Care Home: Keepers Cottage

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What the care home does well New people are able to come and stay to see if they get on with others and want to live in the home. Each person is fully involved in planning his or her support. People are supported to make decisions about their health care and medical treatment. There is enough staff to support people with their chosen lifestyle. People choose what activities, college courses or jobs they want to do. They have a good social life. They are supported to have friends and stay in touch with their families. The house is homely, well maintained, comfortable and safe. The home is well run and people`s views are listened to. People feel able to make complaints and these are taken seriously. The team is small so people get to know staff well. The staff are trained and supported to do a good job. Mr Lafford has managed the home for many years and he always tries to improve the service. What has improved since the last inspection? Another person has been successfully supported to move on to live a more independent life. More staff are now qualified in Health and Social Care. People are better supported to tell the Charity Directors their views. What the care home could do better: Some people said they would like to find a job. It is hoped that more people will be supported to order repeat prescriptions for their medicines and book their own health appointments. The aim to recruit more male staff would balance the staff team better and be beneficial for everyone. Key inspection report Care homes for adults (18-65 years) Name: Address: Keepers Cottage Falcon Lane Ledbury Herefordshire HR8 2JN     The quality rating for this care home is:   three star excellent 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: Jean Littler     Date: 0 2 0 3 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: Keepers Cottage Falcon Lane Ledbury Herefordshire HR8 2JN 01531670772 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: tony.lafford@saltershill.org.uk Salters Hill Charity Limited care home 8 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: 8 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) 8 Date of last inspection Brief description of the care home Keepers Cottage is a rurally based Care Home situated on the outskirts of Ledbury. It is one of a small group of services set up and managed by the Salters Hill Charity. The Home is on two stories and provides accommodation in single bedrooms for eight younger adults, of either sex, with mild to moderate learning disabilities. The home will accept people who are over 18 years on admission and who have an interest in working with animals or on the land. Information about the service is available from the Home. The fees are worked out on an individual needs basis depending upon the support needed. In March 2010 fees ranged between £450 and £675 per week. People pay a contribution towards these Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 8 Brief description of the care home from benefits they receive. In addition to the basic fees the people pay for their personal items such as toiletries and clothes, personal services such as chiropody and hairdressing, the cost of personal phone calls, and a contribution towards the TV licence and holiday costs. 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: three star excellent 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: We, the Commission, carried out this inspection on a weekday between 12pm and 5pm. We had not been to the home for three years as the home was rated as excellent at the last inspection in 2007. The manager, Mr Lafford, was on duty and helped with the process. We looked around the house and spoke with some of the staff and the people living in the home. Two people showed us their bedroom. Three people talked to us in private about their views of the Home. Care Homes for Adults (18-65 years) Page 6 of 29 Some peoples records were looked at such as care plans, medication and money. Mr Lafford sent information about the Home to us before the visit. Surveys were sent out to gain peoples views. Seven people living in the home and three staff returned these. 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: 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. Care Homes for Adults (18-65 years) Page 8 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are provided with the information they need to make an informed choice about moving into the Home. Their needs and aspirations are assessed and they have the opportunity to visit and try out the service. Care is taken to ensure the will get on with the people already living in the home. Evidence: A Statement of Purpose is in place that describes how the service is operated. There is a Service Users Guide and each person has a copy in a format they can understand. Everyone also has a copy of the Terms and Conditions of Residency that they have agreed to. Two new people have moved in during the last year. The Charity has a procedure about the assessment process and an assessment tool that can be used if needed. Both new people had been invited to stay for a week to try out the service. Other interested people had also visited the home. The residents spoken with confirmed that they had been consulted after these visits to see who they felt they would most like to share their home with. Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: One new mans care plan was seen. This contained a placement plan agreed at a planning meeting held with the man, his family and professionals prior to him moving in. The person is being supported to manage his own care funding and the service has been agreed for one year with the specific aim of increasing the mans independent living skills such as using public transport. The man confirmed that he wanted to move in and he had felt supported and made welcome. He was having his first six months review meeting the following week. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are enabled to be fully involved in planning and reviewing their life goals and any support they need. They are supported to take reasonable risks as part of living independently and are fully involved in decisions about their lives and how the Home is run. Evidence: People have a Key and Co-worker who speak to them frequently to ensure they are benefiting from the activities they have chosen and help them plan ahead, manage money etc. The people spoken with said they had a choice over which staff are their Key and Co-workers. Each resident has a person centred care plan. As reported above the plan for one of the new men was seen. Another resident showed us her plan which she keeps in her bedroom. This contained up to date information about the support she needs, how she is being encouraged to be independent whilst staying safe and reports from her recent progress review. She had been supported to present visual information about her life Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: and future aims at her review meeting that her Mother and social worker attended. The plans contain risk assessments. Those seen reconfirmed past evidence that people are consulted and supported to take risks as part of living lives as independently as possible e.g. using a bus alone. Agreements are made if some restrictions to independence are needed in the persons best interest, for example, the person not having free access to their personal money. Review meetings are held at least every six months. People are supported to prepare well for these and decide who they wish to invite. The meetings room in the barn has provided the opportunity for people to use the touch screen large wall board to show photographs and videos of their activities and achievements. For example how well they can ride horses. One man said he had enjoyed his review although he had been nervous to start with standing up in front of everyone. He seemed very proud of this achievement. The residents have a joint meeting each month where decisions are made about how the Home is run. The residents are consulted about the majority of decisions e.g. how some budgets are spent, the recruitment of staff, choices about replacement furniture and redecoration, and house rules and routines. People are encouraged to attend a self-advocacy group, to speak up for themselves and express their views in an appropriate way. The complaints system is well used to help people resolve any differences. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have many opportunities for personal development. They make decisions about their lifestyle and the activities, further education or employment they access. Their rights are actively promoted and they are supported to develop and maintain their personal relationships. People enjoy their mealtimes and have influence over the food they eat. Evidence: There is a relaxed structure to daily routines particularly on weekdays because people share responsibility for housework, shopping, cooking, and caring for the chickens and cows. This shared approach enables all residents to develop their life skills and an understanding of working as a team to benefit all. People told us that they enjoy being involved in running the home and look forward to their turn to cook. The focus on life skills has resulted in five people moving on to live more independently in the last few years. Some of the current residents hope to do this in the future which helps Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: motivate them to learn new skills. People have busy personalised schedules of activities they have chosen to take part in. Staff support people to seek opportunities for part time employment or work experience placements. One man said he hopes to find a new job after the bike repair shop where he worked closed. A new man said he was making plans for when he leaves full time college later this year. Some people access sessions that link to the rural focus of the Home, for example land and livestock, woodwork and horticulture. The Charity encourages support from Volunteers who help enhance the opportunities and social opportunities for people in the home. One Volunteer is a carpenter and teaches woodwork and another was a teacher. On the day a worker had held a course for six residents about Food Hygiene. People spoken with said they had enjoyed this and those seen receiving their certificates and being photographed seemed proud of this achievement. What they had learnt was being discussed later as people were doing food preparation. Comments included in the surveys people completed included; I like the food a lot; I like the activities; I like the courses, the animals and the food; my keyworker and the manager help me when I have a problem, I would like more jobs with gardening and animals. People also have a busy social life. Examples of leisure interests include arts and crafts, horse riding, meals and drinks out, dancing, sailing, chapel and the gym. A group are involved with a football team and play in Hereford and at Aston Villa at weekends. Decisions about group social activities are made when people meet for meals or at the regular house meetings. On the agenda for a meeting that evening was how to raise money for Sport Relief. Holidays are planned and people were asked in private where they wanted to go and who they would like to go with. A selection of holidays were then agreed with small groups for those who wanted to go away. People are supported to maintain and develop personal relationships with families and peers. People open their own post and vote if they want to. They are supported to know their rights and advocate for themselves. Feedback showed that people liked the meals. They shop and prepare their own meals. The evening main meals are agreed by everyone but people can make themselves something else if they change their mind. There is a focus on people having meals they enjoy that give a balanced diet with fresh fruit and vegetables. People take turns cooking with staff support and use recipes to help. Some people have personal food supplies of preferred items. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with personalised support in a way they prefer. Their emotional and physical health needs are being met and they are fully involved in any related decisions. They are supported to administer and control their own medication where possible. Evidence: People told us that staff support them in the way they prefer. The guidance in care plans makes it clear that peoples privacy and dignity needs to be protected if they need assistance with personal care. Tick charts are now being used to help people remember for themselves what personal care tasks they need to complete and when. People buy their own clothes and are consistently well presented when seen at inspections or in the community. Staff were observed to comfort one person when she was upset and had a headache. She was supported to get a paracetamol and staff checked later how she was feeling. The staff handover showed that there is good communication in the team about peoples health needs. Each person has a health action plan and annual health check with their GP. Specialists have been appropriately involved and people have been Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: supported to make decisions about any treatment options. Staff have attended training related to residents health needs. Clear records are made about any medical problems and health appointments. Medical records are being re-organised so essential information is in one file should an urgent admission to hospital be required. Feedback showed that people feel well supported with their health needs. Most people are not taking prescribed medicines. Some have topical creams and treatments but do not take tablets. The central medication storage cabinet is appropriately located and the key is stored securely. One person had just come off tablets following a review by their GP. The charts seen were clear and showed that the doctors instructions have been followed. Peoples ability is assessed and if possible they are supported to look after their medicines. They all have storage cabinets fitted in their bedrooms. All staff are appropriately trained to safely manage and administer medicines. Mr Lafford told us, We have enabled one person to self medicate by requesting the dispensing pharmacy to provide medication in a weeks supply rather than a months, thus reducing risk for individual and complying with British Pharmaceutical guidelines of keeping medication in its original container. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents and their representatives feel able to express their views and these are listened to and acted upon. People are protected from abuse and feel safe in their home. Evidence: The Home has a complaints procedure and an accessible version of this is given to each resident. People told us that they tell staff or Mr Lafford if they have a problem. A record of all complaints is kept and Mr Lafford reviews these every three months. All but one of the complaints were from residents about a fellow resident who had upset them in some way. The complaints log showed what action had been taken to help the problem be resolved. Often a resolution had been found by Mr Lafford chairing a meeting between the two parties. One complaint was from the relatives of a resident and related to communication from staff. Mr Lafford had taken action to improve arrangements and no further concerns had been raised in the last year. We have not received any complaints since the last inspection. The service has a long history of enabling people to voice their views and has always promoted self-advocacy. Policies are in place relating to safeguarding vulnerable adults and the staffs duty to report any concerns. The management team are aware of the local multi-agency procedures should a protection concern arise. No such issues have been raised since the last inspection. Staff receive training on this area in their induction and in a follow up course. The staff spoken with were clear of their role in protecting people and Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: residents told us that they feel safe in the Home. People are also being protected by the arrangements in place to support them with their money. One persons records showed that receipts are kept and that she was spending her money on personal things and activities. Recruitment procedures for new staff also help protect people. Incident reports are completed appropriately, however very few incidents occur as people are supported to express their emotions in an adult way. The reports seen described minor events where no one was injured and verbal support from staff was effective at resolving the situation. 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 homely, comfortable, clean and safe environment that meets their needs. The Home is being continually improved and people are consulted about any changes. Evidence: The Home is situated in a very rural location with lovely views. The house is on two levels. There are eight single bedrooms with sinks, a kitchen, laundry, dining room, lounge, office, sleeping-in room, communal toilets and bath/shower rooms. In the grounds is a large barn that has been fitted out since the last inspection to provide office, workshop and meeting rooms. This new office is being used as the administration centre for the Charity, which was previously in a porta cabin. The Home continues to be well maintained. Improvements are made whenever funds allow. Mr Lafford hopes in the future to fit out the top floor of the barn so it can be used throughout the year as a social resource and games room. All the bedrooms are over the minimum size for able-bodied people. There are sufficient bath and shower rooms. These are small but meet the needs of the current residents. Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: One of the new people showed us their bedroom. He had his entertainment equipment set up with a desk and comfortable chair. He felt he had plenty of storage and said his bed was comfortable. Another person showed us her room. She said her father had decorated the room and she was pleased with how the room was set out. People are involved in decisions about changes to the home at meetings or through discussions with their keyworkers. For example there is new lounge furniture and the room is being slowly modernised with everyones agreement. One man had worked with one of the volunteers to extend the patio outside the lounge and to paint areas of the barn. The Home was clean and everyone follows a rota to ensure all areas are cleaned regularly. Systems are in place to minimise the risk of infection and protective clothing is provided. Mr Lafford reported in the AQAA that all equipment has been serviced regularly such as the fire alarm. Care Homes for Adults (18-65 years) Page 22 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from support from an established, competent and effective staff team. The staff are appropriately qualified, trained and supervised. People are protected