Care Home: Jackson House Nursing Home

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What the care home does well People who live at Jackson House can have confidence in the home because it is managed by a qualified and experienced person who has developed her skills over time through training and personal development. People who are thinking of moving to Jackson House are given good information to help them make decisions about the home. They are encouraged to visit the home so they are able to make an informed choice as to whether it is suitable for them. The information about the home, what it does and who it is for, is written in plain and clear language so people are helped to understand the information and know what the home provides. It is also available on a compact audio disc so people who have difficulty reading can access the information. This showed us that managers and staff understand the importance of providing people with the information they need to help them choose a home that is suitable for them. Each person`s individual needs are known and their rights to privacy and confidentiality are respected so the support they get from staff is given in a way that meets their needs and maintains their dignity. All the people who live at the home have a care plan that has been written and developed with them so they receive care and support in the way they want and prefer. The atmosphere in the home is relaxed and sociable. People are offered a range of activities in the home and are supported and encouraged to explore and take advantage of opportunities for leisure, education and meeting and socialising with other people in the local community. We could see that the people who live at Jackson House have good relationships with staff . One person told us that they liked the staff. We could see that there is a strong and consistent team of staff. They are well trained and were recruited through thorough procedures so they are suitable to work with the people who live at the home. Managers and staff are very good at involving people in the day to day management of the home and getting their views on the quality of care, facilities and services provided. People told us that their views were always taken seriously and acted upon. This showed us that the home is run in the best interests of the people who live there. What has improved since the last inspection? Much has been achieved since our last inspection with significant improvements in staff training, person centred care planning and care practice. The staff present as a cohesive team that benefits from good leadership and shared aims and objectives so the people who live at the home experience good quality outcomes. All staff have completed training on safeguarding vulnerable adults so they know what to do in the event of any suspicion or evidence of abuse. This will help to make sure that the people who live at the home are safeguarded from abuse.All staff have completed training on health and safety and moving and handling so they have the skills they need to carry out their duties safely. What the care home could do better: Staff training and policies and procedures on the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards need to be put in place so staff have the knowledge and skills to make sure the people who live at the home get the right type of support to assist them with their decision making. Stock records of medicines received in their original containers need to be kept accurate and up to date so staff can make effective stock checks to ensure that medicines are administered properly. New staff should receive training on safeguarding vulnerable people within the first six weeks of their employment so they will know what to do in the event of any suspicion or evidence of abuse. Key inspection report Care homes for adults (18-65 years) Name: Address: Jackson House Nursing Home 2 Lode Hill Cottages Styal Cheshire SK9 4LH     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: David Jones     Date: 2 8 0 1 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 27 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 27 Information about the care home Name of care home: Address: Jackson House Nursing Home 2 Lode Hill Cottages Styal Cheshire SK9 4LH 01625522767 01625525443 jacksonhouse2@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Clifford Slack care home 4 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 with nursing - Code N 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: 4 Date of last inspection Brief description of the care home Jackson House provides accommodation and nursing care for up to four adults with a learning disability. The people who live there each have their own room and there are shared lounge and dining areas, plus kitchen and bathroom. People who live at Jackson House are generally physically independent, and the home does not have any aids or adaptations such as a passenger lift or mechanical hoists. The home is close to Styal National Trust village, and a small convenience storepost office and pub are within easy walking distance. The weekly fee payable at the home depends on the needs of the individual. Information is available from the acting manager on 01625 522767. 4 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 27 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 two stars. This means that people who live at Jackson House experience good quality outcomes. This visit was unannounced. It took place over one day, taking 7 hours in total, and was done by one inspector. This report will say we when referring to our activities and findings, as it is written on behalf of the Care Quality Commission. Our visit was just one part of the inspection. Before the visit took place we asked the manager to complete a questionnaire that we call an annual quality assurance assessment or AQAA for short. It gives us information about how the home is meeting the needs of the people who live there and includes plans for future development. We looked at the information that we already had about the home and this, with the information from the AQAA, helped us to form our inspection plan. Care Homes for Adults (18-65 years) Page 5 of 27 We checked the records of two people who lived at the home to see what care they receive. We spoke with some of the people who live at the home and some of the staff who support and care for them and their views were taken into account. We looked at the communal areas of the home, including lounge, dining room and kitchen to see how the home was decorated, maintained and furnished. We also looked at some policies and procedures to check that these were up to date and provided suitable guidance for staff. Care Homes for Adults (18-65 years) Page 6 of 27 What the care home does well: What has improved since the last inspection? Much has been achieved since our last inspection with significant improvements in staff training, person centred care planning and care practice. The staff present as a cohesive team that benefits from good leadership and shared aims and objectives so the people who live at the home experience good quality outcomes. All staff have completed training on safeguarding vulnerable adults so they know what to do in the event of any suspicion or evidence of abuse. This will help to make sure that the people who live at the home are safeguarded from abuse. Care Homes for Adults (18-65 years) Page 7 of 27 All staff have completed training on health and safety and moving and handling so they have the skills they need to carry out their duties safely. