Care Home: Hillcrest (Smethwick)

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What the care home does well There is sufficient numbers of staff and training is arranged to ensure they are competent in meeting the needs of the people who live here. Arrangements are made to ensure people`s personal, health care and social needs are met. There are systems for regularly consulting with individual`s about their preferred routines and activities and about the day-to-day running of the home. They continue to be encouraged to make decisions and are supported to take controlled risks, where possible, to enable them to lead independent lifestyles. Suitable health and safety checks are carried out on the premises, appliances and equipment. This ensures people continue to be provided with a comfortable and safe place to live. What has improved since the last inspection? People`s files contain a copy of their service contract and improved records are kept of discussions held with the individuals. Their records show the service has further improved its approach to person-centred care planning. However, people would benefit from being provided with care plans and additional information in more user-friendly formats. Recruitment records are available for inspection on the premises. However, there were some shortfalls in recording which the service should address to ensure the welfare of people living in the home is fully protected. The service has implements a more planned approach to identifying and addressing the overall training needs of the staff team and the needs of individual members of staff. What the care home could do better: The outcome of people`s reviews should be recorded promptly by the service. This will ensure, where applicable, care plans are updated any changes in how a person`s needs are to be met can be accessed by staff. Periodic reviews of policies and procedures should be carried out to ensure people`s rights and best interests continue to be safeguarded. The service has yet to implement a comprehensive quality assurance system for all aspects of the home and produce an annual development plan to meet the changing needs and aspirations of the people living in the home. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Hillcrest (Smethwick) 13 William Road Smethwick West Midlands B67 6LN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Linda Elsaleh     Date: 0 8 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Hillcrest (Smethwick) 13 William Road Smethwick West Midlands B67 6LN 01214294645 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Michael Jenkins care home 3 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 3 The maximum number of service users to be accommodated is 3. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender; whose primary care needs on admission to the home are within the following category: Learning disability - Code LD, maximum number of places 3. Date of last inspection Brief description of the care home Hillcrest is a small home providing accommodation and care for three adults with learning difficulties. The property is a traditional semi-detached house, well maintained, and situated in a residential area of Smethwick. There is a small driveway providing limited off-road parking. Visitors are able to park on the road close to the home. To the rear of the premises is a garden, with a lawn area, greenhouse and, at the bottom of the garden, a summerhouse. The home is situated close to public transport routes. The ground floor of the house comprises a communal sitting room, kitchen, conservatory/dining area, laundry facilities, toilet and one bedroom. The first floor comprises of two large bedrooms, a walk-in shower room with wash hand basin and toilet. The office/sleeping in room for use by staff is also located on this floor. The facilities are well maintained and the decor and furnishings provide a warm, homely Care Homes for Adults (18-65 years) Page 4 of 31 Brief description of the care home and comfortable ambience. The home should be contacted for details of the current fees charged for this service. 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 peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. This unannounced inspection was carried out on 7th & 11th May 2009. Our findings are based on the information received by the Care Quality Commission (CQC), examination of relevant records and documents kept at the home, discussions with staff and people living in the home and observations made during this visit. At the time of this visit there was no registered manager for the service and two people were living in the home. The atmosphere was relaxed and friendly and people told us I like living here and Its good here and I like the staff. Care Homes for Adults (18-65 years) Page 6 of 31 Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 31 Care Homes for Adults (18-65 years) Page 9 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 10 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. Information provided about the service should be provided in alternative formats. This will give people better access to information which will enable them to make an informed choice about where to live. Assessment procedures are in place to ensure the service is able to meet the individuals aspirations and needs. There are opportunities for them to visit and stay over before a placement is agreed. Evidence: We were shown a copy of the Statement of Purpose and Service User Guide. Both documents are provided in a standard written format. This information should be provided in alternative formats that are suitable for the people who use the service. The services referral and admission policy and procedures includes details of the assessment process and the opportunities provided for people to