Care Home: Hollybank House

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What the care home does well The residents were provided with useful information in a suitable format so they could read about the services and facilities available in the home. The residents` needs were properly assessed and reviewed at regular intervals. This meant the staff were aware of the residents` current needs and how best to provide care and support. Each resident had a support plan based on their assessment of needs and they were supported to participate in the review and development of their plans. The plans were underpinned with risk assessments, which meant the staff had information about how to manage and respond to any areas of identified risk. The daily routines were flexible and designed to meet the needs and wishes of the residents. This meant the residents were able to choose their preferred lifestyle and their individual preferences were recognised. The residents spoken to felt they were well supported and the staff treated them with respect. The residents pursued a range of activities both inside and outside the home. This approach enabled the residents to participate in the life of the home and gave them the opportunity to meet other people. Appropriate policies and procedures were in place to ensure the residents were listened to. The residents spoken with felt confident that any concerns would be taken seriously and acted upon. The residents were provided with a clean, safe and comfortable home, which they enjoyed living in. Staff were provided with a broad range of training opportunities, which gave them an understanding of the needs of the residents. The majority of the staff had achieved NVQ (National Vocational Qualifications) level 2 or above, which meant they had the necessary qualifications to carry out their role effectively. Relationships within the home were positive and the atmosphere was open and friendly. One resident commented, "It`s a good place to live, I like all the staff, we have a good laugh". What has improved since the last inspection? Since the last inspection, the residents had been involved in drawing up their own risk assessments, which helped them to identify areas of risk when carrying out certain activities and how these could be managed. Improvements had been made to the environment to aid the comfort of the residents. For example, two new sofas had been purchased for the conservatory and a new larger television had been installed. In addition, two bedrooms had been redecorated and refurnished and one bedroom was in the process of being redecorated. The residents said they had chosen the colour schemes and furniture, which ensured the rooms reflected their personal taste and preferences. The smoke detectors had been wired into the main electrical system of the house. This ensured that the detectors did not rely on battery power alone. What the care home could do better: The safeguarding procedures must be updated to reflect established local protocols for the protection of vulnerable adults. This is to ensure the staff have accurate written details about what action to take in the event of any suspicion or allegation of harm. The registered manager must ensure that documentation is available to clearly demonstrate the electrical installations have been tested and are safe. This is to ensure the health and safety of the resident`s is fully protected. Key inspection report Care homes for adults (18-65 years) Name: Address: Hollybank House Church Street Stacksteads Bacup Lancashire OL13 0RW     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: Julie Playfer     Date: 0 8 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 30 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) 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 30 Information about the care home Name of care home: Address: Hollybank House Church Street Stacksteads Bacup Lancashire OL13 0RW 01706877659 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Ms Susan Footitt,Ms Mary Lorraine Moden care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The registered person may provide the following category/ies 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 The maximum number of service users who can be accommodated is: 5 Date of last inspection Brief description of the care home Hollybank House provides personal and social care for up to 5 adults with a learning disability aged over 18 years. At the time of the inspection there were three people accommodated. The home is a large terraced property located off a busy main road, on the outskirts of Stacksteads. Rawtenstall town centre is approximately four miles away in one direction Bacup approx 1.5 miles in the other. The home offers 5 single bedrooms, two being en-suite. There is one lounge and one conservatory. The home is tastefully decorated Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 5 Brief description of the care home and maintained to a satisfactory standard throughout. The proprietor aims to offer a homely environment within structured and consistent guidelines. Hollybank House opened in 1998. At the time of the inspection (September 2009) the level of fees ranged from £551.00 to £655.00 a week. There was information available to potential residents in the form of a service users guide advising them of the home and giving them details about the type of service they could expect. Previous inspection reports can be viewed in the home on request or downloaded free of charge from the commissions webiste at www.cqc.org.uk Care Homes for Adults (18-65 years) Page 5 of 30 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: A key unannounced inspection, which included a visit to the home, was conducted at Hollybank House on 8th September 2009. The inspection was carried out by one inspector, however, the report refers to we as it was written on behalf of the commission. We lasted visited this service on 25th September 2007 and an annual service review was carried out on 22nd September 2008. At the time of the visit, there were three residents accommodated in the home. During the inspection we spent time with the residents, looked round the home, read some of the residents care records and other documents and talked to the staff and the registered manager. We also consulted our records about the service and the information we have received since the last key inspection. As part of the inspection process we used case tracking as a means of gathering information. This process allows us to focus on a small group of people living at the home, to assess the quality of the service provided. Care Homes for Adults (18-65 years) Page 6 of 30 Prior to the inspection, the registered manager completed an Annual Quality Assurance Assessment known as AQAA, which is a self assessment questionnaire covering all aspects of the management of the home. This provided us with useful information and evidence for the inspection. