensure the best possible outcome. Prospective Residents have the benefit of a trial period at Harrington Cottage to assess Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: whether the home can or cannot meet their needs. The AQAA also confirmed information with regard to ensuring that the home can meet the needs of residents. We however identified a resident whos increased mobility needs were not fully supported by a moving and handling assessment. The Statement of Purpose states the ethos of the home is to support residents with their needs. Good outcomes were evidenced throughout this report. However on documentary evidence viewed through the care tracking of several residents this was not the case for all residents. The home is required to review the assessments to ensure that arrangements have been made for appropriate support and that documentation is in place. The manager is aware of the shortfall in documentation and has expressed a willingness to address this shortfall as a priority. No requirement has been made at this time as the Commission is confident that improvements will be made. The assessment process as shown in the AQAA recognises cultural needs and the importance of promoting equality and diversity rather than just meeting needs in a reactive manner. The home evidenced in its AQAA and discussions with the manager that it reviews it equalities and diversity policy and ensures that all of the information and policies relating to residents are inclusive to all members of the community. Care Homes for Adults (18-65 years) Page 12 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from having clear individual plans that are comprehensive, identify their needs and are specific to the individual resident. However further evidence that residents are fully involved in the process and contribute towards setting their hopes aspirations and goals was recommended. Care plans showed that residents are enabled to make decisions and choices. Residents are enabled to take responsible risks however the risk assessment process needs to be better documented. Evidence: The key principles of the home for delivering a quality service are based on the belief that residents should be able to take control of their lives. The staff of the home are strongly committed to supporting all residents including those with limited communication or learning disabilities to make informed decisions, understand the Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: range of options which are available to them and have the right to take responsible risks. Evidence of this was gathered through taking to the residents, staff, manager and information contained in the AQAA. The home and its staff are committed to supporting the residents. This was evidenced through the care plans which detailed the areas of support that the resident needed and how this support is provided by the staff. There were guidelines in respect to routines and behaviour. The member of staff confirmed that these are reviewed with the residents on a regular basis and the families are supported to be involved. We recommended that a workbook be devised that explores with the resident areas of their lives that they wish to influence and change. This could be completed by the resident as their capacity and understanding allows to further reinforce their own personal sense of ownership of their plan of care and rights of citizenship. The plan focuses on current needs, development of skills. This follows the principles of person centred planning. Staff have the necessary training and skills to support and encourage the individual to be fully involved. Where Residents have limited communication, staff are skilled in using other methods of engagement. A key worker system provides additional support enabling one to one involvement. Residents rights to make decisions are respected and the care plans reflected their ability to make an informed judgement. Plans sampled demonstrated that the home used positive planned interventions to manage residents behaviour. Care plans included limited risk assessments. Not all areas of risk were identified in the documentation viewed. Whilst outcome for the residents were evidenced as being good the lack of thorough risk assessment could put them at risk. Management of risk takes into account the specialist needs and age of people who use the service, balanced with their aspirations for independence, choice and normal living. Where there are limitations on choice or facilities, it is in the persons best interest. The resident understands and agrees the limitations where possible. Any limitations need to be fully documented and reviewed on a regular basis to ensure their ongoing relevance. No statutory requirement has been made at this stage as the Commission is confident that the shortfall in documentation will be addressed. Care Homes for Adults (18-65 years) Page 14 of 29 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. Residents can be confident that they are offered a wide range of opportunities for personal development and to learn new skills and feel part of the wider community. Residents engage in a higher than average level of activities which are appropriate to their needs and capabilities. Residents are supported to maintain contact with family and friends, which ensures they continue to receive stimulation and emotional support. The residents benefit from the appetising meals and balanced diet offered at the home. Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: Residents are enabled to participate and contribute to meeting their own self care needs and day to day chores around the house. Discussion with residents and staff confirmed that the level of activities were of a high level and that they enjoyed a good level of stimulation through leisure and recreational activities both inside and outside the home. One resident is showing a sheep at the Kent County Show and spoke with us about the preparations needed and the pride he had in caring for the ewe. The staff were very supportive of his wishes and actively support him with his goals. We joined residents at 8:30am while they were getting ready for the day ahead. Residents were observed participating and interacting with staff. Residents have been enabled to and encouraged to participate in hobbies and activities which they had an interest in, such as maintaining and building on personal collections and specific recreational activities. The service actively encourages and provides imaginative and varied opportunities for Residents to develop and maintain social, emotional, communication and independent living skills at Harrington Cottage. The staff have a strong ethos and focuses on involving