Care Home: Kenilworth

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What the care home does well Residents continue to live in a homely and clean environment which is generally decorated and maintained to a good standard. Resident`s personal accommodation is highly individualised to reflect their personalities and lifestyles. The home is clearly able to demonstrate it meets the range of residents needs. A sample of comments made about experiences at the home included "It is like a second home its is like an extension of my own family he has a wonderful life there. He likes his own space peace and quiet and he gets that by being able to just go and stay in his bedroom by himself if he wants" "his quality of life has improved so much since living there he understands so much more he does more now than he ever used to" "I am very contented" and "it is a home from home". Central to the aims of the home is the promotion of person centred support which ensures that residents receive individual care and support based on a thorough assessment of their particular needs and preferences. Resident`s lives are enriched by excellent practices in the promotion of meaningful occupation, leisure pursuits, choices and being enabled to live chosen lifestyles. Comments included "he always seems to be doing something different he is developing more and more which is down to the staff" and "he has blossomed since being there he is now aware of his choices which has made him stronger". Residents are active participants in the running and daily live at the home. Resident`s benefit by being supported to maintain relationships with their families and friends with relatives confirming that they are always made to feel welcome. The meals are excellent offering both choice and variety and catering for special dietary needs. Excellent provision has been made to identify residents individual preferences for their end of life care. Staff make a positive contribution in residents lives as residents benefit from a stable, well supervised, suitable trained and enthusiastic staff team that know them and who are generally robustly recruited and employed in sufficient numbers as is necessary to meet their needs. A sample of comments about staff included "Staff wonderful they care" "they all seem to understand him and how to communicate with him. Lovely always smiling very helpful" and "staff excellent everyone is I can not praise them highly enough they provide good quality care its like a large family". Resident`s benefit from a well motivated and knowledgably manager who promotes good practices and provides a clear sense of leadership and direction with the home run in the best interest of residents. What has improved since the last inspection? All of the shortfalls noted at the previous inspection have now been addressed this has resulted in residents safety being improved through more robust risk management practices, clearer guidance for staff on medication procedures. Further improvements have been made the environment with the redecoration of further bedroom and repair of the porch, driveway and path. What the care home could do better: There are no shortfalls in practices that have lead to requirements being made at this inspection. The manager was aware of the need to continue with the refurbishment of the home to address the minor areas of redecoration needed. To further personalise the homes literature and person centred plans in order to make them more accessible. Key inspection report Care homes for adults (18-65 years) Name: Address: Kenilworth 117 Balcombe Road Horley Surrey RH6 9BG     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: Jane Jewell     Date: 0 8 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 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) 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 29 Information about the care home Name of care home: Address: Kenilworth 117 Balcombe Road Horley Surrey RH6 9BG 01293784299 F/P01293784299 theavenues.co.uk glebe.house@theavenuestrust.co.uk Avenues Support Services care home 6 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 6. The registered person may provide the following category/ies of service only: Care home only - (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). Date of last inspection Brief description of the care home Kenilworth provides a home for six adults with a moderate to severe learning disability and behaviours that may be challenging and who have a good level of mobility. The home was first opened in 1997. The home is owned and managed by The Avenues Trust, which has a number of similar homes in the Southeast of the Country. Kenilworth is a converted two floor domestic house situated in a residential area of Horley, within reach of the town centre with its amenities. The building is owned by a housing association who take part responsibility for its Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 6 Brief description of the care home upkeep and repair. The building is presented across two floors with stairs providing access to the first floor. All bedrooms are single occupancy. Communal space consists of a lounge large dinning room, and kitchen. The home is set in its own grounds with a secure garden which contains seating areas and a summer house that has been converted for use as a sensory room or a meeting room. The fees for residential care are currently £797.90 to £1245.80 per week, depending on the services and facilities provided. Extra such as: newspapers, hairdressing, chiropody, transport , toiletries are additional 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: The information contained in this report has been comprised from an unannounced inspection undertaken over five and half hours and information gathered about the home before and after the inspection. The manager had completed an Annual Quality Assurance Assessment form prior to the inspection and the information contained in this document has been used to inform the inspection process. The inspection was facilitated by the Pamela Jugurnauth (Registered Manager). The focus of the inspection was to look at the experiences of life at the home for people living there. The inspection consisted of being shown around the communal areas, and being invited to view residents bedrooms, examination of the homes documentation and observations of residents daily routines and in their interactions with staff. Three residents, four staff and three relatives were consulted as part of the inspection process. Care Homes for Adults (18-65 years) Page 6 of 29 Feedback surveys were sent to the home for distribution, in order to obtain the views on the quality of the services and facilities being provided. Six were returned in total, two from residents who were supported to complete them and four from staff. Their feedback is included in this report. There were six residents living at the home at the time of the inspection. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? All of the shortfalls noted at the previous inspection have now been addressed this has resulted in residents safety being improved through more robust risk management Care Homes for Adults (18-65 years) Page 8 of 29 practices, clearer guidance for staff on medication procedures. Further improvements have been made the environment with the redecoration of further bedroom and repair of the porch, driveway and path. 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 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. There is a good range of accessible information available about the home and the services and facilities it provides, in order to help residents and their families make informed choices about the home. The home is able to clearly identify and meet the wide range of residents needs accommodated at the home. The assessment process ensures that only residents who))s needs can be safely met at the home are admitted. Evidence: The homes statement of purpose, which is a book that tells people who the home is for and the service users guide, which is the book that tells people how the home works, is comprehensive and provides a wide range of information about the home and the services it provides. Each resident is provided with their own service user guide which is in a format which Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: helps to aid their understanding and includes pictures and easy read formats. Although this was in a standardised format used across the organisation the manager agreed that it could be made more relevant to Kenilworth by including photos of the actual home and its facilities. This information about the home would be sent to prospective residents and their representatives to help make informed choices about the homes suitability. Residents confirmed that they were provided with information about the home before they came to visit. There have not been any new admissions to the home in some time. Therefore, this standard was assessed in respect of the admission procedure should a vacancy occur. The manager was aware of the admission criteria for the home and knowledgeable about admissions practices that would ensure a comprehensive range of information is gathered about prospective residents. This would then inform their decision whether a prospective residents needs could be met at the home. There are also policies to ensure an effective pre-admissions process and moving in plans. There are currently four males and two female residents who are largely assessed as having a medium range of needs including some residents who also have some mental health conditions, visual impairments and behaviour which can be challenging. Two residents are assessed as needing specific one to one time with staffing. Most residents have lived at the home since it opened and present as a close cohesive group. Through observation, looking at records and speaking to residents staff and relatives, evidence was gathered that the home is clearly meeting the range of residents needs. All persons consulted about the home spoke positively about their experiences of the home, a sample of their comments included It is like a second home its is like an extension of my own family he has a wonderful life there. He likes his own space peace and quiet and he gets that by being able to just go and stay in his bedroom by himself if he wants his quality of life has improved so much since living there he understands so much more he does more now than he ever used to I am very contented and it is a home from home. The manager confirmed that prospective residents are provided with the opportunity to visit the home in advance to assess the quality, facilities and suitability of the home with their family and representative. The length and type of any visit would depend on the individuals needs and preferences. The first six weeks of residency is looked upon as a trial occupancy. Permanent residency is usually subject to a review of care needs with the residents their representatives and any care manager. Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: The manager stated that residents are provided with a written contract of terms and conditions of residency with the home. This is used with residents and their families to make explicit the placement arrangements and clarify mutual expectations around rights and responsibilities Care Homes for Adults (18-65 years) Page 13 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. Residents benefit from a good person centred care planning process, that provides clear, up to date and accurate information about their individual needs and goals and the support needed to achieve them. The home balances well the rights of residents to take reasonable risks as part of an enabling lifestyle. Residents are actively involved in the running and in daily live at the home. Evidence: Each person has a comprehensive person centred plan in place which is designed to enable personal, health, communication, social, cultural and religious needs of each person to be addressed. Four person centred plans were sampled which had been implemented in consultation with residents and who had been actively involved in their development and review. Any changes in residents needs and preferences are identified through the regular review of care plans. Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: Staff were very clear about the principles of person centred planning and spoke about the positive influence of the Person Centered Active Support (PCAS) programme introduced by the organisation. This they felt was significantly increasing residents choices and enabled residents further to live their chosen lifestyle. Staff were very knowledgeable about the individual support needs of residents and were observed following them. The manager spoke of new person centred documentation about to be introduced to further enhance an individualised approach to care planning. The manager also agreed that further work could be done to the documentation and presentation of the plans to further individualise them. The home has a developed system in place for enabling residents to take reasonable risks as part of an enabling lifestyle. For example core risks faced and posed by residents are assessed and any measures to reduce or mange the risk is recorded for staff to follow. Respecting residents rights to make decisions about their lives is integral to the ethos of the home. Much feedback was received from residents and families on how residents are encouraged and enabled to make decisions about what to eat, how to spend their day and what leisure activities to undertake. Consideration has also been given to new legislation (Mental Capacity Act) which effects residents rights to make decisions in their lives. Staff spoke of taster sessions regarding favourite flowers and activities that have been undertaken to help residents identify their preferences and therefore able to make informed decisions in the future. A range of ways was seen of how well residents are actively involved in the running of the home with regular meetings and consultations, all of which was confirmed in records and discussions with staff. Residents are involved in some light household chores including laundry, hoovering, table setting and clearing. Staff demonstrated an awareness of good practices about confidentiality, ensuring that sensitive information is kept secure and knowledgeable about the circumstances under which information must be shared with management and others. Staff are also aware that residents have the right to ask that some information not be shared with family or others. Care Homes for Adults (18-65 years) Page 15 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. Residents lives are enriched by excellent practices in the promotion of meaningful occupation, leisure pursuits, choice and being enabled to live chosen lifestyles. Residents benefit by being supported to maintain relationships with their families and friends. The meals are excellent offering both choice and variety and catering for special dietary needs. Evidence: It was clear from reading documents, speaking with staff and from direct observations that residents are given the opportunities to maintain and develop independence, communication and living skills. Without exception all relatives consulted spoke of the individual progress made in their relatives personal development since they have lived Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: at the home. A sample of comments included he always seems to be doing something different he is developing more and more which is down to the staff and he has blossomed since being there he is now aware of his choices which has made him stronger. Residents have individual weekly programmes which have been created based on their individual needs and preferences. These plans showed that residents access a wide range of meaningful activities including aromatherapy, holidays, horse riding , day centres, trampoline, line dancing, art and crafts sessions. The organisation has a sports and active lifestyles group which looks at how they can encourage residents to access and take part in more sports. Staff spoke of the flexibility in each residents activities plan according to the residents needs at the time. The home has sole use of a mini bus with the majority of staff reported to be drivers. A relative fedback that since living at the home their relative now undertakes a wide variety of activities. A resident has recently been enabled to display their art work at the organisations head quarters. A resident had recently enjoyed celebrated a milestone birthday at the home with their friends and family. Residents access a variety of community resources including the local shops and amenities of nearby town of Horely. Relatives commented upon how welcomed they are made to feel when they visit, this included being offered beverages and staff being friendly and approachable. All relatives consulted with spoke of the good level of communication ensuring they are kept informed of any significant changes or events. A relative spoke of the support provided by staff in enabling their relative to also visit them at home. Staff spoke of coffee mornings held at other homes across the organisation at the weekend, which enabled residents to meet up with friends. On the day of the inspection, it was observed that the routines of the home were reflective of residents individual needs and lifestyle. Residents were able to move around the communal space freely, choosing which rooms to be in and what level of company they wanted to enjoy. Residents are able to help plan menus, shop for food and in some cases help prepare meals and snacks. Menus are displayed in an accessible format and showed that a varied and balanced diet is provided, which includes fresh produce and caters for specialist diets. Mealtimes and arrangements for eating are tailored to meet individual residents needs and what events and activities were occurring that day. Staff spoke of preparing different cultural meals from around the world for residents to try. Care Homes for Adults (18-65 years) Page 17 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. Residents benefit from the excellent provision of flexible and respectful personal and healthcare support that is individual and respects their privacy and dignity. The medication systems are well managed promoting good health. Excellent provision has been made to identify residents individual preferences for their end of life care. Evidence: Staff were observed providing dignified and sensitive care to residents which helped to maximise choices and independence. Staff were knowledgeable about the personal care and support needs of each residents and were knowledgeable about how this should be provided in order to respect residents rights and dignity. Person centred plans contained cultural assessments which highlighted residents individual cultural needs and how staff should support them to meet them. A staff member spoke of the support they have provided in a resident being able to maintain contact with their cultural community. Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: The organisation operates a same sex policy when undertaking personal care and ensures that male staff do not provide one to one support for female residents. Staff felt that this did not inhibit practices at the home but worked well due the stable staff roster which is well organised. Residents are supported to access a range of health care services, to meet their individual needs and their individual health action plans. This included Gps, specialist nurses, dentists, psychologist and opticians. It was clear that where there are concerns regarding the health or welfare of residents medical assistance is sought promptly. No residents are assessed as self medicating. Medication profiles are in place which provides information on how much medication is provided, how medication should be administered , side effects and any allergies. Clear records were maintained of when each medication has been administered. Residents plans contains individual guidance on how each residents prefers to have their medication administered. In accordance with the previous requirement the manager reported that protocols have now been developed for the administration of as required medication. These make clear the individual circumstances for when this medication should be administered. An inclusive approach was noted to end of life planning within each residents individual levels of understanding. Each resident is currently compiling a farewell plan. This has involved taster sessions to help identify which flowers individuals would prefer as part of their funeral arrangements. Care Homes for Adults (18-65 years) Page 19 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. An effective complaints procedure and appropriate adult protection policies helps to protect the rights and interests of residents. Evidence: There is an accessible complaints procedure for residents, their representative and staff to follow should they be unhappy with any aspect of the home. Although it is recognised by staff that residents would require support to make a complaint and were knowledgeable on how they would support a resident to do this. All relatives consulted said they felt able to raise any concerns they had with the manager and were confident that they would be addressed promptly. The manager reported that one formal complaint has been received since the last inspection by a neighbour. This was dealt with promptly and in accordance with the homes procedure. The home has written policies covering adult protection and whistle blowing. These make clear the vulnerability of people in residential care, and the duty of staff to report any concerns they may have to a responsible authority for investigation. Staff have received formal training in safeguarding adults and prevention of abuse and the staff consulted with showed a good understanding of their roles and responsibilities under safeguarding adults guidelines. 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. Residents live in a clean, homely environment, which is generally decorated and furnished to a good standard with their bedrooms furnished and decorated according to their individual lifestyles. Evidence: The home continues to undergo a gradual upgrade and refurbishment with all of the previous shortfalls relating to the environment noted at the last inspection now addressed. This has seen the repair of the porch, resurfacing of the driveway, rebuilt pathway and redecoration of the some internal parts. Standards of maintenance are now good with the manager reporting prompt action is taken to address any maintenance areas. Some minor redecorations works are still needed which the manager had identified and confirmed that this works was due be imminently undertaken. This included the redecoration of communal areas and new kitchen cupboards. A sample of comments about the environment included good lovely home they have worked hard over the last 2 years to improve it significantly the environment is excellent it has all the equipment he needs hand rails controlled water temperatures his bedroom is always neat and tidy and lots of fresh air. There is a large rear garden which has many attractive features including a summer Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: house which has been converted for use as a meeting or sensory room. Various seats are located in the garden which is generally laid to lawn with flower beds, making this a very attractive area for residents to access. A resident has a small vegetable patch with residents also assisting in the creating and maintaining the many flower pots and hanging baskets around the home. Much effort is made to create a modern homely feel to the environment. Some residents invited the inspector to view their bedrooms, which had all been individualised to reflect their lifestyles. One resident had choosing to have double beds and cable television in their bedroom. There are sufficient number of toilets and bathrooms located around the home. The home is not designed to offer a service to people with physical disabilities and the stairs and other access arrangements would make it unsuitable for residents with significantly restricted mobility. There are some aids and adaptations around the home to help aid residents independence, this includes assisted bathing facilities and hand rails. All areas inspected were observed to be cleaned to a good standard with any malodours odours confined to one bedroom. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff make a positive contribution in residents lives as residents benefit from a stable, well supervised, suitable trained and enthusiastic staff team that know them and who are generally robustly recruited and employed in sufficient numbers as is necessary to meet their needs. Evidence: It was observed through the inspection that staff understood their roles and had a good rapport with residents and planning skills. Staff spoke about the good levels of communication between themselves and management. The tasks of the day appeared well organised and individual staff appeared confident in carrying them out. This helped ensure that residents knew who was support them. Staff consulted with had a clear understanding of the aims of the home and how their individual role contributed towards achieving this. Staff felt that there was always sufficient staff on duty for residents to get the support they needed when they wanted it. Staff confirmed that there is some flexibility in the staffing hours should they need additional cover. There is a small stable staff team who have worked at the home for a number of years and who knew the residents extremely well and were observed providing appropriate Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: levels of support. Humour was observed to be used successfully in communicating with a resident, which promoted relaxed friendly interactions with staff. A sample of comments made about staff included staff wonderful they care they all seem to understand him and how to communicate with him. Lovely always smiling very helpful and staff excellent everyone is I can not praise them highly enough they provide good quality care its like a large family. The manager reported that there is little staff turnover and therefore limited recruitment. A resident was involved in the recent recruitment process for the deputy manager at the home and residents are generally involved in meeting and greeting any candidates. There is a central recruitment process with recruitment documentation held at head office, who then sent out confirmation when all of the required documents have been obtained. One example was noted whereby confirmation of a Criminal Records Bureau check (CRB) had been obtained therefore the manager could not be confirmed that the staff member was safe to work with vulnerable people. The area manager subsequently confirmed that a CRB check had been undertaken and confirmation sent through to the home for filing. The home has been proactive in ensuring that the majority of staff have undertaken a National Vocational Qualification (NVQ) in Care. There is a commitment to improving staff skills through an ongoing training programme both in practical matters and the broader aspects of working with people who have learning disabilities. Staff spoke of selecting which courses they would like to attend from the range of course provided by the organisation. Staff consulted with confirmed that they had undertaken all of the mandatory areas of training needed to work safely with residents including first aid medication, manual handling, safeguarding adults. A staff member spoke of undertaking some specialist training in epilepsy and autism. The manager recognises the need for some training in mental health conditions and agreed to access some awareness training to further enhance staffs understanding of the needs of some residents. The manager confirmed that new staff would undertaken a skills for care induction, which is the industry recommended minimum inductions standards. Staff confirmed that there is a formal programme of supervision and direct supervision with the manager working along side support staff each shift. All staff consulted with felt well supported by the manager to undertake their roles. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a well-motivated and knowledgably manager who promotes good practices and provides a clear sense of leadership and direction with the home run in the best interest of residents. The home regularly reviews aspects of its performance through a good program of self-review and feedback. A range of regular health and safety checks helps to promote the health and safety of residents and staff. Evidence: The manager has been in post for eighteen months and confirmed that they are in the process of undertaking the recommended management qualification. They demonstrated much commitment towards best care practices in the care of people who have a learning disability. They provide a clear sense of leadership and direction which enables staff to then provide good individual consistent care. All persons Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: consulted spoke positively about the management with particular reference to their approachability, relaxed supportive nature and willingness to listen to new ideas. There are mechanisms in place for the manager to obtain feedback on the quality of the services of the home and whether it is achieving its aims and objectives. These includes annual placement reviews, residents and staff meetings, internal quality audits, written feedback from relatives and health care professionals. Examples were noted whereby improvements to working practices and the environment have been made based on this feedback. A staff member felt that what the home does really well is listening to suggestions and uses staffs knowledge of residents to help make their lives better. The manager is supported by experienced senior management who also comprehensively undertake the required monthly audit and monitoring of the homes services and facilities on behalf of the organisation to ensure that standards are being maintained. Written guidance is available on issues related to health and safety. Records submitted by the manager prior to the inspection stated that all of the necessary servicing and testing of health and safety equipment has been undertaken. There are regular health and safety checks around the building. Systems are in place to support fire safety, which include: regular fire alarms and emergency lighting checks, staff training and maintenance of fire equipment and fire drills were reported to have been undertaken. The manager reported that a fire risk assessment has been undertaken by themselves which is due to be imminently reviewed. This records significant findings and the actions taken to ensure adequate fire safety precautions in the home. In accordance with the previous requirement different window restrictors have now been fitted to relevant windows and a legionella test now undertaken. 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. 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