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The safeguarding procedures must be updated to reflect established local protocols for Care Homes for Adults (18-65 years) Page 8 of 30 the protection of vulnerable adults. This is to ensure the staff have accurate written details about what action to take in the event of any suspicion or allegation of harm. The registered manager must ensure that documentation is available to clearly demonstrate the electrical installations have been tested and are safe. This is to ensure the health and safety of the residents is fully protected. 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 9 of 30 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 30 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 residents were provided with useful and appropriate information about the home and their needs were properly assessed and reviewed. Evidence: Written information was available for the residents in the form of a statement of purpose and service users guide. Both documents met regulatory requirements and were presented in an easy read format. One resident spoken to was familiar with the guide and said it contained useful information about the home. The previous inspection report was available for the residents to look at in the office. This meant the residents were provided with up to date information about the services and facilities available in the home. The residents had lived in the home for many years and were well established. Two of the residents files were looked at in detail as part of the case tracking process. From this we could see that the residents needs had been reassessed at regular intervals by Social Services and by the staff in the home. The assessments focused on all areas of the residents needs and considered individual requirements in respect of personal, Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: social and cultural needs. This meant that staff had access to information about the residents current needs and preferences. At the time of the inspection, a person had expressed an interest in moving into the home and a preliminary assessment of needs had been carried out, during a series of introductory visits to the home. The registered manager explained that a full assessment would be completed before the person moved into the home, to ensure their needs could be fully met. From the personal files seen it was evident that the residents had been issued with a contract. The contracts had been signed by the residents and included information about the level and payment of fees, the room occupied and their individual rights. The contract was easy to read and was presented in a clear format. This meant the residents were aware of the terms and conditions of residence and knew what they could expect from the service. Care Homes for Adults (18-65 years) Page 12 of 30 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. The residents individual needs were fully addressed and the residents were well supported to enable them make their own decisions and participate in life in the home. Evidence: Two personal files were looked at in detail, as part of the case tracking process to assess the quality of the care planning documentation and other associated paperwork. From this we could see that the overall support plan comprised of four overlapping documents, known as an action plan, pen picture, person centred plan and health assessment plan. These documents covered the residents personal and health needs as well as their wishes and aspirations. The plans were designed to help the residents plan for what they wanted and needed now and in the future. As such the residents views and wishes were seen as central to the care planning processes and they were thus supported throughout the development and review of their plans. The plans were written in plain language and looked at all areas of the residents life. The staff maintained daily records of care and Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: support, which provided information about changing needs and any recurring difficulties. The records were detailed and the residents needs were described in respectful and sensitive terms. A key worker system allowed staff to work on a one to one basis with the residents and support the residents to make contributions to the development of their plans. The support plans were reviewed at six monthly intervals or more frequently in the event of changing needs. Risk assessments had been carried out to help the residents take responsible risks and lead the life they wanted. Since the last inspection, the residents had been involved in drawing up their own risk assessments, which helped them to identify areas of risk and how these could be managed. The risk assessments were supported by risk management strategies or control measures,which provided the staff with guidance on how best to manage and respond to particular risks. This meant risks were managed in a consistent and safe manner. During conversations with the residents, it was evident they were consulted both formally and informally about life in the home. This was achieved by way of residents meetings, daily conversations and satisfaction questionnaires. This meant the residents had various opportunities to express their views about life in the home. Policies and procedures were in place to support the residents with their financial affairs. Records were made of all financial transactions and regular audits were carried out by the registered manager. A random check of money deposited in the home for safe keeping corresponded accurately with the records. This meant that the residents finances were fully accounted for and safeguarded. Care Homes for Adults (18-65 years) Page 14 of 30 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. The residents were able to make informed choices about their lifestyle and were well supported to develop their skills. Evidence: The individual plans and care records demonstrated that the residents had opportunities to maintain and develop practical life skills. As such, residents were supported to identify their personal goals and work to achieve them. The residents were encouraged to participate in life in the home and carried out domestic tasks commensurate with their abilities and interests. These tasks included tidying the bedrooms, helping in the kitchen, going to the local shops and light domestic chores. The residents spoken to said they enjoyed participating in the tasks, especially helping in the kitchen and keeping the home clean and tidy. The residents were involved in a variety of activities, which were arranged in Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: accordance with their individual interests, needs and capabilities. Wherever possible and appropriate the residents participated in community based events and accessed facilities within the local town for example restaurants, pubs and shops. Support was also given to the residents who wished to pursue occupational and educational activities, such as attending a horticulture course. The staff team helped the residents with their communication skills, to enable them to fully participate in daily living activities and have valued roles in the community. This meant the residents were able to develop an individual lifestyle which met with their needs, interests and preferences. On the day of inspection, the residents