Care Home: Heathcotes Care (Hucknall and Watnall)

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What the care home does well +0The people in charge of Heathcotes Care (Hucknall and Watnall) are making it better for everybody and the group of people living there have been the same for some time.The people in charge of Heathcotes Care (Hucknall and Watnall) are always listening to the people who live there and have changed things in the ways that they want.People from outside, such as doctors, nurses and social workers, are regular visitors to the home and they have helped staff at the home to look after people properly and to be healthy. Staff at the home work well to give people a good life and they get regular training to help them do things even better.Staff look after people properly and treat them with respect.The new manager at the home does a good job.The home has been made a nicer place to live in by improvements to rooms the areas that everybody uses. People living at the home have said what they want changed about the building. What has improved since the last inspection? The people who run the home have done everything they were asked to at the last inspection and the way they run it has been improved. The home is a better place to live and this includes the improvements to thebuilding. Staff have had more training which has helped them do their jobs better and many have achieved an approved qualification. What the care home could do better: No statutory requirements have been made as a result of this inspection Everything is going well at the home and the people who run it don`t have to do too much more to improve things. Key inspection report Care homes for adults (18-65 years) Name: Address: Heathcotes Care (Hucknall and Watnall) 220 Watnall Road Hucknall Nottingham Nottinghamshire NG15 6EY The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Brian Marks Date: 1 7 1 1 2 0 0 9 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 31 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Heathcotes Care (Hucknall and Watnall) 220 Watnall Road Hucknall Nottingham Nottinghamshire NG15 6EY 01159636379 01159638222 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.heathcotes.net Heathcotes Care Ltd Name of registered manager (if applicable) Mrs Karen Lesley Tingle Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 12 12 0 0 care home 12 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is 12. The registered persons 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 are within the following categories: Learning disability - Code LD Mental Disorder - Code MD. Date of last inspection 2 0 1 1 2 0 0 8 Care Homes for Adults (18-65 years) Page 4 of 31 X2 A bit about the care home Heathcotes comprises of two large detached houses. Hucknall x6 x2 The home is situated in Hucknall. Accommodation in each house provides for up to six people, and there are large gardens accessible to residents. People have their own rooms and there is also shared facilities in each house People are encouraged to use community facilities, including day centres. Fees for accommodation are individual to each person. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 31 How we did our inspection: This is what the inspector did when they were at the care home X We came to the home without telling the manager before we came and spent part of two days there. We had received a lot of information about the home from the manager, the staff and people living at the home before we came. The information we received before we came helped us plan what we would do when we arrived. At the home we spoke to the manager who told how things had changed since we last came. We looked at a lot of papers and documents in the office that told us about the home. X5 We spoke to five staff who were working during the time we were at the home. Care Homes for Adults (18-65 years) Page 7 of 31 X5 We spoke to five people who live at the home about their rooms and how much they enjoy living there. We walked around the home and saw how it had been improved. This is the first inspection of this home since 20 November 2008 - one year ago. What the care home does well 0 The people in charge of Heathcotes Care (Hucknall and Watnall) are making it better for everybody and the group of people living there have been the same for some time. The people in charge of Heathcotes Care (Hucknall and Watnall) are always listening to the people who live there and have changed things in the ways that they want. People from outside, such as doctors, nurses and social workers, are regular visitors to the home and they have helped staff at the home to look after people properly and to be healthy. Staff at the home work well to give people a good life and they get regular training to help them do things even better. Care Homes for Adults (18-65 years) Page 8 of 31 Staff look after people properly and treat them with respect. The new manager at the home does a good job. The home has been made a nicer place to live in by improvements to rooms the areas that everybody uses. People living at the home have said what they want changed about the building. What has got better from the last inspection The people who run the home have done everything they were asked to at the last inspection and the way they run it has been improved. The home is a better place to live and this includes the improvements to the Care Homes for Adults (18-65 years) Page 9 of 31 building. Staff have had more training which has helped them do their jobs better and many have achieved an approved qualification. What the care home could do better 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 Brian Marks Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Care Homes for Adults (18-65 years) Page 10 of 31 03000 616161 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 11 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 12 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs and hopes of individuals are identified before they move to the home, so that these are properly planned for and people are assured that the home is right for them. Evidence: In the AQAA we were told that comprehensive assessments are carried out before a new person moves to the home and that this is started in the persons familiar settings before they complete a