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 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 9 of 27 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 are thinking of moving to Jackson House are given clear information and are invited to visit so they can make an informed choice about the homes suitability for them. They have their needs assessed so they can be confident that their needs will be met when they move in. Evidence: The information about what the home provides, how it works and who it is for is written in plain language and is available in an audio format so people are helped to understand what the home has to offer. All the people who live at the home responded to our survey and sent completed questionnaires back to us. They all told us that they were given enough information about the home so they could decide it was the right place for them. We looked at the records of two people who had moved into the home in the last 18 months and we could see that they had their needs assessed before they moved in. Their assessments had been done with them so they received care and support in the Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: way they wanted and preferred. Following the assessment staff from the home had worked with them and people close to them, including family members and health and social care professionals, and developed an individualised plan to introduce them to the home. We could see from their records that these plans had gone well. They had been supported to visit the home on a number of occasions so they could get to know the home, staff and the other people who lived their. This helped them to make an informed choice about the home so they could be confident it was suitable for them before they moved in. Care Homes for Adults (18-65 years) Page 11 of 27 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 people who live at Jackson House are actively involved in developing their own care plans so the health and personal care they receive is based on their individual needs. Evidence: We looked at the care records of two people who live at the home to check the arrangements made for their care and support. We could see that each persons care plan was based on their individual needs and reflected their personal preferences, likes and dislikes so they would receive care and support in the way they wanted and preferred. People told us that they were happy and content at the home and we could see that they were supported to live a fulfilling lifestyle. They had opportunities to take part in social, educational and leisure activities in the home and local community. Staff were skilled and confident in their abilities. They were well trained and had a clear understanding of each persons individual needs so they were able offer support in a way that promoted dignity, mutual respect and independence. Where there was Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: confusion, misunderstanding or anger staff were able to offer sensitive guidance and support so potentially difficult situations were defused and a positive atmosphere was maintained. Individualised procedures for the management of aggressive or potentially harmful behaviours had been established where they were needed. These were based on good practice guidelines and focused on positive outcomes so staff were able to respond to and manage challenging situations effectively and safely and in the best interests of all concerned. It was clear that any limitation on a persons freedom of movement or power to make decisions was made in the persons best interests and in agreement with them and their representatives including health and social care professionals. This was not always clearly recorded but the manager rectified this shortly after our inspection and wrote to us to confirm that the care plans had been revised and updated. Risk assessment is an important part of the homes care planning procedures so the people who live at the home are helped to make their own informed decisions and have the right to take risk in their daily lives. Each persons care file contained a range of risk assessments addressing potential hazards in and around the home and local community. We could see that risk assessments balanced choice and risk so people were supported to take an element of risk in the interest of living an independent and fulfilling lifestyle. For example one of the people who lived at the home showed is their bicycle which they enjoyed riding. Their risk assessment weighed risks and benefits and identified safeguards so they could ride and enjoy their bike safely. At the time of our visit the manager was in the process of developing policies and procedures on the Mental Capacity Act 2005 Deprivation of Liberty Safeguards. However, we could see that the people who lived at the home were able to make decisions about their lives and lifestyle and got the right type of help where needed. We could see that people were involved in the day to day running of the home. They met with staff on a regular basis and discussed issues that were important to them and made plans for future development. They set the agenda for the meeting and typed the minutes themselves so they had control over their meetings and what they chose to discuss. They were asked about the quality of meals, standard of care and facilities and services provided on a regular basis through the homes quality assurance process and we could see that their views were taken seriously and acted upon. Care Homes for Adults (18-65 years) Page 13 of 27 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 who live at Jackson House are supported to make choices about their lifestyle and are offered a range of activities in the home and local community that meets their needs and expectations. Evidence: The homes activity records show that people are supported and encouraged to enjoy a full and stimulating lifestyle. Individual hobbies and interests are supported and promoted and people have opportunities to take part in a range of social, educational and leisure activities in the home and local community. People told us that they were able to do a range of activities including going to college to do interesting courses on computers and healthy eating, going to the pub and joining in with Quiz night. Records show that people living in the home are encouraged