Care Home: Iona

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What the care home does well The people who use the service are treated as individuals and the staff ensure they make day to day life as pleasurable as they can. Staff practices support people to live a lifestyle of their choice ensuring their best interests. There is an ever widening range of activities on offer within the home and in the community. People are encouraged to take part in the daily routines of the home where possible. Plans of care are well written offering information on daily routines, choices, likes, dislikes and preferences. This shows the service looks at every individual independently to ensure their needs are met. Good plans of care give the staff the information and confidence needed, and demonstrates they are aware of individuals needs and are able to meet them. Health care monitoring which includes weight charts, and medication requirements are well recorded, this means people are fully supported with their health requirements. There is safe and thorough recruitment of staff, this means the service provides safeguards for people who live at the home. We received positive comments about staff being caring and friendly. What has improved since the last inspection? The home has continued to improve since the last random inspection where we were able to evidence that the requirements we had made at that inspection had been complied with. The service has provided medication `when required` protocols which include information about as and when medication. This is so they represent what the prescriber intended for the administration of these medicines. Clarity of information is now in place to protect everybody involved with medication administration and the people living at Iona. The service now has written evidence to verify the staff administering the medication are confident and competent to do so. Following initial training there were no records to confirm the staff have been assessed by the home as competent to continue to administer medication safely. These are now in place and help to ensure people who use the service are safeguarded. For a full account of this please refer to the random inspection report dated 26th February 2010. Systems and structures that have been put into place now need to be embedded; this means the manager will have clear audit trails and clarity of information. People living at the home are more than satisfied with Iona and as a result they receive good care and good outcomes. What the care home could do better: We have not made any requirements on this key inspection however the recommendations made should be implemented to futher improve the systems and structures in place at Iona. The home should continue to review and update all policies and procedures in line with good practice guidelines and changes in legislation. Key inspection report Care homes for adults (18-65 years) Name: Address: Iona 104 Well Street Biddulph Stoke on Trent Staffordshire ST8 6EZ     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: Rachel Davis     Date: 2 5 0 5 2 0 1 0 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 29 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 29 Information about the care home Name of care home: Address: Iona 104 Well Street Biddulph Stoke on Trent Staffordshire ST8 6EZ 01782523396 01260289107 Iona@imladris.me.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ms Jill Stockdale-Fisher Name of registered manager (if applicable) Provider in day to day control Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category of service only: Care Home Only (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 (LD) 6 Date of last inspection Brief description of the care home Iona is a care home for adults providing personal care and accommodation for up to six people with a learning disability. One place can be used to provide a service for someone with both a learning disability and mental health needs. The home is owned and managed by Jill Stockdale - Fisher The home is situated close to local amenities very close to Biddulph town centre. There are good public transport links to the home. The building is a semi-detached house with a lawned garden area and patio. There is Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 6 Brief description of the care home one single ground floor bedroom with a shower cubicle, a further three bedrooms are on the first floor, two shared and one single. There is a bathroom on the first floor. The communal rooms provide adequate lounge and dining space. Details of the weekly fees for accommodation were not available at the time of the inspection visit and the reader may wish to contact the service directly for this information. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: This key inspection focused on the outcomes for people using the service. The key inspection was unannounced this means the people who use the service and the staff team did not know we are coming. The purpose of the inspection is to assess the outcomes for people who use the service, using the National Minimum Standards and Regulations for Care Homes. A quality rating is provided throughout the report based on each outcome area for the people who use the service. These ratings are described as excellent, good, adequate or poor based on the findings. In order to prepare for this visit we looked at all the information we have received. We look at what the home has told us about things that have happened in the service, these are called notifications and are a legal requirement. Care Homes for Adults (18-65 years) Page 6 of 29 We read the annual quality assurance assessment (AQAA). This is a self assessment that focuses on how well outcomes are being met for the people using the service. Useful information should be offered in the Annual Quality Assurance Assessment and it was completed by the registered manager prior to the key inspection taking place. We sent surveys to a sample number of people with links to the service, including people using the agency and staff members. Six were returned from people using the service and three from the staff. During the inspection process we look at the way staff are recruited and trained and if the service is being managed effectively. We also check any necessary health and safety documentation, the complaints folder and plans of care. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Adults (18-65 years) Page 8 of 29 We have not made any requirements on this key inspection however the recommendations made should be implemented to futher improve the systems and structures in place at Iona. The home should continue to review and update all policies and procedures in line with good practice guidelines and changes in legislation. 