Residents in all areas of their life, and actively promotes the rights of individuals to make informed choices, providing links to specialist support when needed. The AQAA showed that residents are encouraged to use all aspects of their home according to their ability and wishes - these include laundry, cooking, cleaning and gardening. Residents are encouraged to pursue activities, hobbies and interests both inside and outside of the home. Staff encourage spontaneity and will often take advantage of good weather and undertake outings. Residents undertake a wide variety of activities including cinema, theatre, crafts, adult education, clubs and social functions. Key workers encourage integration within the community. It was confirmed that residents are enabled to maintain contact with relatives and friends where they wished to do so. Examples of such included provision for relatives and friends to visit the home and support being provided to enable services users to visit relatives or friends outside the home. Residents were consulted with regard to whom they saw and when and were under no compulsion to accept visitors should they not wish to do so. From observation, records viewed it was evident that residents were offered a choice of menus that meet their dietary needs and individual preferences. Meal times are flexible to suit the residents activities and schedules. Residents are able to choose where to eat, and also have facility to make drinks, meals and snacks for themselves and others with staff support should they wish. Residents on evidence seen have had Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: been involved in planning and choosing what to eat. One resident explained the menus and how his choice and preferences influenced the menu. He also spoke of his interest in cooking and related to the occasions he had personally helped cooked a meal. Care Homes for Adults (18-65 years) Page 17 of 29 Personal and health care 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. Residents feel supported by the level of help given and that their healthcare needs are addressed. Residents can feel confident that their wellbeing will be protected by the homes policy and procedures with regard to the handling and administration of medication. Evidence: The care plans fully documented the personal support required for individual Residents within Harrington Cottage. They reflected their choices and preferences and staff were observed offering guidance where needed. Times of getting up / going to bed, having baths, eating meals and other activities are flexible to allow for different Residents daily routines. All residents are allocated a key worker and we observed excellent interaction between staff and residents. Staff understand the key principles of giving personal support and are responsive to the varied and individual requirements of the residents. It is recognised that the delivery of personal care is highly individual and must be flexible, consistent and Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: reliable. Attention is given to ensuring privacy and dignity when delivering personal care and staff are sensitive to changing needs of Residents. When ever possible residents are able to have choice about who delivers their personal care. Where possible residents are supported and helped to be independent and responsible for their own personal hygiene and personal care. The care plans also fully documented all physical and emotional healthcare needs and where able Residents filled in or were supported to fill in appropriate forms. Within the care plans records of health care provided by G.P, chiropodist, dentist, and opticians was evident. Residents physical and emotional health is monitored on a daily basis. Through their daily records and these correspond with support assessments held in the care plans. This system ensures that all Residents receive continuity of care and supports potential complications and problems at an early stage. It is evident through records that the emotional health support is of a high priority to this home and the staff are pro-active in maintaining and supporting residents with their emotional needs in order to maintain their quality of life. Evidence to support the judgements made within this section have been obtained within the AQAA and discussions with the residents, manager and staff. We viewed the storage arrangements and some records including Medication Administration Record (MAR) sheets, and the protocols for the administration of PRN/As Required Medication. The medication was seen to be stored appropriately and administered in accordance to current guidance. Some recommendations were made to the manager with regard to ensuring any additions to the MAR sheets are doulble signed The staff member confirmed that all staff who dispense medication have received appropriate training from South Kent College. Care Homes for Adults (18-65 years) Page 19 of 29 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. Residents know that their concerns and complaints are taken seriously and are protected from the risks of abuse. Evidence: A copy of Harrington Cottage complaints procedures was reviewed. The procedure included details of how to complain, timescales for response and information for referring a complaint to the service provider. Residents within the service have an understanding of how to make a complaint as their capacity and understanding allows. The complaints procedure is highly visible within the service and is more readily available in different formats. The procedure however needed updating as it referred to the Care Quality Commissions previous legacy organisation. The homes Policy for the Protection of Residents and staff Whistle blowing procedure was discussed. These include procedures for the reporting of suspicion or evidence of abuse with a format for the recording of any allegations and action to be taken. Full training is provided adult protection. The home promotes an open culture where Residents feel safe and supported to share any concerns in relation to their protection and safety. Policies and procedures regarding protection are in place. Any referrals made have been dealt with appropriately and were well managed by the home. The home ensures through training, review and quality monitoring that care staff fully Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: comply with the policies and procedures provided in relation to protecting and safeguarding the rights of people who use the service. Staff spoken with had a good understanding of abuse and how to address it should it be evidenced. Criminal Record Bureau Checks (CRB) have been obtained for all staff. Care Homes for Adults (18-65 years) Page 21 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a clean comfortable home, which is suitable for their needs. Evidence: It was apparent that the individual and collective needs are being met in a comfortable environment. The standard of internal decoration and fixtures and fittings are well maintained and of a good quality. The home benefits from a selection of communal areas thus affording residents space should they so wish or desire. The AQAA states that various parts of the home has been redecorated, namely the hallway, stairs and landing. A new downstairs wetroom has also been installed in response to residents needs. Plans are also in place to update the upstairs bathroom. The premises are kept exceptionally clean, hygienic throughout and systems are in place to control the spread of infection. The laundry facilities currently meet the needs of the residents living within the home. Care Homes for Adults (18-65 years) Page 22 of 29 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. Residents care, social and emotional needs are promoted by the employment of caring and suitably trained staff. Residents are protected from potential abuse by the homes robust staff recruitment procedures. Evidence: Staff members spoken with discussed the training they had undertaken and felt well supported. From discussions with the manager, observations and reviewing the staff rotas more than sufficient staff were on duty at the time of inspection to meet the residents needs. The availability of the manager meets with the needs of the service and sufficient staff are available at all times. Staff are receptive to residents needs and work together as a team. The staff training records indicated planned and undertaken training. The manager evidenced that individual and group staff training needs had been identified. A wide range of training has been identified for all staff . The manager present confirmed that the induction programme adopted complies fully with the recommendations of the Skills for Care Councils current guidance. The staff training records indicated planned and undertaken training in all the key Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: areas. Core training in Infection control, Moving and Handling, Basic Life support, fire training, food hygiene, and Adult protection has been provided. Core courses are undertaken by staff to maintain current qualifications and for protection of residents. Staff have achieved NVQ qualifications in Care to level 2 or above. Many of the staff are qualified at a much higher level, thus exceeding the required standards. The service has a recruitment procedure that has the needs of people who use the service at its core. The recruitment of good quality carers is seen as integral to the delivery of an excellent service. This was evidenced through discussions with the staff team and the manager. The service is highly selective, with the recruitment of the right person for the job being more important to the filling of a vacancy. Whilst the Commission did not view details of the homes recruitment procedures the standard was met at the previous inspection and no evidence or intelligence would suggest that it does not continue to be met. Care Homes for Adults (18-65 years) Page 24 of 29 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. Residents benefit from living in an overall well run and managed home. Residents and or their relatives can be fully confident that their views and opinions effect how the home is run and that their best interest are safeguarded by appropriate policies and procedures. Residents can always feel fully confident that their health and safety/ welfare is protected by robust policies/ procedures and safety checks. Evidence: The registered manager is actively involved in the day-to-day management of the home and works with staff and residents. Outcomes for the quality of care are excellent. However shortfalls identified within this report with regard to documentation potentially put residents at risk. The manager is aware of the shortfalls and has indicated a willingness to work with the Commission to address these issues. Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: Residents expressed a great deal of satisfaction of the care provided and the staff are very supported of the manager and have a positive ethos. From observation and staff feedback the manager offers a clear sense of direction and leadership, which staff and residents understand. Residents, their relatives and staff are encouraged to comment on the services the home offers and to voice any concerns they may have. The home operates a keyworker system to identify an individual staff member to directly to work with a service user on a one to one basis. The home has a quality assurance system. Quality monitoring systems provide management evidence that practice reflects the homes policies and procedures. However risk management has not been fully audited. Quality assurance was discussed and the views and opinions of many of the residents and stakeholders sought. The residents spoken with confirmed a great deal of satisfaction living within the home and felt confident that their views and opinions were valued by both staff and management. An appointed person of the registered provider of the home does regularly visit the home and complete what is known as a Regulation 26 visit. This requires the provider to assess the quality of care within the home and ensure that it is meeting with the required National Minimum Standards. The home has a full range of policies and procedures to promote and protect residents health and safety. Staff consistently follows these. There is full and clearly written recording of all safety checks and there is no evidence of a failure to comply with other legislation. There is a understanding of risk assessment and this is taken into account in all aspects of the running of the home, however the environmental risk assessment had not been updated. Quality assurance was discussed and the views and opinions of many of the residents and stakeholders sought. The residents spoken with confirmed a great deal of satisfaction living within the home and felt confident that their views and opinions were valued by both staff and management. Care Homes for Adults (18-65 years) Page 26 of 29 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 27 of 29 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 20 Some recommendations were made to the manager with regard to ensuring any additions to the MAR sheets are double signed Care Homes for Adults (18-65 years) Page 28 of 29 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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