to maintain contact with family and friends. The homes quality assurance survey show that relatives feel Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: welcome when they visit. The atmosphere in the home is relaxed and sociable. Staff tend to take the lead on certain domestic tasks such as meal preparation but are quick to step back when a person shows interest or takes the initiative to get involved. Meal times were relaxed social occasions and records of meals served show that a varied and nutritious diet is on offer. Care Homes for Adults (18-65 years) Page 15 of 27 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 physical and mental health of people living at Jackson House is monitored by staff and other health and social care professionals so they get the care they need. Evidence: Personal health care needs, including specialist needs and dietary requirements, are clearly recorded in each persons care record file. Care records provide an overview of the persons health care needs and act as an indicator of change in health requirements. Care plans show that all people living at the home are registered with a local doctor and other health care specialists monitor their mental heath. This helps to make sure that people stay healthy and their specialist heath care needs are met. We spoke with a social care professional who supported three of the people who lived at the home. They told us the manager and staff communicate and work well with them so the health and social care needs of the people they support are met. This had positive outcomes for all three people who had settled in to the home remarkably well and were enjoying a range of social, educational and leisure activities. Medicines management and administration was checked. Most of the medication Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: prescribed for the people who live at the home is packaged in a monitored dosage blister packs but this is not appropriate for some medicines which are supplied in the original packaging. We looked at medicine administration records (MAR) sheets and found that these were accurate and up to date. Stock records of loose medicines were not kept in the required detail so the amount of medication in stock did not match what the records showed. However, the manager conducted a thorough investigation and on finding that a recording error had been made took action to improve the recording of loose medicines received in the home. This is important because it will help to ensure accountability on the handling and storage of medicines so the people who live at the home will always receive their medication as their doctor prescribed it. Care Homes for Adults (18-65 years) Page 17 of 27 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 who live at Jackson House are able to express their concerns and have access to an effective complaints procedure. They are safeguarded from abuse and have their rights protected. Evidence: We could see that the manager and staff share positive attitudes toward receiving and acting on complaints and people who live at the home say staff listen and act on what they say. The complaints records showed that 19 complaints had been received in the 12 months before this visit but most of these were minor issues that were dealt with at the time. One of the people who lived at the home had made a complaint in writing. We could see from the complaints records that the concern they raised had been taken seriously, acted upon and addressed to their satisfaction. Staff have access to written policies and procedures for responding to suspicion or evidence of abuse including a whistle blowing policy so they know that they can report poor practice. Staff training records showed that all but the most recent recruits had received training on adult safeguarding procedures so they know what to do if there is any evidence or suspicion of abuse. We recommend that newly recruited staff receive training on safeguarding vulnerable people within the first six weeks of their employment. Records and information provided by the manager showed that there had been no safeguarding referrals to the local authority since our last inspection of Jackson House. Care Homes for Adults (18-65 years) Page 18 of 27 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 home is clean, tidy and well maintained so people live in comfortable, clean surroundings that meet their needs. Evidence: The home is in Styal conservation village and is in keeping with other domestic houses in the area. This helps to provide an ordinary life in the community for people who live at Jackson House. One of the people who lived at the home showed us around the garden and communal areas of the home. They told us that they were very happy at the home and were very comfortable. We could see that the home was clean, comfortable, well equipped and decorated and furnished with good quality furniture fixtures and fittings. We looked at maintenance records and could see that portable electrical appliances had been checked so they were safe but there was no record that the electrical wiring had been checked in the last five years or that the fire alarm had been checked by a qualified person since our last inspection. However, the manager arranged for this work to be done shortly after the inspection so the people who live and work at the home are safe. Care Homes for Adults (18-65 years) Page 19 of 27 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. Managers and staff are trained and have gone through thorough recrutment processes so they are suitable and have the right skills to work with the people who live at the home. Evidence: Jackson House is registered to provide nursing care so there is a qualified nurse on duty on each shift throughout the day and night. Our observations and discussions with staff and the people who live at the home showed that there were enough staff on duty to meet the needs of the people who live at the home. Staffing rotas take account of the changing needs of people so more staff are employed at times of higher demand. We could see that care staff were skilled and experienced. They carried out their work in good humour with sensitivity and understanding, giving timely prompts and direction to help people achieve what they wanted to do, with the minimum of fuss and intervention. We checked the recruitment file for one new staff member and we discussed recruitment procedures with the manager and some staff. Records show that the homes recruitment procedures are thorough so staff are suitable and have the right Care Homes for Adults (18-65 years) Page 20 of 27 Evidence: skills and knowledge to work with the people who live at the home. We talked with the manager, two nurses and a support worker about training opportunities and we looked at the staff training records. We could see that there was a comprehensive staff training and development programme with opportunities for training in a range of relevant