move. We were told that trial visits and transition plans are organised and these allow for the person to plan their room, acquire information about the home and the services offered and to give reassurances to all concerned about the future. Transitional periods have been extended to allow people to have plenty of time to make decisions about the future and for them to see how well they will get on with the other people living a the home. Since the last inspection there have been no new people at the home but we looked at the care records of two people who had moved in during 2005 and 2008 to see how their admission had been arranged. From looking at these records, we were able to confirm that detailed assessments of need were carried out before they came to live at the home. These involved all the important people in their lives and were completed by senior staff Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: from the home as well as professionals from relevant health and social care services. Further assessments had been completed about their lives after they had decided to stay at the home and more recently the parent company has introduced assessment procedures that relate to peoples ability to make decisions for themselves under the Mental Capacity Act, which will help make sure that peoples interests are fully protected. Each of the files looked at held a record that indicated that the key documents had been monitored by the manager regularly; this indicates that actions and interventions by staff are based on up to date information. The people living at the home that we spoke to told us that the home has always been there to help us and now we go to college and do a lot of good things that we want to do and that I have always been able to decide for myself and since I came here have built up outside contacts that the home helps me to keep. Care Homes for Adults (18-65 years) Page 14 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents care needs have been assessed, risk factors identified and care planned in ways that reflect their individual preferences and abilities and staff are working in more person centred ways. Evidence: In the AQAA we were told that all the people living at the home have care plans, which are detailed, comprehensive and are produced with the full involvement of the person concerned. We were told that the care plans are person centred, live documents that are holistic in nature and that staff use creative methods such as pictures to record preferences and to encourage involvement. The two care records we looked at had comprehensive personal care plans, prepared mainly for use by staff but which were very detailed and individualised to the person concerned. These plans included detailed actions for staff to take in all key areas of the persons life such as anxiety management and associated behaviours, promoting independence, community access and helping with choices and decisions. All of the areas Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: that indicated an element of risk to the people concerned were supported by detailed risk assessments that made sure nobody would come to any harm from the work being carried out. Accompanying these more traditional documents was a Listen to Me workbook which described key areas of the persons daily life in first person terms, a detailed Health Action document, again written in the first person, and a detailed assessment and checklist that identified limitations imposed by the recently introduced Mental Capacity Act. The latter clearly establishes rights and responsibilities and offers protection in a very clear explicit way. The individual concerned retains a booklet that summarises the main support plan in an easy read picture style and is used by them to understand and give insight into particular aspects of their support. There was clear evidence that the person concerned and their representative had been involved in the process of creating plans for care and support, and also a clear indication that all the support plans and summaries had been looked at regularly and updated where necessary, and also of the involvement of outside professionals. There were also background histories and personal profiles, along with agreements and consent forms signed by the individual concerned, and overall it was clear that the care documentation indicated that staff were working with up to date information and in ways that put the person at the centre of things. We spoke to most of the people living at the home who were willing and able to meet with us and they all said how very happy they were at the home and how they all get on really well together, and that staff are really good too. One person said that they are all friends here and Ive got no bad things to say about anything. Another, who has quite a lot of independence around the home told us about her plans to move on and how the homes staff work hard to keep up standards and how she has been helped to organise my life and make decisions for myself; the staff never put obstacles in my way or stop me from doing anything. She told us that she had a big review meeting that afternoon and about the plans to go and see another home where she would take another step towards being more independent. Staff were all observed interacting in a relaxed and friendly manner with the people living at the home and we saw how the latter were also encouraged to help with domestic activities, including room cleaning and helping in the laundry. Care Homes for Adults (18-65 years) Page 16 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are supported by the homes staff to enjoy a wide range of social, educational and leisure activities of their choice, so that independence and decision making are encouraged and they enjoy as many opportunities as possible. Evidence: In the AQAA we were told that people are given the opportunity to access activities of their own choice and are encouraged to get involved in community based activities to encourage inclusion and promote a sense of belonging. They are also involved in vocational activities, work placements and a wide range of leisure activities; adequate staff support is made available to help them achieve this. Discussion with staff and observations made during the visit confirmed that the daily