Care Home: Lakeside House

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What the care home does well It is the view of the inspector that this is a well run home, and that service users receive good levels of care and support. Service users spoken to expressed satisfaction with the home. One service user commented that "The staff are alright here. They are all nice." The home has started to use an independent advocacy service to support service users since the last inspection, and there was evidence that service users have a large degree of control over their daily lives. The home seeks to meet the equality and diversity needs of service users. Service users have access to a variety of community based social and leisure activities. What has improved since the last inspection? There have been improvements to the home since the previous inspection, and the inspector was pleased to note that all five outstanding requirements from the last inspection were found to have been met. Staff now have an annual appraisal of their performance, and policies have been reviewed. Over 50% of staff now have a relevant care qualification, and the home has new curtains in the sitting room. What the care home could do better: Despite these improvements, there are still some issues that must be addressed, and a total of three requirements have been made in this report, along with two good practise recommendation. The home must ensure that care plans are subject to regular review, and that service users have access to routine dental care. The home must ensure that it seeks appropriate employment references for all staff working at the home. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Lakeside House 21 Chadwick Road Leytonstone London E11 1NE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Robert Cole     Date: 0 2 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Lakeside House 21 Chadwick Road Leytonstone London E11 1NE 02089236841 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) : adeimode@yahoo.co.uk Mr Siddicq Yadallee care home 8 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 8 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 - Code LD Date of last inspection Brief description of the care home Lakeside House is a residential care home registered with the CSCI to provide accommodation and support to eight adults with learning disabilities. The home is situated in a residential area of Leytonstone, in the London Borough of Waltham Forest. The home is situated close by to shops, transport networks and other local amenities, and is in keeping with other homes in the area. The home is privately run. The current rate of fees is between #600 and #900 per person per week. Care Homes for Adults (18-65 years) Page 4 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was a key unannounced inspection, which took place on the 2/06/09. The inspector had the opportunity of speaking with service users, staff, and the homes manager was present throughout the course of the inspection. In addition to these discussions, the inspector was able to observe staff as they interacted with service users. The inspection also included an examination of records and other documents, and a tour of the premises. Prior to the visit, the Care Quality Commission issued surveys to service users to gain their feedback on the home, Four of these were completed and returned. The home completed an Annual Quality Assurance Assessment (AQAA) at the request of the CQC before the site visit. All of this has contributed to the overall Care Homes for Adults (18-65 years) Page 5 of 30 inspection process, and to the judgements made within this report. 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 set out 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 7 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. It is the view of the inspector that service users are provided with sufficient information about the home to make an informed choice as to move in or not. This information is provided through written documentation, and the opportunity of visiting the home. Evidence: The home has a Statement of Purpose and Service User Guide in place. Both documents are written in plain English. The Statement says We aim to foster an atmosphere of care and support which enables and encourages our residents to live to their preferred lifestyle with rules and regulations kept to a minimum. The Statement also includes details of the staff team and their qualifications, arrangements made in the home for activities, and the aims and objectives of the home. The Service User Guide has been reviewed since the previous inspection, and now includes details of the fees payable, what they cover, and what is extra. The Guide also contains information on the facilities and services provided, and details of the Care Homes for Adults (18-65 years) Page 9 of 30 Evidence: homes physical environment, and was in line with National Minimum Standards. There have been no new admissions to the home since the previous inspection. The home does however have an admissions procedure, which was appropriate. This made clear that pre admission assessments will be carried out on any prospective service users, and that they would have the opportunity of visiting the home before making a decision as to move in or not. The procedure also stated that service users would initially move into the home on a trial basis. Written contracts/statement of terms and conditions are in place for all service users, these have been signed by the service user and a representative of the home. They include details of fees payable, and the rights and responsibilities of both parties. Through observation and discussion with service users and staff, there was evidence that the home is able to meet the needs of service users, both collectively and individually. For example, one service users first language is Urdu, and the home has employed two members of staff who also speaks Urdu to aid communication with this service user, and to help meet their needs with regard to equalities and diversities issues. The manager informed the inspector that they are in the process of producing some key documents within the home in pictorial form, to help make them more accessible to service users. Care Homes for Adults (18-65 years) Page 10 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. It is the judgement of the inspector that service