by the recruitment procedures. Evidence: The Home is staffed by a team of support workers, two co-ordinators and the manager. There has been staff changes over the last three years, however feedback showed that people like the current staff. No bank or agency staff are used and the team work flexibly to cover the rota. The worker spoken with said two staff is enough to support people with their daily routines. She said one worker is always a driver and they provide transport for planned activities and appointments, while the other supports the people at home and arranges the daily living activities such as meal preparation. Mr Lafford is on site each day and is available to provide cover if needed. One worker sleeps-in at night. There are several volunteers who provide support in different way, such as teaching woodwork. Staff have job descriptions and staff at each inspection have demonstrated they have a clear understanding of their role as enablers. The worker spoken with had no previous experience and had been in post a year. She was positive about her role and said that people are treated with respect and encouraged to be independent. The Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: interactions observed confirmed there was a good relationship between people in the home and the staff. The feedback received about the staff team was very positive. Mr Lafford has a good record of recruiting appropriate staff and ensuring they are suitable to work with vulnerable people. People from the home are always involved in the recruitment process. Mr Lafford told us that there are robust equal opportunity procedures and that appropriate checks are carried out before new staff start work. Feedback from staff confirmed that appropriate recruitment procedures are followed. The worker spoken with said she had found the induction and training provided very helpful. She had worked as an additional member of staff for the first month while she got to know people and had felt well supported by Mr Lafford and her colleagues. She found the staff meetings professional and they focused on the needs and development of the people in the home. Mr Lafford meets all staff regularly to provide supervision that covers training needs and personal development. The worker felt these meetings were positive and that she had been encouraged to develop her strengths such as outdoor projects. The Charity have well organised training arrangements and encourage staff to develop professionally. A training plan is developed each year and workers have their own training record. All staff attend core safety training e.g. First Aid, Moving and Handling, Food hygiene. More specialised training such as Medication, Safeguarding Vulnerable Adults, Equality and Diversity, and Person Centred Planning is also provided. Staff are kept informed about changes in relevant legislation such as the Mental Capacity Act. After their induction staff complete the Learning Disability Qualification and then start NVQ awards. Eight of the ten support staff have gained an award and those who have level 2 are encouraged to work towards the level 3. Care Homes for Adults (18-65 years) Page 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in the home benefit from a well-run home and effective leadership that continues the Charitys person centred ethos. They and their representatives are fully involved in the review and development of the service. Evidence: Mr Lafford continues to manage the home. He is experienced and holds the Registered Managers Award, NVQ 4 in Care and a Diploma in Social Work amongst other qualifications. As well as managing the home Mr Lafford spends 25 of his time managing a small Supported Living service run locally by the Charity. The service continues to run smoothly with this arrangements. There is an out of hours on call support system in place for when Mr Lafford is not available. All feedback received confirms the view that the Mr Lafford is professional, committed and approachable. The AQAA and other communications with us shows he has kept himself well informed about professional developments and ensures these are implemented in the Home when appropriate. He is based in the Charity office in the barn but comes to the home every day and attends daily handovers between staff Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: shifts and other meetings. The Organisation has a comprehensive set of policies and procedures, which have been kept under review. A worker confirmed she had been made aware of these during her induction. Some have been developed into a format more accessible to the residents and they have access to copies. The records seen were being generally well maintained and Mr Lafford reports incidents appropriately to us and other agencies. The Charity has well developed quality assurance systems and holds several quality awards such as ISO 9001-2008. Audits are carried out and feedback is obtained from annual surveys, regular reviews and the various meetings that are held throughout the year. Information gathered is included in an annual report for the Charitys Annual General Meeting. A Business plan is developed each year from this feedback and discussed at the AGM. To increase the involvement of people in the home a professional Advocate has recently been commissioned to work with people to enable them to give direct feedback to the Charity Directors. Mr Lafford told us that health and safety arrangements continue to be given priority. The Charity holds a Kite Mark award for C.H.A.S. (Contractors Health and Safety Assessment Scheme). This requires ongoing audits to ensure high standards are kept. The Charity has also gained the IS14001 Environmental accreditation and the homes carbon footprint has been reduced. Appropriate safety based training is provided for staff, hazards are risk assessed and safety equipment provided. Monitoring systems are in place and kept up to date, for example fire alarm checks and the cooking temperature of meat. The fire evacuation arrangements have been set up in line with the recommendations of the last Fire Safety Officer to inspect the service. Care Homes for Adults (18-65 years) Page 26 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 27 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 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. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!