routines of the home continue to be flexible and residents were seen in both of the houses by themselves or with staff during the inspection. Since September a good number of people living at the home have started attendance at local college courses and one that we spoke to described her enthusiasm for a number of horticultural activities Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: that she has extended to the gardens at the home: this year we grew some giant sunflowers and are planning a vegetable patch for next year. Two others, who are not able to go out to college receive the services of college tutors for two sessions of activities within the home, centred around arts and crafts and gardening. A number of activities for the more able are focused on improving domestic and community skills and we were told about simple cooking and catering activities, and spoke to one person who works in the college cafeteria. Another told us that I help with the shopping and cleaning and at my big review this afternoon we will be discussing another place for me to live where I can be more independent. We talked about a wide range of leisure activities that people are involved in, both inside and outside the home and these include music, DVDs, knitting, artwork as well as visits to the local gym, bowling alley and snooker hall within the wider community; this is all with staff support. They also told us that visits to local shops, pubs, cinemas and restaurants are regular, and about shopping trips to Mansfield and Nottingham. Arrangements for holidays have been made that included a camping trip earlier in the year. Contact with their families is varied, ranging from weekly to none at all; one told us how she regularly goes to see her mother in Chester. The staff we spoke to were keen to emphasise the important of activities and community contact; they said that stimulation is good to overcome boredom and frustration and the links with local community facilities we have worked to develop have been successful and are very supportive. We noted that much of the activities are carried out with individuals but that some choose to develop friendships and do things in small groups. The catering arrangements at the home are very domestic and flexible in style and we were told that the 6 week menu is a guide but that staff more or less follow the menu plan for the evening meal. The feedback received was positive about the meals provided and we were told that the food is very nice and there is something there for everybody to enjoy. Staff told us that some of the people living at the home join in with the kitchen arrangements and the weekly supermarket shopping trip, and that birthdays and takeaway meals are a regular feature; meals can be changed on the day if the group decides. They also told us that home cooking and healthy eating are the principle they try to work to, and fresh fruit and vegetables were seen in the kitchen store. Overall foodstocks seen in the kitchen and storage areas were satisfactory. Staff also told us how they have seen a recent increase in involvement in domestic activities at the home. Care Homes for Adults (18-65 years) Page 18 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal and health needs of people at the home are dealt with in a satisfactory way, and they continue to receive good support from outside professionals; they have access to local services like everybody else. Evidence: In the AQAA we were told that people living at the home receive personal care in the way that they prefer and that their health and medication needs are met with the involvement of their own GP and other services such as dentist, chiropody, community nurse and psychiatrist. All appointments and their outcomes are recorded in individual care records and their keyworker makes sure that everything that is needed is provided for. Care records indicated that the people living at the home require differing levels of personal care support or prompting with self care, and the care plans indicated detailed action steps for staff to follow where support is necessary. As reported before they are encouraged to do as much for themselves as they can and this is reflected in the personal plans we looked at. Care plans confirmed the involvement of local Learning Disability Services professionals where necessary, although all have support from a social worker and some see a psychiatrist at a local health service clinic. Records indicated that people also have routine access to general healthcare services such as GP but the manager Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: confirmed they were generally all in good health. Individual Health Action Plans are used for documenting all of this activity. As noted above written risk assessments are identified on individual care records and they include such areas as hot water, bathing and receiving personal care, and any medication needs; there were regular monitoring checks taking place on weight and personal care activities. We saw from written records that everybody receiving prescribed medication require staff help with its management. Examination of the arrangements for the receipt, storage and administration of medicines indicated that these were satisfactory, and there was indication of audit checks being carried out by the team leaders and the manager. Medication was stored securely and the home uses a Monitored Dosage System for the dispensing of most of the medicines in use; entries in the written records had been made properly. Care Homes for Adults (18-65 years) Page 20 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are protected by having their rights to complain upheld and by staff who understand their responsibility to report concerns and to safeguard vulnerable people from harm. Evidence: In the AQAA we were told that a system is in place and has been developed to ensure that complaints by service users and others on their behalf are listened to acted and upon accordingly. The complaints procedure, designed to protect vulnerable people from possible abuse and harm, is available in a simplified format that may be understood by them. We were also told that records of all complaints and their outcomes are held on file and are used to learn from things that have gone wrong. The home has a comprehensive complaints policy and procedure that is on display, and this includes an easy read summary referred to above, a copy of which is given to everybody living at the home. Records indicated that there had been one complaint investigated by the manager since the last inspection, and it was resolved soon after it was made. The small size of the home and ready availability of senior staff means that concerns and problems are usually dealt with immediately and informally as they arise. The home has a copy of the statutory safeguarding procedures and other national guidance, and records indicated that the manager had attended training the trainer sessions provided by the Local Authority. This has resulted in the issue being kept at a high profile with the staff group and all have been given a good grounding in the subject. Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: There has been one incident since the last inspection which resulted in an investigation under these procedures by key staff from the local Adult Social Services Department; the manager and staff involved had acted properly to report and protect as they are required and the outcome of the investigation did not substantiate any ongoing issues for the home to resolve. It is the nature of a small number of people living at the home that their emotional lives sometimes result in untoward incidents occurring. There are now systems in place to record these incidents and the record indicated that there had been eight in the past two months. These were instances of brief abscondings and minor occurrences of slapping and hitting out. Records also indicated one incident where staff had to use physical restraint and this was fully reviewed and evaluated by the manager; all staff have received appropriate training and instruction in how to manage such situations and this incident was successfully managed. Care Homes for Adults (18-65 years) Page 22 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home have continued to benefit from a homely domestic style environment that is equipped to meet their needs. Evidence: In the AQAA we were told that the home environment is appropriate for individual needs, is accessible to the local community and is well maintained. We were also told that peoples bedrooms are individualised and they are given the choice to decide how they want their bedrooms decorated. We were told how the home is designed to be homely and to avoid any institutional feel or appearance. However we were also told that the entire building has been assessed for risks and any that have been identified have been minimised to make the place safe for people to live in. We made a brief tour of the two buildings and found them clean, tidy and offering domestic style accommodation which people occupy in single rooms with all the required facilities. Good standards of decoration have been maintained and the manager described how they had almost completed a programme of complete refurbishment of both buildings since the last inspection, with only the kitchen and bathrooms in Hucknall requiring further attention. The home had been visited earlier in the year by the Environmental Health and Fire Officers and all their recommendations have been dealt with. Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: All the bedrooms are very much to each occupants individual choice of style and furnishing, and all have televisions and other electric equipment for them to use. They are personalised with pictures, personal momentoes and photographs. The manager described a continuous programme of decoration, and there have been recent improvements to the garden which have allowed people to take part in vegetable growing, flower planting and use of the greenhouse. Staff are mainly responsible for cleaning and domestic arrangements around the building, but are helped by people tidying their own rooms. The laundry is domestic in style and is in use most days; again some of the people living at the home take all or some responsibility for their own laundry. Standards of cleanliness and hygiene around the home were good and everybodys clothes were clean and appropriate. Care Homes for Adults (18-65 years) Page 24 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has good systems for recruiting, training and supporting its staff, so that the interests of the people in their care are protected and their overall welfare is promoted. Evidence: In the AQAA we were told that staff levels are maintained in relation to resident needs, based on assessment and also that staff are recruited using processes that ensure those chosen have the appropriate values and attitudes to work effectively with the people at the home; the latter are involved in those processes. We were given details about staff training, induction and qualification and told how overall staff turnover has reduced significantly in the past year and that the staff have become more or less settled. The home employs a substantial number of support workers, to ensure that people in both houses are enabled to access all the service and facilities they are able to. This has resulted in daily staff numbers equivalent to the number of people living at the home with specific individuals requiring two staff when they are using community facilities outside the home. There is always a team leader on duty in each house to support and maintain staff activities, and they have supervisory responsibilities as a result. There is a separate group of staff who cover the night shifts. We looked at the recruitment files of the last two workers to be employed at the home and these indicated that a standardised procedure is in place and that all the proper references and checks were obtained. One of these staff had declared a past minor criminal offence, but the records of the assessment Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: of this were not clearly recorded. We looked at the overall training record for the staff team and sampled some individual files and these indicated a good standard of achievement across the relevant range of subjects. These included first aid, safe manual handling, safeguarding vulnerable adults, equal opportunities, fire and other key areas of health and safety and, as mentioned above, all staff have received instruction in managing aggressive