visit and meet the residents and staff. Arrangements are also made for people to stay at the home on a Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: trial basis prior to a placement being agreed. A copy of the service contract is available on peoples files we looked at. The two people who live in the home have done so for the last ten years. The proprietors told us their needs and wishes strongly influence any decision made about another person coming to live in the home. Both people told us they like living here. Care Homes for Adults (18-65 years) Page 12 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. Peoples needs and personal goals are reflected in their care plans. They are encouraged to participate in decisions about their lives and supported to take controlled risks as part of an independent lifestyle. They meet regularly with staff to discuss their views about how the home is run. Evidence: We looked at the care plans for both people living in the home. These identify individuals personal and health care needs, their daily routines and activities and how these are to be met. Staff told us these are monitored each month. The monitoring dates are recorded on each persons file and were last done in February 2008. The care plan for one person identifies they require support with her/his communication needs. This person showed us their communication book which had clear pictures, symbols and signs. Staff told us they had worked closely with the Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: speech and language therapists to produce pictures, signs and symbols that would be the most meaningful for the individual. We saw copies of the assessments reports and progress records on the persons file. The proprietor told us reviews are held regularly and attended by relevant health and social care professionals. Individuals are consulted about who they would like to attend, for example a family member or advocate. The minutes of the reviews held in February and September 2008 show the person attended on both occasions. The minutes of the March review for the other person shows they did not attend and the September minutes were not on her/his file. The proprietor is advised to record the reason why a person does not attend their review meeting. The deputy told us reviews had been held this year, one persons was in March and the other in May. The minutes had not been received. There is no record of the outcome of these meetings on the peoples file. The service is advised to promptly record the outcome of reviews and ensure care plans are revised accordingly. This will ensure up to date information about any changes in a persons care needs and how these are to be met are available to staff. The people we spoke to told us they are able to make their own decisions, such as following their preferred routines and attending social events of their own choice. The proprietor told us staff have attended seminars and training in the Mental Capacity Act and Deprivation of Liberties Safeguarding. The daily records show how people are encouraged to make their own decisions. One person has been supported to access an independent advocate service. There has been a change in the time the transport arrives to take her/him to the day centre and s/he is finding it difficult to adjust. The care plan should be updated to reflect this change and include any strategies developed to support her/him during this period. People who live at the home meet and discuss their views and ideas about the day-today running of the home. The minutes of these meetings include discussions about meals and activities. One person told us Staff listen to what we say and gets things done. Staff told us the meetings have had a positive affect in the way people express their views and has improved communication between the staff and people who live here. Risk assessments are available on peoples files and reviewed regularly. Staff told us the people living in the home require different levels of support when in the community. For example, one person is able to travel independently when using the Ring and Ride service. Another person is easily distracted and unaware of the dangers when out in the community. This puts her/him at risk; therefore they are supported by staff when they go out. The person told us they like walking to the day Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: centre with a member of staff. Care Homes for Adults (18-65 years) Page 15 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides people opportunities for personal development and supports them to participate in a range of activities and maintain relationships with family and friends. Staff respect peoples rights to follow their chosen lifestyles and regularly consults them about the day-to-day running of the home. People are provided with varied and nutritious meals that meets their individual preferences. Mealtimes are arranged to suit the needs of the people who live here. Evidence: People living in the home have a varied social life. They attend local day centres and social clubs. One enjoys art & craft sessions and is a member of a luncheon club. S/he Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: told us s/he likes knitting and crochet, meeting up with friends and a person who use to live at Hillcrest. The other person attends college and told us s/he is re-starting gardening sessions. Staff told us the day centre had worked well with them to support this person to improve her/his communication skills. S/he also said they enjoy going to church on Sundays and attending different church events throughout the month. The other person prefers to spend a quiet day in the home on Sundays. Both people told us they enjoy going to the MENCAP social club on a Thursday and staff help them to book