Care Home: High Road 410-412

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What the care home does well Good and detailed assessments are carried out on all service users ensuring their involvement as far as possible. There is a strong staff comittment to ensuring that the needs and aspirations of service users are followed through. A good emphasis is placed on meeting the cultural and diverse needs of service users., including their dietary needs. Strong management and quality assurance systems are in place at 410 High Road. The environment is homely and service users are supported to personalise their private spaces. The management and staff maintain strong and positive links with service users` relatives and friends in their best interests. What has improved since the last inspection? Health action plans were updated and reviewed regularly. Action was taken to provide more appropriate dining chairs. Staffing deployment and levels are now more reflective of service users` needs. More training has been provided in meeting the specific needs of service users. What the care home could do better: Ensure that handwritten entries on the medication administration charts are signed and dated at all times. Explore with staff `how to improve the quality inputs from agency staff when they are used. Key inspection report Care homes for adults (18-65 years) Name: Address: High Road 410-412 410-412 High Road Ilford Essex IG1 1TW     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: Stanley Phipps     Date: 2 4 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: High Road 410-412 410-412 High Road Ilford Essex IG1 1TW 02082526256 02082526517 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.caretech-uk.com Sunnyside Care Home Ltd Name of registered manager (if applicable) Patrick Anthony Gayle Type of registration: Number of places registered: care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users who can be accommodated is: 7 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Physical disability - Code PD Date of last inspection Brief description of the care home 410-412 High Road Ilford is a Residential Home for seven adults with Sensory, Learning Disabilities and Mental Health Difficulties. The home has recently been registered and has undergone refurbishment of an existing double fronted three-storey house situated on the main Ilford High Road. Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 0 7 7 Brief description of the care home Since its original registration the home has changed owners in that as of 18th May 2006, the service has been acquired by a large private organisation under the provider name of CARETECH - Community Services Limited. The home is close to community facilities such as swimming pools, shops, Churches, a Mosque, Hindu temple and Synagogue. The home also has good transport access and is near Ilford station and regular bus services. There are seven bedrooms, all with a full en-suite, which includes either a bath or a shower. Six of the bedrooms have ceiling re-enforcements, in case of a need for a ceiling hoist. There is ramped access to the front of the premises and also to the garden area from the lounge/dining room. A statement of purpose is made available to all service users in the home and is kept in the main Office. Given the level of disabilities service users are likely to have, this document is also made available to relatives and stakeholders. A service user guide is also given to each service user upon admission to the home. Fees are currently charged at £1350 - £1880 per week. Items not included in these fees are holidays, clothing, hairdressing, toiletries, items of luxury of a personal nature and unlimited support to access the local community. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: An unannounced site visit was carried out on the 24/09/09, during which interviews and discussions were held with the management and staff, a small sample of service users, and relatives. Assessments were carried out on; the environment, all records required by regulation, activities, policies and procedures, medication management, staffing impact and recruitment, and the overall management practices in the home. Consideration was also given to feedback received from external professionals and information provided in the Annual Quality Assurance Assessment (AQAA) document provided by the registered persons. Given that it was key inspection of the service, our attention focused on the primarily the key minimum standards for Younger Adults. Care Homes for Adults (18-65 years) Page 6 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 7 of 28 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 8 of 28 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. Service users are assured that the home carries out a robust screening assessment prior to their admission, which takes into consideration - their wishes and a decision that home has the resources to meet their needs. They also have the benefit of receiving updated information about the home in a format that is better-suited to their diverse communication needs. Evidence: The assessment files of three of the most recently admitted service users were assessed and they identified a wide range of needs for each of the individuals concerned. The assessment tool used was that of CARETECHs and the assessments were carried out by the registered manager and a senior staff from the organisations commissioning team. There was good evidence that the home continued to obtain preadmission assessments from referring authorities so as to gather as full a picture as possible of each individual. From the information gathered service user plans were drawn up in relation to the needs identified. The process of admitting service users to the home continues to as far as possible Care Homes for Adults (18-65 years) Page 9 of 28 Evidence: ensure that service users and/or their representatives are involved in choosing whether the home is suitable to meet their needs. In this respect they have