were observed to pursue a variety of activities, with the support of staff. For example, after lunch at a local restaurant, one resident visited a farm and two residents went shopping. The residents went away on holiday at least once a year and they said they were greatly looking forward to a forthcoming holiday in Skegness. This enabled the residents to have a break from the home and spend time doing different activities. Earlier in the year, the residents had been away to Scotland for a long weekend. The residents had the opportunity to develop and maintain important personal and family relationships. As such friends and family were welcome to visit at anytime convenient to the residents. Some residents also visited their families on a regular basis and were provided personal support and help with any arrangements. The residents had unrestricted access to the communal areas and grounds. The residents were also able to use their room at anytime should they wish to spend time alone. The residents participated in planning, purchasing and preparing the meals. Meals were provided three times a day with a range of drinks and snacks available at all other times. The residents spoken to said they liked the food and confirmed there was always plenty to eat. The records of food served were maintained on an individual basis and demonstrated that the residents were provided with a nutritious and balanced diet, which catered for individual dietary requirements and preferences. Care Homes for Adults (18-65 years) Page 16 of 30 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 health and personal care received by residents was based on their individual needs. There were arrangements in place to manage medication safely and effectively. Evidence: The individual plans set out the personal support required by each resident and provided guidance to staff on how the residents wished to receive this support. The residents spoken to confirmed that personal care was responsive to their needs and preferences. Comments included, The staff are all really good. Discussion with staff and the registered manager demonstrated their awareness of the residents rights to privacy and dignity and the need to respond sensitively to individual issues and changing needs. This meant that the delivery of personal care was flexible, reliable and person centred. Health care needs were appropriately assessed and were included in the support plans. Specific information was included in the health assessment plans, which provided details about the residents medical histories. A separate record was made of medical appointments and there was evidence to indicate the residents had access to NHS services such as General Practitioners and Consultants. The residents also Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: attended routine health appointments with the chiropodist, dentist and optician. This meant the residents healthcare needs were understood by the staff team and an appropriate response was made to changing needs. Policies and procedures were in place to cover the management of medicines and were available for staff reference in the policy and procedure file. The home operated a monitored dosage system of medication, which was dispensed into a blister pack by a local Pharmacist. Appropriate records were in place for the receipt, administration and disposal of medication and all records seen were complete and up to date. However, we noted that not all handwritten entries on the medication administration records had been signed by two staff. This is important to minimise the risk of error. Staff designated to administer medication had received accredited training. This meant that the staff had received the necessary training to ensure that medication was managed in a safe and consistent manner. Care Homes for Adults (18-65 years) Page 18 of 30 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. Residents were able to express their views and any concerns and had access to a clear complaints procedure. There were established ways of working to respond effectively to any suspicion or allegation of harmful practice. Evidence: The registered manager fostered an open culture in the home to ensure the residents were able to express their views in a safe and understanding environment. As such ways of working were in place such as residents meetings, daily conversations and satisfaction questionnaires, which provided the residents with various opportunities to discuss life in the home. The residents spoken to said they felt comfortable about expressing their views and were aware of whom to speak to in the event of a concern. The complaints procedure was included in the service users guide and displayed in the kitchen. The procedure contained the necessary information about the complaint process and included the relevant telephone numbers and contact details should a resident wish to raise a concern. The registered manager had not received any complaints during the last twelve months. There were procedures in place to respond to any allegation, suspicion or evidence of abuse. However, the procedures seen did not reflect established local protocols to safeguard vulnerable adults. The registered manager therefore agreed to review and update the procedures immediately following the inspection. Safeguarding issues were Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: incorporated into the induction and mandatory training and staff received specific tuition as part of their NVQ training. Staff spoken to during the inspection confirmed they had received training on the protection of vulnerable adults and they were aware of where and how to direct any alert. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were provided with a clean, pleasant and well-maintained environment, which promoted their comfort and independence. Evidence: Hollybank House is a large terraced property located approximately one mile from Bacup town centre. The premises are in keeping with the neighbouring community and are close to local amenities such as shops. Accommodation is provided in five single rooms, two of which have an ensuite facility. At the time of the inspection, building work was ongoing in the ground floor bedroom to convert the room and the ensuite facility into suitable accommodation for a person using a wheelchair. Since the last inspection, two bedrooms had been redecorated and refurnished and one bedroom was in the process of being redecorated. The residents said they had chosen the colour schemes and furniture, which ensured the rooms reflected their personal taste and preferences. The residents said they liked their rooms and commented that they liked to spend time on their own in their bedrooms. The furnishings and fittings were domestic in character and a satisfactory standard throughout. Shared space was provided in a conservatory, living room and kitchen. Since the last Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: inspection, two new sofas had been purchased for the conservatory and a new larger television had been installed. Appropriate arrangements were in place for general maintenance and repairs. This meant that routine problems with