the Ring & Ride bus. After tea they got ready for their evening out. The deputy told us the Ring & Ride service was a safe way for them to travel independently. There is a selection of board games in the home and a television, dvd and music centre in the lounge. They continue to enjoy frequent holidays in Spain. The proprietor told us arrangements are made to go during spring or late summer when the weather is not at its hottest. The staff told us the older resident had found the journey a little difficult to cope with last year, although s/he had enjoyed the holiday. An alternative holiday will be looked into if the person did not wish to travel so far in the future. The service continues to operate an open visiting policy. Staff support people to maintain contact with family and friends wherever possible. One person told us s/he regularly visits a family member and staff had helped her/him write a postcard to them when they were on holiday. Staff respect peoples rights to chose who they wish to see and they are able to receive their visitors in the privacy of their own room. People follow their own preferred routines such as when they like to get up. The daily records show people get up and retire to their rooms at different times throughout the week. The atmosphere in the home was relaxed throughout our visit. Staff addressed people by their preferred name and encouraged them to participate in the discussions being held about the service. People have unrestricted access to all communal areas, with supervision being provided in high risk areas such as the kitchen and laundry. We were told by the people living here that the lounge is kept clean and tidy by staff. One person said I often make my own bed and sometimes a member of staff will help me. They always help me to keep my room nice and tidy. Information provided to us by the service shows all staff had attended training in basic food hygiene and a member of staff confirmed there attendance on this course. People continue to be consulted about their choice of meals on a daily basis and these are served at times that are suitable for the people who live here. The proprietor told us no-one has any special dietary needs. However, they had put on weight on during the winter months. Records are kept of meals taken by individuals and their weight is regularly monitored. Both residents commented that the quality and variety of food Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: remains good. One person told us s/he sometimes likes to help out in the kitchen by washing up. The other person said they particularly like to help with Sunday lunch by peeling the vegetables. 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. People receive personal support in the way they require and prefer to meet their physical and emotional needs. Suitable arrangements are in place to ensure peoples medication is safely handled and administered by staff who have been trained to do so. Evidence: People who live in the home require different levels of assistance with their personal care. This is provided in the privacy of their bedroom or bathroom. The type of support needed is detailed in their individual care plans. For example, one person generally requires prompts to support her/him to maintain good hygiene standards. The other person requires more physical support. Staff we spoke to showed us they are familiar with peoples needs as detailed in the individuals care plan. A record of the support provided is kept on the peoples files for monitoring purposes. The people who live in the home told us they are pleased the bath has been replaced with a walk-in shower, particularly the person who requires more assistance due to her/his reduced mobility. The staff team supports people to access local health care facilities. The records show Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: people attend regular healthcare check-ups with their GP and other health care specialists. One person told us they choose not to visit a dentist and her/his decision is respected by staff. The proprietor told us this person is advised about the benefits of receiving regular dental checks but, at present, s/he is not experiencing any problems. The persons reluctance to attend is discussed at each review. Information provided to us by the service states staff members have access to policy and procedures for the safe handling and administration of medication. Certificates of training were available on the staff files we looked at. The proprietor and staff we spoke to told us they had recently attended refresher training and were waiting for their certificates to arrive. The service manages both peoples medication. There are suitable and safe arrangements for storing medication. In order to provide a more personal service we were told arrangements have been made for medication cabinets to be fitted in each persons bedroom. We looked at the completed medication administration record (MAR) sheets. These contained the relevant information and a record of prescribed medication is also kept on peoples files. The proprietor told us over the counter remedies such as paracetomol is only administered following consultation with the persons GP. 