and violent behaviours. A programme of training about recent legislation concerning peoples mental capacity and restraints on freedom has been started and the manager described plans to include awareness training in specific conditions such epilepsy and autism. The records of newly appointed staff indicated that they now undergo a structured programme of induction to their work and the manager described how this would lead to the new Learning Disability Qualification, itself leading to enrolment in the already recognised National Vocational Qualification (NVQ). Records indicated that the target for achievement of the latter had been achieved. The manager and staff at the home have benefited from the appointment of a new training officer for all the companys homes. The manager and staff on duty described how the staff team had stabilised through this year, how they had built up a lot of knowledge about the people at the home and described how they had come to understand and interpret those who had difficult communication skills. The staff members we spoke to told us about their working experiences at the home and said there is a lot of teamwork here which benefits the residents, the training has been very useful and has helped me do my job better, things are very positive at present and a sense of stability has been introduced; were all here to help each other, were all happy so the residents are more settled and job satisfaction is high and we are able to change peoples lives for the good. The staff also told us that because they work together for a lot of the time and, as there is always a team leader on duty, they feel that they have access to good support and are able to resolve difficulties quickly from the homes management. Staff records indicate that staff have an agreed contract for formal meetings with the manager or team leader (supervision) and these indicated that meetings were taking place monthly as agreed. We were told that any problems now get sorted out immediately, we meet regularly as a team for information sharing, they also act on our ideas, the manager is very supportive which wasnt the case with previous ones, and the manager is always available and I feel I can now contribute. Care Homes for Adults (18-65 years) Page 26 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is a well-managed and safe environment in which to live and work. Evidence: In the AQAA we were told about the homes new management and about improvements that have followed, with new systems in place and a new approach to making sure people involved with the home are happy with what it is being done. We were told about the new managers background and how she has made a positive impact on the running of the home. During the inspection, the manager confirmed that she had completed the Registered Managers Award qualification at NVQ level 4 in care and management and she told us about other qualifications she has achieved and is currently completing. Records indicated that she has continued to take up training opportunities with the other staff as they have been arranged. The manager has just completed the registration process with the Commission and has wide experience of managing services for people with a learning disability that has also involved registration in other settings. As reported above, she is supported by a staff team that now enjoys improved stability, and the resulting consistency has allowed for the plans for the home to be formulated under an Annual Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: Plan that is completed and evaluated as part of steady development and growth. There was a relaxed atmosphere at the home throughout our visit and everybody spoken to was positive about the impact the manager has made on improving things at the home. They told us that the manager has changed a lot of things since she arrived, it was appalling here when I first arrived last year, the manager has made a big difference and everybody seems to working much harder, things are now on the up, a 100 per cent improvement on this time last year, things have changed a lot this year with better planning for activities and routines, and it feels like we are being valued now, it feels like a proper home. The manager is the only one for such a long time who has taken an interest. The manager and area manager described methods by which people living at the home and their supporters give feedback and how this is now being organised from company HQ regularly. Both managers carry out a number of regular audits and checks which are fed into the overall management processes of the company. Everybody living at the home has an external evaluation meeting with a social worker, every six months or more regularly, and all key people are invited to contribute to this and give their opinion as to how things are going. The manager also keeps outside professionals in the information loop through a monthly report on each individual. As we have noted above one of the people we spoke to was looking forward to her big meeting on the afternoon of the inspection in which she would be making plans for future changes in her life. Staff also told us about the weekly consultation meeting with people living at the home when everybody is given the chance to have their say, and this was confirmed by the people we spoke to. In the AQAA the manager told us about standards of health and safety activity and regular servicing of equipment at the home, and observations made around the building and a sample of fire safety and servicing records indicated that the home was hazard free at the time of the inspection. The process of environmental risk assessment has become a routine basis for this level of activity. Care Homes for Adults (18-65 years) Page 28 of 31 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 29 of 31 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation 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 34 Clear records of declared criminal offences, and their evaluation, made by staff as part of recruitment should be made to allow for better management monitoring. Care Homes for Adults (18-65 years) Page 30 of 31 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 © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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