topics. These included moving and handling, protection and safeguarding of vulnerable adults, fire safety awareness, health and safety, food hygiene, dementia awareness, first aid, infection control, challenging behaviour including safe physical intervention, epilepsy including administration of rescue medication, and behaviour analyst training. However, only the manager had had training on the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards. We recommend that all staff are given this training so they know how to make sure that the people who live at the home always get the help they may need to make informed decisions about their lives, care and welfare. All new staff complete the Skills for Care induction training programme. This includes the common induction standards so they have the skills they need to do their jobs effectively and competently. The staff team comprises of seven qualified nurses including the manager and ten support workers. The training matrix shows that eleven members of the homes seventeen staff have achieved a national vocational qualification (NVQ) in care at level two or above and three others were working toward the qualification. This means that the home had exceeded the target for a minimum of fifty percent of staff to achieve a nationally recognised qualification in care by a good margin. This showed that people who live at the home are in safe and competent hands. All staff spoke highly of the manager telling us that communication in the home is good and they appreciated her leadership and support. They had the benefit of an annual appraisal, and regular supervision and staff meetings. This showed us that the staff have opportunity to discuss care practice and personal development needs so they are well supported. Care Homes for Adults (18-65 years) Page 21 of 27 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. Jackson House is managed in the best interests of the people who live their so they experience good quality outcomes. Evidence: Jackson House has been without a registered manager since 30 November 2007. However, the deputy manager had been appointed as manager and at the time of our visit was in the process of completing her application for registration with the commission under the Care Standards Act. The manager is an experienced and qualified registered nurse specialising in learning disability who has been able to develop her skills over time through a number of training courses achieving NVQ level 2 and 3 in social care, along the way. Currently she is working toward NVQ level 4 in Leadership and Management in Social Care. Our observations and discussions with staff, the people who live at the home and a visiting social care professional showed us that the manager is person centred and has a clear understanding of what needs to be done to make sure the home is run in the best interests of the people who live there. All staff we spoke with were familiar with Care Homes for Adults (18-65 years) Page 22 of 27 Evidence: the concepts of equality and diversity and told us how they recognised and met each persons individual needs through person centred care planning. Much has been achieved since our last inspection with significant improvements in staff training, person centred care planning and care practice. The staff present as a cohesive team that benefits from good leadership and shared aims and objectives so the people who live at the home experience good quality outcomes. This shows us that the home is managed well by a competent person. Effective quality assurance processes were in place. These were based on seeking and acting on the views of the people who live at the home and their relatives and other representatives. Feedback is actively sought through quality assurance questionnaires, and residents meetings. The manager produced a report on quality issues shortly after the inspection and sent a copy to the commission for our records. This report is open to all people who live at the home and their representatives so they can see that their views have been taken seriously and acted upon. We recommended that the home widens the scope of its quality assurance survey and sends questionnaires directly to all health and social care professionals associated with the home so their views can be gathered and taken into account. We could see that the health and safety of people who live and work at the home is promoted but we found that the electrical wiring system had not been serviced in the last five years and the fire alarm had not been serviced in the last twelve months. This meant that the health and welfare of people living and working at the home could have been at risk because routine checks of these systems had not been carried out. However, the manager took immediate action to address these issues and following the inspection confirmed in writing that the fire alarm and electrical wiring system had been serviced by a suitably qualified electrician. The manager and other senior staff carry out risk assessments so hazards are identified and where appropriate risk management plans are put in place so people are safe. One of the risk assessments seen needed revising because it was based on outdated information and had not been updated properly when new people moved into the home. The manager took immediate action to address this issue at the time of the inspection. Care Homes for Adults (18-65 years) Page 23 of 27 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 24 of 27 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 7 The homes policies and procedures on the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards should be developed so staff have guidance that will help them make sure that the people who live at the home get the right type of support to assist them with their decision making, if required. Stock records of medicines received in their original containers need to be kept accurate and up to date so staff can make stock checks to ensure that medicines are administered properly. Newly recruited staff should receive training on safeguarding vulnerable people within the first six weeks of their employment so they will know what to do in the event of any suspicion or evidence of abuse. All staff should be given training on the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards so they know how to make sure that the people who live at the home get the help they may need to make informed decisions about their lives, care and welfare. 2 20 3 23 4 35 Care Homes for Adults (18-65 years) Page 25 of 27 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 5 39 The home should widen the scope of its quality assurance survey and send questionnaires directly to all health and social care professionals associated with the home so their views can be gathered and taken into account. Care Homes for Adults (18-65 years) Page 26 of 27 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. 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