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. The service provides people with opportunities to express their views and ensures these are listened to and acted upon. There are procedures to promote their welfare and protect them from harm. Evidence: A copy of the complaint procedure is displayed on the notice board in the hall. Each person has been provided with their own pictorial copy. Both people told us they would speak to a member of staff if they were unhappy or worried about anything. No complaints about the service have been reported to us. Staff told us none have been received by the home and, should any concerns be raised, they are confident these would be dealt with appropriately by the proprietors. The service has policies and procedures for the protection of vulnerable adults and arranges for all staff to receive training. Two new members of staff are due to attend training in June and refresher training is periodically arranged for other staff. Peoples finances are not managed by the service these, where necessary, are managed by a family member or the local authoritys appointee-ship unit. There are suitable systems where the service looks after peoples personal allowances. Records and receipts are kept of purchases made on persons behalf. No concerns about peoples well-being and safety have been reported to us or the service and none were raised during this visit. Care Homes for Adults (18-65 years) Page 21 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. The people at this home live in a homely, clean, safe and comfortable environment which is well maintained and where there are good arrangements for the prevention and management of infection control. Evidence: All areas of the home viewed were found to be clean, tidy and well maintained. There are attractive potted plants at the front of the premises and the hall way is pleasantly decorated. Information about the service is displayed on the notice board. The communal areas consist of a lounge and conservatory/dining room. There are some personal items belonging to the people who live here on display in the lounge. This creates a homely atmosphere. The rear garden can be viewed from the conservatory. The garden is well looked after and staff told us a trip to the garden centre is being arranged to purchase new plants and furniture for the summerhouse. Both people allowed us to view their bedrooms. They told us these were decorated to their individual preference and the array of photographs, ornaments and posters reflected their different personalities. Environmental risk assessments are carried out to ensure the premises are safe and Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: continue to meet the needs of the people who live here. Staff regular monitor peoples well being and ensure aids and adaptations are provided promptly. For example to meet the changing needs of one person living in the home and another who has since left the service replaced the bath with a walk-in shower. This was approved by all the people who lived here. It also has arranged for a second hand rail to be fitted to the stairs. There are procedures for the prevention and management of infection control and information on the control of substances hazardous to health (COSHH). Lockable facilities are provided for storing cleaning chemicals to reduce the risk of accidents occurring. All staff recently attended health & safety courses and included prevention and management of infection control. Care Homes for Adults (18-65 years) Page 23 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. People are supported by a sufficient, competent staff team who are trained to meet their needs. The service has procedures for the recruitment of staff. However, to ensure people are fully protected more detailed records should be kept about newly appointed staff. Evidence: Information provided by the service shows one person has left the homes employment during the last 12 months. Two staff have been employed. This makes the total of staff, including the deputy, five. The deputy holds the National Vocational Qualification (NVQ) Level 3 and one member of staff holds a NVQ Level 2 certificate. The proprietor told us the two new members of staff have been registered for the NVQ Level 2 course. This shows the services commitment to ensuring the staff team is suitably qualified to meet the needs of the people who live in the home. The staffing complement has sufficient hours to ensure the needs of the people living in the home are met. Systems are in place to deal with unexpected situations or staff absences through an on call system. This ensures people are supported by a staff member that is familiar with their needs, routines and personal preferences. The deputy told us communication within the staff team is good and staff regularly read Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: polices and procedures to update and refresh their knowledge. She told us she had recently looked at the complaints and protection procedures. Staff meetings are held at least once every six months and additional meetings are arranged where necessary. We looked at the recruitment records for two staff. The files contained references and relevant checks, PoVA First (Protection of Vulnerable Adults) and CRB check (Criminal Record Bureau). The application forms do not provide a full employment history. The proprietor said this is discussed during the applicants interview, but had not been recorded. Staff told us new members of staff receive an in-house six week induction from the proprietors. An induction checklist and record of supervision sessions were available on the files and signed by the supervisor and supervisee. However, to fully protect the well being of people living in the home a risk assessment should be carried out where the service decides it is necessary for newly appointed staff to commence work before a satisfactory CRB check has been received. The proprietor told us the Skills for Care Induction & Foundation workbook is completed by newly appointed staff. Staff told us good opportunities are provided for training and stated ...NVQ training had been particularly informative and made me reflect on my practice... She confirmed all staff had recently attended various training courses on issues of health and safety. Other courses included the Mental Capacity Act and Deprivation of Liberties Safeguarding. The training