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 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and 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 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Iona have been suitably assessed prior to moving in. Evidence: The AQAA tells us: All our current residents have resided with us for some considerable time, and were only admitted following professional assessment and the home was able to meet the needs of these residents. All residents followed an introductory visits schedule and trial stays. Contracts are drawn up by the local authority for each individual resident from the placing authority and it is this contract that the resident or their representative sign as to what is agreed in the contract price. All our contracts are signed on behalf of our residents by the funding local authority. We support this mechanism by using a service user guide. All our residents have annual statutory reviews as well as internal personal care plan reviews with key-workers and the staff team. Our inspection process validated this statement. Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: We did not look at the Statement of Purpose or Service User Guide on this inspection, we concentrated on the core standards, these focus on the outcomes for the people who use the service. The core standard for this outcome group is the needs assessment. There have been no new admissions since our last inspection, there is presently one vacancy. The needs assessments have been looked at on previous inspections and demonstrate they are in keeping with the practices at the time of the assessment. We discussed the Service User Guide with the registered manager as we have previously asked for the fees to be included within it. The manager told us this will be completed when the Service User Guide is reviewed and offered in a format suitable to the needs of the people who live there. We have also requested there is a clear picture regarding costs, for example the expectations around holidays and outings. This means people have a clear understanding of the financial implications. Care Homes for Adults (18-65 years) Page 12 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Plans of care offer all the required information to fully support the people who live at the home. Evidence: The AQAA tells us: We agree individual service user plans with all of our residents and obtain their consent. Staff support individuals with making choices and decisions about their life, and help them access external support and it is recorded in the individual care plan. Residents are involved in the day-to-day running of the home. We support our residents through the use of risk assessment to undertake activities in a safe and supported manner. Confidentiality of residents information is held securely and supported by staff training and policy and procedure. People told us they were actively involved in planning their care, enabling them to maintain daily routines that reflected their lifestyle and personality. People had signed their plans to confirm they agreed with the content. Overall support plans are well documented and there are clear day Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: to day records to confirm how people wish to live. This was verified during the inspection process. Questionnaires returned from the staff confirmed they felt they had enough information about the people who use the service. One questionnaire recorded: Communication between staff and residents is excellent. Six questionnaires were returned by people who use the service . All stated they received support with completion from the staff, except one, who received support from a family member. Everyone verified they were asked if they wanted to move in, and all said they received enough information. Three people said they always make decisions about what to do each day and three said usually. Here are their comments: The home is a nice place to live , we have good food. They look after my personal needs. I get supported on holidays. Plans of care offer information covering 24 hours they are informative and give a clear indication of peoples needs, aspirations and desires. We noted that management plans are in place, this means there are clear instructions for staff to follow and ensures consistent and appropriate care management is provided to the people who use the service. The manager needs to ensure the staff do not make assumptions in daily records for example; X is in a lovely mood. Records should only offer factual information. We are satisfied that other professional support is requested when necessary e.g. from the optician, chiropodist or doctor as records verified this. The home provides a professional visits form so this information is easily accessed for reference within the support plan. Risk assessments are in place and offer clear information because they are tailored to individuals. Care Homes for Adults (18-65 years) Page 14 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live a lifestyle that meets their individual needs and preference so they are able to lead a fulfilling life. Evidence: We looked at the plan of care for one person using the service; we also talked to the manager about how they support people using the service. Plans show there are opportunities to maintain and develop social skills and take part in appropriate activities, for example going to work, shopping, visiting family, eating out. Everyone participates in the homes food shopping and their personal shopping. They access community facilities for activities and health appointments. People receive varied meals and have chosen to plan their menus on a weekly basis. We could evidence meals were discussed regularly and they are soon to introduce Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: pictorial information to assist people in making choices. People using the service prepare meals with support, and a range of foods and healthy options are encouraged; weight and diet are regularly monitored. On the day of the inspection one person was at college and another went to day care. During the day people using the service went out for lunch, did their own banking with support, and later went to do the weekly shop. Everyone we spoke with said they are happy at Iona, one person said; we are doing more things now. The minutes of meetings showed discussions about food, domestic chores and health and safety. People said they were actively involved in the daily routine, including care planning, the menu, domestic tasks, amongst other things. When we arrived one member of staff was talking about the weekly menu plan and everyone has the opportunity to make choices. Regular meetings with people and access to an advocacy service enhances peoples rights to make decisions in areas