users have a large measure of control over their daily lives, and that they are involved in the day to day running of the home. Evidence: Individual care plans are in place for all service users. These are drawn up with the involvement of the service user, their relatives, keyworker and the senior staff within the home. Care plans are of a good standard, clear and detailed. They provide detailed information around service users health and personal care needs, and make clear that service users are supported to manage their own personal care as much as possible. Plans also include relevant information around service users social and leisure needs, and their needs around equalities and diversity issues, including religion, disability, sexuality and ethnicity. Reviews have been signed by the service users to indicate their inclusion in the process. However, not all care plans have been subject to regular review. For instance, the care plan for one service user has a section on encouraging Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: them to access the local community more. One of the strategies is to seek psychiatric support for this, and talks about an appointment been made around this in early 2007. The plan is dated September 2007, and has a review date set for March 2008. There was no evidence that any such review took place, and the care plan is now out of date. It is required that all care plans are subject to regular review, at least once every six months. Risk assessments are in place for all service users, and as with care plans these are also of a good standard and are subject to regular review. Assessments include risks associated with epilepsy, smoking and violence and aggression. Clear individual guidelines are in place on the management of any challenging behaviours that service users may exhibit. Risk assessments identify risks, and include strategies to manage and reduce these risks. The assessments make clear that service users are supported to take reasonable risks, to enable them to be able to make choices over their daily lives. For example, it has been highlighted that one service user is not aware of the potential dangers of working in a kitchen, such as electrical appliances and sharp objects. However, the risk assessment sets out how this person can still work in the kitchen with appropriate staff support. There was evidence that service users have a large degree of control over their daily lives. During the course of the inspection, it was evident that service users are able to get up at a time of their choosing, choose what they wear, and have flexibility over meal times and the choice of meal. Service users are offered keys to their bedrooms, subject to the completion of satisfactory risk assessments. The AQAA supplied by the home states Service users are supported to make decisions about the day to day running of the home such as activity plans, meal planning and shopping, service users are also encouraged to make decisions about their own lives such as their educational, social and leisure needs, they are supported to do this through the key worker system, the key worker will provide information and support to service users ensuring they understand the choices available to them enabling them to make an informed choice. It was positively noted that the home has introduced the use of independents advocates since the previous inspection to help support service users, and to enable them to have a greater say over their lives. An advocate was visiting on the day of inspection, who spoke with the inspector. They informed the inspector that staff at the home always make them welcome. The advocate is able to speak with service users in private, and is invited to attend their annual review meeting arranged by the placing authority. The advocate informed the inspector that they are currently working with the home to get a new wheelchair for one service user, which should enable them to Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: have greater access to the local community. The home holds service user meetings to provide service users with the opportunity of been involved in the day to day running of the home. The manager informed the inspector that they should have these meetings on a monthly basis, but records indicated that there has only been one such meeting since the 28/11/08. Service users said they valued their meetings, one commented that We have not had many meetings lately, I would like more. It is recommended that the home arranges regular service user meetings, at least once a month. The home has a confidentiality policy in place. The inspector was pleased to note that this has been revised since the previous inspection, and now includes details of when a confidence should be broken in the health, safety and welfare interests of service users and others. Staff spoken to demonstrated a good understanding of the issues around confidentiality. Care Homes for Adults (18-65 years) Page 13 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The inspector was satisfied that service users are supported to live valued and fulfilling lives. Service users have access to the local community, and through social activities and food the home has sought to meet the equalities and diversity needs of service users. Evidence: Service users attend various activities. One service user attend Kaleidescope, a weekly social event organised by MENCAP. They informed the inspector that they planned to go their in the evening on the day of inspection, and that it gave them the opportunity of meeting with friends. Another service user attends an African-Caribbean centre, and they were there on the day of inspection. This helps to meet their cultural needs, through its various activities, such as dancing and the food provided. Another service user attends an Asian Mothers group, which arranges various activities such as Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: swimming and day trips. Service users are members of a local organisation called Eastsiders, which arranges outings. Service users are involved in educational activities. Two service users have just finished an arts and craft course at college. The manager said the home is looking for further courses when the new college term begins again in September. Artwork produced by service users was on display within the home. One service user has some part time employment