opportunities to view the facilities and each have the benefit of a trial stay at the home. It was noted that the statement of purpose have improved to ensure that it is more accessible to the service users group in terms of identifying what is provided at 410 High Road. All service users were given a copy of the service user guide. which is positive. Care Homes for Adults (18-65 years) Page 10 of 28 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. Service users continue to benefit from having comprehensive individual plans and risk assessments to enable them to work towards their individual goals in a safe manner. The management and staff remain pivotal to ensuring that service users are supported and encouraged to determine what is best for them. Evidence: Good evidence remained in place to demonstrate that service user plans were in place for each individual and that they were used as working tools. In one case, a recently admitted service user had a transitional plan in place to ensure that there was both consistency and continuity of care for the individual concerned. The key-working system continues to be an effective mechanism of ensuring both the coordination of care and support, and the maintenance of service users plans. Two service users spoken to confirmed that they knew what their personal plans contained and that they were quite happy with them. One relative informed that the manager and deputy were quite good in keeping her involved in her daughters care and support arrangements. Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: All of the sampled plans were updated, regularly reviewed and reflective of service users needs. Service users meet individually with their key-workers to review their care and discuss issues or developments on a regular basis or as they arise. They also have good access to advocacy services and some receive support from relatives or their representatives. From observation, talking to service users and members of staff, it was clear that service users are involved in making decisions particularly as it relates to their lives for example; types of food they eat, religious affiliations and activities. Evidence of this was drawn from the fact that some service users take responsibility semi-independently for various aspects of their well-being while others receive varying levels of support in this respect. What was important was that everyone worked towards some goal or life ambition and the staff were pivotal in enabling and supporting them with this, albeit at varying degrees. Risk assessments remain a key aspect of safely supporting service users in the home. In all of the cases sampled - updated information was available on how service users were enabled to maintain their independence while limiting the risk of coming into harm. It must be noted that the home caters primarily for service users with a physical disability and as such, it was important to see that they were linked to each of the service users plan. Staff spoken to showed a good awareness of the strengths and limitations of each individual and it was clear that the risk assessments were used as working tools during their engagement with each person. Two of the service users spoken to expressed the view that their risk assessments gave them more confidence to try and do more for themselves, which is positive. Care Homes for Adults (18-65 years) Page 12 of 28 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. Service users continue to participate in their community and benefit from a good range of social and personal activities. They are supported to maintain their personal networks, and are respected and treated in a dignified manner by all staff. Meals are provided in line with service users nutritional and cultural interests, and needs. Evidence: Service users continue to receive good support to take part in activities that were best suited to them. Each individual had an individual activity plan, which was reviewed in their weekly one to one talk time. From the records seen, some were much more structured while others were a bit more flexible. It was noted that a member of staff has the responsibility for coordinating activities. Internally, service users have access to a wide range of activities to include: board games,art, television, music (widely enjoyed by some individuals), a computer, which was under repair at the time of the visit, and stimulation provided by staff using a sensory box. They are also supported Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: by staff to take up activities in the wider community and an example of this is where in July two service users went out for lunch in the West End. A full range of activities undertaken was logged in the activities folder and what was useful to note is that where activities were not taken up - reasons for this as well as options were explored. To this end staff worked flexibly to ensure that service users received a quality experience whatever they chose. There were cases in which service users relatives took them out for a family based activity that added a great deal of value to their lives. Sound arrangements were in place to facilitate this. One individual spoke of how much she was looking forward to going to the cinema on the 25/9/09, although she was unsure what she wanted to see. She informed that the staff were very good at encouraging her to participate in activities of her choice, which she thoroughly enjoys. Despite the varying levels of disability, service users did enjoy full use of their community resources and again the management and staff worked creatively and flexibly to ensure this. One service user informed that she went to church the night before the inspection, while another was observed returning from an outing with her relative. Service users records bore evidence of their continued engagement with local entertainment centres, restaurants, shops, parks, the library, their GP and other religious establishments. Although a mini-bus is available for transporting service users, other