affecting their lifestyle and ensures they have a say on how the home is managed. People told us they had access to their local community such as the pub and having meals out. Staff said people are able to pursue activities of their choice. This means people are supported to live meaningful lives which reflect their social interests. People were keen to share their experiences of a recent holiday and they said they had enjoyed new pursuits such as golf. Care Homes for Adults (18-65 years) Page 16 of 29 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 needs of people living at the home are met. Medication is securely stored, administered and recorded. Evidence: The AQAA tells us: Staff provide personalised support based on assessed needs of residents, and agreed with the residents in the appropriate environments. Continuity of care is provided through the use of key workers and care planning to which the residents contribute. Professional support in the form of chiropody, continence nurse, GP, dentist, to name a few are accessed by all our residents. Annual health checks are undertaken at the local GP surgery, and residents are supported to access all services by staff on a regular and routine basis. Administration of medication is undertaken by appropriately trained staff only, and following legislative guidelines and is kept under review by the pharmacist and home manager. All medicines are receipted and disposed of in the appropriate manner. All medicines administered to residents as they are assessed as requiring this are kept securely and details of all medication and side effects are held on file. Through regular reviews and monitoring of our residents health we are well equipped to notice and respond to changes in health, and are conscious that are residents are ageing, the appropriate referrals and access to Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: specialist support is requested through our GP. We have included an end of life section in our care planning and are undertaking reviews to try and ensure that the appropriate plans are in place for each individual, and referring out for specialist advice and support. This is an accurate reflection of what we saw. We looked at the health care provided to one person living at the home. We can see that they have had a range of routine health screening with, for example, the dentist, optician and doctor to ensure any changes in health can be identified and acted on early. Weight charts are being completed for the people who use the service and staff can clearly refer to these to ensure weight is appropriately maintained. We were able to see people who use the service on the day of inspection. They were well dressed, clean and presented as being calm and comfortable. We made a requirement at the last random inspection about medication and we can confirm this has been complied with. Written records and prescriptions tally and the manager confirmed everyone has had a medication review. The manager has updated the homes policy and it auditing medication issues well. All the staff bar one have received training in medication. The home is also monitoring competency around medication practices, this assists in ensuring a safe service is continually promoted. Care Homes for Adults (18-65 years) Page 18 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are adequately safeguarded, this means people are protected from harm. Evidence: The AQAA tells us: Complaint procedure on noticeboard in prominent place in the home for all to see. Residents raise concerns through resident meetings, and when undertaking 1 to support and through reviews. Staff raise concerns through staff meetings, individual meetings with manager and on handover. Staff have training with respect to protection of vulnerable adults. Complaints book and minutes of meetings documented. Policy and procedures in place with respect to bullying, whistle blowing, and up-to-date guidelines on abuse and reporting under vulnerable adult procedures. Individual care plans in relation to individual needs regarding behaviour, reviewed and supported by community nurses. Our inspection corroborates this statement We can verify the home has a complaints procedure, which is made available to people when they move in. The manager has confirmed they will amend this to become more user friendly. There have not been any complaints since the last inspection. We recommend a grumbles /comments book so that all comments have the opportunity to be evidenced to support the service with identifying how changes are made to improve the services for the people who live there. Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: Safeguarding Adults is a process of identifying and reporting suspected or potential abuse to vulnerable people and provides a framework of consistency to protect those individuals who are at risk. During our inspection we check to ensure vulnerable people are suitably protected. The home has policies and procedures for safeguarding people in the home. The staff have received training for recognising signs of abuse and reporting incidents. There has been one safeguarding referral since the last inspection. This is not yet concluded. Everyone living at the home has had a full review and issues that required attention have been resolved. The local authorities commissioning team have also undertaken a review with a positive outcome; a small number of recommendations were made which included introducing a compliments book, decorating the hall and using a thermometer to ensure medications are kept at a safe temperature. The home has introduced polices to support them when people do not have capacity; this is with regard to The Mental Capacity Act and Deprivation of Liberty Safeguards. The manager has ensured the staff are aware of The Mental Capacity Act Deprivation of Liberty Safeguards and completed Best Interest assessments for everyone living at Iona. We discussed and observed how peoples money is protected and we are satisfied that effective systems are in place. We recommend that when anomalies are noted this is recorded in peoples plans of care to offer a clearer picture and audit trail. Care Homes for Adults (18-65 years) Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that meets their needs and expectations. Evidence: The home is accessible to local amenities including shops, pubs and the medical centre. The property provides single and shared bedrooms situated on two floors. There is presently one single room vacant on the first floor. People told us they are happy with their bedrooms and facilities provided, bedrooms are personalised to reflect their interests. Due to the design of the property the home would not be suitable for individuals with restricted mobility. People who use the service confirmed they all