the building were promptly rectified. The home had a good standard of cleanliness in all areas seen and was free from offensive odours. Care Homes for Adults (18-65 years) Page 22 of 30 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 residents benefited from well supported and trained staff. Evidence: Staff had been issued with an appropriate job description during the recruitment process, which clearly set out their roles and responsibilities. During conversations with the staff, it was evident they were aware of the limitations of their role and had a good understanding of the needs of the residents. Staff referred to the residents in respectful terms and were observed to interact with the residents in a pleasant way. A staff duty roster was drawn up in advance and provided a record of the number of hours worked by the staff in the home. The roster indicated that a sufficient number of care staff were on duty throughout the waking day. One member of staff carried out a sleeping in duty during the night with an additional person available on call. All staff left in charge of the building were aged over 21. The staff had worked at the home for some time, which meant they had a good knowledge of the needs of the residents. A recruitment and selection procedure was available; however, the procedure did not cover all the elements listed in the Regulations. This is important to ensure that all legal requirements are considered during the recruitment process. There had been no new staff employed in the home for over two years. Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: Since the last inspection, arrangements had been put into place for any new employees to undertake induction training, which incorporated the Learning Disability Qualification. The latter provided underpinning knowledge for NVQ level 2. According to information supplied by the registered manager, three out of the four care staff had completed NVQ level 2, which equated to 75 of the staff team. This meant the majority of staff had achieved the necessary qualifications to enable them to carry out their role effectively. Staff attended both internal and external training courses and had at least three paid days training a year. Staff discussed their individual training needs during their supervision sessions and staff meetings. Staff had completed an individual training and development assessment and profile and a overall staff training matrix had been compiled. The latter enabled the registered manager to plan future staff training effectively, in line with the needs of residents. Consultation with staff was ongoing and handover meetings were held on a daily basis. Staff had the opportunity to attend meetings on at regular intervals and minutes were seen of the last meeting held in the home. The staff were encouraged to add to the agenda and openly discuss issues affecting the operation of the home. Staff spoken to confirmed that they met up regularly with their line manager for supervision and had an annual appraisal of their work performance. The supervision meetings enabled the staff to discuss their experience of working in the home and their future training needs. Care Homes for Adults (18-65 years) Page 24 of 30 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. Management and administration practices were effective in ensuring the home was run in the best interests of the residents. Evidence: The registered manager had overall responsibility for the day to day operation of the home. The manager had completed an NVQ level 4 in Care and Management and had 17 years of working with adults with a learning disability. The manager had also undertaken periodic training to refresh her skills and knowledge. The management approach was consultative and there were established ways of working to consult the staff and residents on an ongoing basis. Relationships within the home were positive and staff spoke to and about the residents and other staff in respectful terms. The service was reaccredited with an Investors in People Award in 2008. This is a professionally recognised quality assurance award. The registered manager was working towards Preferred Provider Status with the Local Authority. The manager had Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: established systems to monitor the quality the quality of the service, which included regular internal audits. Satisfaction questionnaires had been distributed to residents and their families in March 2009. The results had been collated and feedback had been given. The registered manager had produced a business/annual development plan, which outlined the managers priorities and plans for the forthcoming year. The plan linked with the AQAA questionnaire submitted to the Commission. All sections of the AQAA were completed and the information provided gave a clear picture of the current situation within the service and the planned areas for development. There was a set of health and safety policies and procedures, which included the safe storage of hazardous substances, food safety and infection control. Staff received mandatory health and safety training, which included moving and handling, food hygiene, first aid and fire safety. Documentation seen during the inspection and information supplied in the AQAA indicated that the electrical, gas and fire systems were serviced at regular intervals. However, the documentation relating to the safety of the electrical installations was unclear. Further to this the manager gave assurances that immediate arrangements would be made to clarify this situation to ensure that the electrical installations are safe. The fire log demonstrated that the staff had received instructions about the fire procedures during their induction and had participated in regular fire drills. Since the last inspection the smoke detectors had been wired into the main electrical system of the house. Arrangements were in place to record accidents and incidents in the home. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 30 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 23 13 The safeguarding procedures 01/10/2009 must be updated to reflect the Lancashire Safeguarding Adults - Multi Agency Policy and Procedure. This is to ensure the residents are fully protected. 2 42 13 The registered manager must ensure that documentation is available to clearly demonstrate the electrical installations have been tested and are safe. This is to ensure the health and safety of the residents is fully protected. 01/10/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 20 Handwritten entries on the medication administration record should be signed by two members of staff to Care Homes for Adults (18-65 years) Page 28 of 30 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 minimise the risk of error. 2 34 The recruitment and selection procedure should be updated in accordance with the requirements set out in the Regulations. This is to ensure all such legal requirements are considered during the recruitment of new staff. Care Homes for Adults (18-65 years) Page 29 of 30 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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