forms of transport were also used to ensure that individual preferences and needs were considered in enabling them to widely use the community resources. In discussions with staff, most felt that resources were better deployed to support service user activity in the community, which is positive. Most of the service users have some level of involvement with their relatives and/or personal friends. Despite this being variable, a sound visiting policy is in place to facilitate these relationships. From observation, viewing records and speaking with service users and staff, the involvement of relatives and friends forms an essential and meaningful part of enabling service users to lead fulfilled lives. One individual had a relative who visited all the way from the St. Lucia in the Caribbean. Another spoke of her long standing friend who regularly visits and offers some level of support in her care. Some individuals enjoy short periods away from the home with their loved ones and as a matter of course, invitations are extended to relatives to social events and reviews. Contacts with relatives and friends are also maintained through letters and telephone calls and where possible transport is provided to ensure that friends and family networks, are maintained. Service users choices are reflected in their individual plans and monitored through Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: reviews, one to one talk time and in service user meetings. From observation, staffing interventions remained positive and those on duty were well aware of the various preferences of individual service users. Information on advocacy remains widely available to service users and some relatives take an active part in supporting their loved ones. Service users take an active part in; food shopping, activities, menuplanning using objects of reference, photos and picture cards, choosing their personal and cultural effects such as; hair/skin products/clothes, and in deciding their individual gender care. In discussion with the manager, he planned to look in greater detail at the sexuality of individual service users, with a view to providing more support to them as required in this area. On the day of the visit lunch consisted of beef stew and rice with mixed vegetables. An alternative in - fish fingers, green salad and brown bread was also available. All service users were very pleased with the meals provided in the home and this view was also echoed by relatives spoken to. The menus were assessed and were in line with service users wishes and nutritional requirements. They were also diverse e.g. use of Halal meat or the non-use of pork. Sound arrangements were in place to support service users at mealtimes, which was a relaxed affair. Service users had good access to snacks and drinks throughout the day. They continue to enjoy the benefits of freshly prepared meals, which included fresh vegetables. Fresh fruit was also widely available to all service users. This is a strong area of the homes operations. Care Homes for Adults (18-65 years) Page 15 of 28 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. Sound arrangements remain in place for the provision of personal support along with the emotional and physical needs of service users. This has been enhanced through improvements in reviewing health action plans. The support provided with medication continues to be a key feature in promoting and maintaining the health and well-being of all service users. However, handwritten entries on medication recording charts need to be signed at all times. Evidence: Service user plans were in place and found to be - individualised and used as working tools. Service users personal preferences and needs were detailed and so staff were very clear about the way, and level of support that each person required. It was noted that they continue to have a choice in who cares for them in relation to gender, and a good key-worker system ensures that the care and support is delivered in line with personal preferences. In assessing one of the service user plans, the personal support required to meet the individuals physical needs were quite specific and detailed. Staff worked extremely well in meeting the identified needs and the service user concerned was full of praise for the quality of the staffing input. This included praise for the work carried out with external professionals in achieving the desired outcomes for this Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: individual. From the two other plans assessed, a very similar standard of care support was provided in each case. On the day of the visit there was evidence of improvement in the quality of health action plans for all the service users living at 410 High Road. They were updated and accessible to service users and staff using them. All service users were registered with a GP and had good access to externally provided health care services such as: the dentist, district nurse, physiotherapist, chiropodist and opticians to name a few. The management and staff worked closely with each individual and were successful in enabling one individual to stop using a laxative, which resulted in greater personal comfort. Another was assisted to see a urologist with good follow up plans in place. In another case staff were proactive in ensuring that an individual got on to the waiting list for neurological rehabilitation. Good arrangements were also in place for psychological and diabetic input for other service users. The provision for, and monitoring of service users healthcare was very good. Generally the support provided with medication effectively ensures that service users healthcare is promoted. At the time of the visit, all service users needed support to have their medication and staff handling medication had appropriate training to so do. A medication policy was in place and clear instructions remained available to staff to minimise the risk of errors being made. Medication records were generally good apart from the lack of signatures when handwritten