helped to keep the home clean and tidy. Infection control measures are in place and the manager considers they meet with the Hygiene Code Regulations which come into force in October 2010. Care Homes for Adults (18-65 years) Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience 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 staff who are suitably recruited, skilled and experienced to meet their needs. Evidence: We looked at one staff personnel file, which contained evidence of the necessary checks. This means people have been vetted to ensure they are suitable to work with vulnerable people. The manager told us told us that people who lived at the home are involved in the recruitment of staff. This practice supports peoples rights to choose who works with them. The registered manager stated they are fully staffed, that is, six people (one male) including the manager. This means people receive a consistent service from a knowledgeable workforce. The staff informed us through three returned questionnaires that they receive support regularly (two staff) and usually (one staff). Two staff stated there are always enough staff on duty and one said, usually. These are their comments : Home meets the needs of clients and supports them day to day. Makes atmosphere as homely as possible. Cares for residents very well. Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: Certificates were checked and everyone has received the necessary training to meet the needs of the people who use the service. We recommend the home provides a training matrix for ease of reference. New staff receive an appropriate induction which meets with the Skills for Care common standards, There was also evidence of appraisal, supervision and team meetings . This means the staff receive the support they require. Care Homes for Adults (18-65 years) Page 23 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured the service will be managed in a way to support their rights, choice and independence so they can live a lifestyle of their choice. Evidence: Iona provides 24 hour care for five people with a learning disability. The registered manager Jill Stockdale Fisher is also the registered provider and she was available during this key inspection. The Annual Quality Assurance Assessment was completed by the manager and it was returned to us within the agreed timescale. The annual quality assurance assessment (AQAA) is a legal document that all services have to complete on a yearly basis. The information was as detailed as it could be to demonstrate the service was based on robust and continual self assessment. The AQAA gave us a clear picture of the service which was verified through the inspection process. We saw and heard evidence to validate the manager promotes equal opportunities, has good people skills and understands the importance of person centred care and effective outcomes for people who use the service. Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: The AQAA tells us: The home is managed on a day-to-day basis by an experienced registered nurse in the field of learning disability who is undertaking and accessing regular up-dating and training. We strive to have an open and inclusive atmosphere and encourage reflective practice. We involve our residents in the running of the home on a daily basis and are small enough to be flexible to changing needs. We hold regular resident and staff meetings where issues concerning the home are aired and discussed and plans made as a united team. There is no fear of recrimination and all are encouraged to have their say. Residents individual care plans are up-to-date and demonstrate multidisciplinary and professional involvement. Residents have routine access to their files and where possible sign off on any care plans, these are kept safe and securely. Maintenance of the home with regard to fire, health and safety, first aid, infection control are all evidenced and current. Business plan is in place for continued development and maintenance of the home, plus public liability insurance. Clear and established lines of accountability and effective supervision through senior carers as well as manager. It usually means at least one of us is on shift over 7 days. Quality assurance needs to be undertaken and the manager has identified when this will be done. The outcomes from the quality assurance surveys will need made available for people who use the service. All service maintenance records that we requested in the AQAA were up to date to show the environment is being safely maintained. We noted that freezer and meat probing temperatures are not recorded, we recommend these are evidenced alongside the daily fridge temperatures. We discussed individual fire risk assessments and advised the home to consult with the fire officer regarding this. We also advised the home to formally consider and record how each individual person would be evacuated in the event of a fire. At the last key inspection we made requirements and went back earlier this year to check these had been complied with. We can evidence that the service operates procedures that seek to ensure the quality of the service provided is good, and the people living there receive positive outcomes. The manager is clear of what further improvements she wishes to make and we are confident that new practices and policies are being embedded. Care Homes for Adults (18-65 years) Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The Service User Guide should offer information about what people pay for regaring their support from staff. This means everyone has a clear understanding. Daily records should only contain factual information to ensure peoples own views are not misinterpreted. Continue to promote choice by using methods and aids suitable for the people who use the service. Comments and grumbles should be recorded to assist the manager in identifying any patterns or trends. The home could provide a suggestions, comments or complaints box which is easily accessible. This is so people may provide information anonymously if they so choose. Ensure any anomalies with finances are well documented, this could include a written statement within individuals plans of care. This means there is a transparent audit trail if required. Consider using a training matrix for ease of reference. Ensure freezer and probing temperatures are recorded to offer a clear audit trail. Page 27 of 29 2 3 4 6 17 22 5 23 6 7 35 37 Care Homes for Adults (18-65 years) 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 8 42 Speak with the fire officer to confirm the need for individualised fire risk assessments for the people who use the service. This means people will be suitably protected. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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