certificates for the most recent courses have not yet been received. Certificates are available to show previous training has been undertaken, for example managing medication. The proprietor confirmed this member of staff had attended recent training to update her/his knowledge. There are some omissions in the training records. For example; the team records show all staff attended a fire safety course in March, but this was not recorded on the individual staff files we looked at. The proprietor is advised to keep all training records up to date to ensure accurate information is available when planning future training programmes. Care Homes for Adults (18-65 years) Page 25 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. People benefit from good working relationships between the staff and the proprietors. There service continues to seek peoples views and the implementation of a comprehensive quality assurance should reinforce their confidence that their views are acted upon by the service as part of its self-monitoring, review and plans for development. There are policies and procedures available in the home to promote and protect the health, safety and welfare of people living in the home. These should be periodically reviewed to ensure they remain appropriate and comply with any new legislation and good practice guidance. Individual care files should be kept in good order to enable information and records to be easily accessed for reference, monitoring and review purposes. This will ensure peoples rights and best interests are safeguarded. Evidence: At present the proprietors are supporting the deputy in the day-to-day running of the home. She has worked at the home for six years and holds the NVQ Level 3 Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: qualification. The post of manager is being advertised and once the recruitment process has been completed an application to register the person appointed as the manager for this service will be made to us, the Care Quality Commission. There are systems in place for monitoring different aspects of the service such as environmental risk assessments and seeking the views of people living at the home, their relatives and relevant professionals. The majority of comments received are positive about the service being provided. The proprietor is aware of the need to implement a comprehensive system for assessing the services performance. Action is being taken to address this and for annual development plans to be produced. The Statement of Purpose, Service User Guide and policies and procedures are available in the home. Staff told us during quiet periods they select different documents to read. This is to ensure they continue to be familiar with the contents and follow procedures correctly. However, there is no evidence to show these are periodically reviewed and, where appropriate, produced in easy to read formats for people living in the home, with the exception of the complaint procedure. The proprietors are advised to introduce a tracking system for the periodic review of its policies and procedures to ensure these are up dated with current legislation and good practice guidance. The records kept by staff provide good information about the support they provide and the progress being made by people living in the home. However, accessing and retrieving information and records from the care files took some time. The service is advised to look at how this can be improved to reduce the risk of details being missed. We looked at a sample of records for appliances and equipment such as electrical installation, electrical and gas appliances. This shows the service continues to arrange for regular checks and services to be carried out to ensure people live in a safe environment. Information provided to us show there have been no accidents or events that adversely affect the safety and well being of people living in the home. The proprietor confirmed this continued to be correct during this inspection. First aid and fire safety training is included in the recent health & safety course attended by staff. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 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 Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The Statement of Purpose and Service User Guide should be produced in alternative formats that meet the needs of the people who use the service. This will enable them to make an informed choice about where to live. Outcome of reviews should be recorded promptly on the individuals file to ensure the staff team have up to date information about a persons care needs and how these are to be met. Care plans should be amended to reflect any change in routine and include any strategies identified to support her/him to adapt to change. A record of risk assessments carried out by the service should be kept where it has been decided necessary for a new member of staff to start work prior to a satisfactory Criminal Record Bureaus CRB) check beening received. A full employment history should be obtained from applicants and gaps explored with them during their interview should be recorded to demonstrate peoples welfare is fully protected by the services recruitment process. A comprehensive quality assurance system should be Page 29 of 31 2 6 3 7 4 34 5 34 6 39 Care Homes for Adults (18-65 years) implemented to ensure all aspects of the service is regularly monitored and reviewed. 7 40 Policies and procedures should be periodically reviewed to ensure they continue to promote and protect the welfare of people living in the home. The files of people living in the home should be kept in good order to enable information and records to be easily accessed. 8 41 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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