entries were made. It would be very unlikely that this would adversely affect the well-being of service users, however it needs to be done to demonstrate accountability for the management of medication. The registered manager acted upon a recommendation by re-locating the medication cabinet, to improve safety and ease of accessibility. Medication monitoring is carried internally through spot checks by the deputy manager and externally by the medication providers. Care Homes for Adults (18-65 years) Page 17 of 28 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. The management and staff have a positive approach in dealing with complaints and concerns, which is reassuring to service users and their relatives. Sound safeguarding protocols and practices ensure that service users and protected from the risk of harm from abuse. Evidence: At the time of the visit, the complaints procedure was under review to make it more accessible to the service user group, given their specialist communication needs.The existing procedure remained available to all service users, staff, external professionals and relatives. In speaking with a sample of service users and a relative, they demonstrated a sound awareness of their right to complain, as well as who they could complain to. The complaints record was examined and no complaints were recorded since the last inspection (October 2007). Staff spoken to had a good understanding of their role in supporting service users to complain should they become unhappy with any aspect of the service. It was noted that staff were adept to the communication needs of each service user and so are generally able to identify concerns as they arise. The manager uses concerns and complaints as a mechanism for evaluating and improving the service and so concerns are picked up and treated just as important as complaints. A wide range of forums are available for service users to complain or raise a concern. Although good systems remained in place to safeguard service users, there was one Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: safeguarding matter raised since the last inspection. This matter was handled by the London Borough of Waltham Forest, the outcome of which was unsubstantiated. However, several recommendations were made to reduce the risk of such allegations and by extension, the risk of service users coming to harm. The registered persons did comply with all of the recommendations and worked cooperatively to ensure improved outcomes for all service users. Importantly they acted to ensure that specialist support was arranged for the service user concerned who remained at the home. During the inspection the individual concerned expressed great satisfaction with the service. All staff have safeguarding training and access to an updated safeguarding policy/procedure. Sound recruitment and health and safety practices ensure that service users are protected from coming to harm. Care Homes for Adults (18-65 years) Page 19 of 28 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. Service users continue to enjoy living in a safe and homely environment. Regular monitoring, maintenance, and high standards of cleanliness ensures that 410 High Road remains a comfortable and safe place for both service users and staff. Evidence: The home was in good decorative order, clean and generally tidy throughout the inspection. Service users were using various aspects of the home - communal and private at different times and did so with ease and comfort. Relatives and external professionals spoken to, were satisfied with the quality of the furnishings, fixtures and decor at 410 High Road. Plans were in place to decorate the quiet room on the ground floor and a quotation was obtained for carpet replacement. Plans were also in place to cut the rear garden lawn and the dining chairs were replaced as required by the last inspection. Clear protocols were set out for dealing with general maintenance and refurbishments, and the quality of environment is monitored on a monthly basis by the area manager. Service users therefore live in a homely environment and they were quite pleased with it. Good systems remained in place to ensure that the home is clean and hygienic. This includes; health and safety practices, quality monitoring and staff training. In a small number of cases service users participate in keeping the environment clean, for Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: example one individual likes to do a bit of dusting, which is encouraged. Handling soiled linen remains satisfactory and staff demonstrated a good understanding of their role with regard to health and safety. Infection control protocols were in place including facilities for hand washing. It was noted that clear guidance was in place for dealing with swine flu, which was positive. Laundry facilities remain appropriate and there is continued compliance with the Water Supplies Regulations 1999. Care Homes for Adults (18-65 years) Page 21 of 28 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. Service users continue to benefit from having a staff team that is committed and wellsupported to meet their needs. An improvement in the staffing deployment and levels gives greater assurances that service users needs would be met at most times. Recruitment practices also ensure that service users remain safe while living at 410 High Road. Evidence: There was evidence that the management and staff were motivated in providing a good service at 410 High Road. Despite an increase in the number of service users, evidence taken from; the rosters, talking to staff, relatives and service users indicated that the staffing deployment had improved. In one case a staff was specifically contracted for up to four hours to provide one to one support for an individual. Service users were engaged in various activities both internal and external with readily available staff. One service user commented:staff are timely and responsive when supporting me. More importantly, the staff on duty had a good understanding of the support needs of each service user, which were complex and varied. The staffing view was unanimous and positive with regard to the levels and training provided, although one individual was concerned that when agency staff is used - permanent staff feel more under pressure. The view was that external staff are less productive, which is something the homes management would need to look into. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: On examining the recruitment information on the three most recently employed staff, recruitment practices were carried out to a good standard. All relevant checks were carried out for example: a minimum of two satisfactory references, satisfactory Criminal Records Bureau checks including Safeguarding of Vulnerable Adults (SOVA) First Checks, identification verifications and health declarations. Two staff interviewed confirmed that they went through a thorough process of recruitment to include attendance to an interview. All staff had the benefit of an induction and have been provided with a copy of the General Social Care Councils code of conduct, which gives good guiding principles in the delivery of care. It was also noted that one of the staff was undergoing their probation, which seeks to confirm their suitability for the job. Service users can be assured that only suitable staff are selected to work with them. The registered manager has in place a training matrix which identifies the training that staff have either undertaken or need to undertake. This is based on the needs of the service users, which were at the centre of team meetings and service user reviews. There were thirteen permanent staff with more than fifty per cent achieving at least an NVQ Level two in Care. The training provided included mandatory areas along with those areas specific to the needs of the service user group. Some of the training that has been provided since the last inspection included: Mental Capacity Act, and Deprivation of Liberty Safeguards (DOLS), Diabetes, Safeguarding Vulnerable Adults, First Aid, Epilepsy, Health and Safety, Food Hygiene and Moving and Handling. Two of the staff interviewed were satisfied with the quality and level of training that is provided by the registered persons. Service users therefore benefit from a staff team that have the skills and support to meet their needs. Care Homes for Adults (18-65 years) Page 23 of 28 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. Service users continue to enjoy living in a home that is well-managed with their best interests at heart. Good quality assurance systems including monitoring systems, were in place to ensure that the service is developed in line with service users needs and wishes. Health and safety protocols and practices are in place to promote the safety and welfare of service users and staff. Evidence: The registered manager is suitably experienced and qualified to run the home and he has retained the support of his deputy manager, which adds stability to the managerial aspect of the home. The staffing structure now includes the manager, the deputy, two senior support workers and nine support workers. From talking to staff, service users, and relatives, the registered manager has the support, confidence and respect in his leadership. He has a good understanding of the needs of the service users and is usually involved in all first line assessments and so is in touch with the service as a whole. There was also evidence to confirm that he takes responsibility for his professional development and learning, and has effective support from his area manager. His cooperation in complying with the national minimum standards and its Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: associated regulations could only result in better outcomes for service users. Service users progress and development is measured through; their reviews, service user surveys and from the feedback obtained from monthly service user meetings. Regular audits in the form of monthly provider monitoring (Regulation 26) visits were carried out. They were detailed with a good system for achieving desired outcomes. An annual development plan was in place for the home, which is outcome-focused with service users and staff in mind. An annual audit of the service was undertaken which was linked to the annual development plan. Staffing views are gathered regularly at monthly staff meetings with a view to improving and developing the service. Policies and procedures were generally updated and although it remains unclear as to how service users are involved in staffing recruitment, this remains an area that is continually growing. A number of health and safety records were assessed during the course of the inspection, which included; food hygiene, fire safety, infection control, hoist maintenance, risk assessments - both specific and generic, emergency lighting, portable appliance testing, health and safety audits,gas, and electrical safety reports and certificates.They were all found to be in order and updated and it was noted that the service received a five-star rating in Food Safety (6/5/09) from the London Borough of Redbridge. All levels of staff received health and safety training, and health and safety policies were updated. A record of accidents and incidents was held in the home and from the evidence gathered the home remained compliant with the building, fire and environmental regulations. As such the health and safety practices and protocols ensure that service users and staff continue to live and work in a safe environment. Care Homes for Adults (18-65 years) Page 25 of 28 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 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 The registered manager 12/06/2010 must ensure that all hand written entries on the medication administration charts are signed and dated. This is to ensure that an accurate audit trail of all medication is maintained. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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