working in a garden, and they are also very active in maintaining the homes garden. The manager informed the inspector that the home is currently exploring the possibility of getting an allotment. Service users have access to a variety of social and leisure activities, both in house and in the community. In house service users have access to television, DVDs, music, board games and books. On the day of inspection staff were observed to arrange a bat and ball game in the garden, which service users were seen to participate in and enjoy. In the community service users visit pubs, cafes, restaurants, the gym, the cinema, bowling and swimming. The home arranges occasional day trips, which service users are involved in planning. Recent trips have included Southend and the London Eye, and there are plans to visit Thorpe Park in the near future. Service users are supported to go on holidays, and have recently returned from a holiday on the South Coast. Service users spoken to said they very much enjoyed this, and liked going swimming, to the beech and to karaoke on holiday. Service users also access various community based facilities, such as shops, markets, parks, the library and the post office. Service users access public transport including buses and tube trains. The home supports service users to visit places of worship as appropriate, and one service user visits the Temple with their family. Service users are able to maintain contact with family, and often visit them, including for overnight stays. On the day of inspection one service user was observed to be able to phone their family. Service users informed the inspector that they are given their own mail to open. Records are maintained of menus, these indicated that service users are offered a varied, balanced and nutritious diet. Service users are involved in planning the menu, and in food preparation, including buying the food. There was evidence that the food provided helps to meet the equalities and diversity needs of service users, for example some service users prefer a Halal diet, while another enjoys Caribbean food, and there was evidence that this is catered for. Fresh fruit was available in the home, and service Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: users were observed to help themselves to drinks and snacks. The kitchen was clean and tidy, and food was stored appropriately.Records are maintained of fridge and freezer temperatures. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. It is the inspectors judgement that the home is generally able to meet the health and personal care needs of service users, although it must ensure that service users have access to dental care as appropriate. Evidence: There were clear guidelines in place around the provision of individual personal care, included in service users care plans. Service users are encouraged to manage their own personal care as much as possible. Service users are able to choose their own clothes to wear, and on the day of inspection all service users were dressed appropriately. All service users are registered with a GP, dentist and an optician. Records are maintained of medical appointments, including details of any follow up action required. Records indicated that service users have access to health professionals such as psychiatrists, CPNs and opticians. On the day of inspection both a dental hygienist and psychiatric nurse visited the home. However, records indicated that one service user has not seen a dentist since December 2007, and the home should ensure that service Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: users have access to routine dental care as appropriate. Health Action Plans are in place for all service users, these are drawn up with the involvement of their CPNs. The home has attempted to support service users with a healthy eating plan, along with encouraging regular exercise, such as going to the gym, swimming and walking. The home has an appropriate policy in place around medication, and all staff first undertake training before they are able to administer medications. Medications are stored within a locked cabinet inside the homes office. No service users currently self medicate, or are on any controlled drugs. Records are maintained of medications entering the home, and of those that are returned to the pharmacist. Medication Administration Record charts are maintained. Those charts seen by the inspector were for the most part up to date. However, there was no entry on the charts for the morning of inspection and the morning before of one particular medication been administered. An audit of the medication suggested that it had been given. The manager was able to identify who was responsible for administering those two doses, and informed the inspector that they would be addressing the issue with that member of staff. Where service users have been prescribed medication on a PRN basis, there are clear protocols in place around administering this. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. It is the inspectors judgement that the home has suitable policies and procedures in place to help ensure that service users are safeguarded from the risk of abuse. Evidence: The home has a complaints procedure in place. This includes relevant details of the CQC, and timescales for responding to any complaints received. The home also has a complaints log, which evidenced that complaints received have been recorded and investigated as appropriate, although the manager informed the inspector that the home has not received any complaints since the last inspection. Service users spoken to demonstrated a good understanding of whom they could complain to if they so wished. The home has a copy of the Local Authorities adult protection procedures, and also its own adult protection policy. This appeared to be in line with current legislation. All but two of the staff employed at the home have undertaken adult protection training, the manager informed the inspector that the remaining two staff would have this training in the near future. Staff spoken to by the inspector were able to demonstrate a good understanding of their roles and responsibilities with regard to adult protection issues. Earlier this year, there was a theft within the home, and around £1000 of service users money was stolen. The home notified the CQC, the local authority safeguarding team Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: and the police as appropriate at the time of the theft. Although the money was never recovered, the safeguarding team made some recommendations to help ensure that such an occurrence does not happen again. These included the purchase of a new safe, controls on key holding for the safe, and limiting the amount of money kept in the home at any given time. The inspector was pleased to note that these recommendations have been implemented, and that service users were refunded the money that they had stolen. Records and receipts are kept of transactions involving service users monies. Those records checked by the inspector were satisfactory. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. It is the view of the inspector that the home is suitable to meet its stated purpose with regard to its physical environment. The home was generally well maintained, both internally and externally, and service users are provided with adequate communal and private space. Evidence: The home is situated in a residential area of Leytonstone in the London Borough of Waltham Forest. The home is close to shops, transport links and other local amenities, and is in keeping with other homes in the area. The home was generally well maintained both internally and externally, and on the day of inspection was clean and tidy. New curtains have been purchased for the sitting room since the previous inspection. The communal space consists of a dining room, two interconnecting sitting rooms, a kitchen and garden. It was noted that the kitchen was beginning to look a bit tatty and worn, and it is recommended that the home considers replacing the kitchen. The home has garden furniture, which was of a suitable standard, and the garden was well maintained, and included various fruit trees. The manager explained that service users enjoyed eating the fruit from these trees. Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: The home has two bathroom/toilets and three toilets on their own. All bathrooms had working locks fitted (including an emergency override device) and were clean, tidy and free from offensive odour. The inspector was satisfied that the home has sufficient numbers of bathrooms and toilets to meet the needs of service users. All service users have their own bedrooms. Bedrooms have hand basins in them, and adequate natural light and ventilation. Bedrooms have been personalised to service users individual taste, for instance with televisions and family photographs. Bedding, carpets and curtains were generally well maintained and domestic in character. Rooms had appropriate furniture, including table, chairs, wardrobes and a chest of draws, and meet National Minimum Standards on size requirements. Some of the bedrooms have been decorated since the previous inspection.. The home has a policy in place on infection control. Protective clothing such as latex gloves are available to staff. The home has separate laundry facilities, and handwashing facilities are situated throughout the home. COSHH products were stored securely. Service users have been provided with individual laundry baskets for their bedrooms, to help ensure they only ever wear their own clothing. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The inspector was satisfied that the home is staffed in sufficient numbers to meet the needs of service users, and that staff have a good understanding of their roles and responsibilities. Evidence: The home provides 24-hour support, including waking night staff and an emergency on-call procedure. There was a staffing rota on display, this accurately reflected the staffing situation on the day of inspection, and indicated who was in charge of the home at any given time. All staff have been provided with a copy of their job description. Regular staff meetings are held. There was evidence that through its recruitment practises the home has sought to meet the equalities and diversity needs of service users. The current service user group come from ethnically divers backgrounds, and this is reflected in the staff team. As mentioned, the home has recruited two Urdu speaking carers to help meet the needs of one of the service users. It was positively noted that service users are involved in the recruitment and selection procedure for recruiting new staff. The AQAA supplied by the home indicates that the home has all required employment Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: related policies in place, including on equal opportunities and recruitment and selection. The inspector checked several staff files at random. These were found to contain evidence that the home has sought proof of ID and carried out CRB checks on all staff. Two written references were in place for staff, but some of these did not include any contact details of the reference writer, or even give any indication of in what capacity they knew the staff member. It is required that written references are sought, at least one of which must be from the staff members most recent employer. These references must include details of who has written the reference, so that the home is able to verify the reference as appropriate. Through observation and discussion there was evidence that staff have built up good relations with individual service users, and that they have a good understanding of their needs. Staff were seen to interact with service users in a friendly and respectful manner. Although at times some service users made it clear they wished to be left alone, which was seen to be respected by staff, at other times staff were observed to be proactive in engaging with service users. For example, playing a bat and ball game in the garden, and supporting a service user to calm down when they became distressed. The home has taken steps to ensure that all staff receive training as appropriate. The manager has highlighted areas where there is a need for training, and it was clear that training is seen as a priority by the homes manager. Recent staff training has included oral hygiene, infection control, basic nutrition and care planning. Service users have also been supported to attend some training events, such as on oral hygiene and safeguarding. The inspector was pleased to note that since the previous inspection over 50 of care staff now have an NVQ Level 2 in Care or equivalent qualification. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. It is the judgement of the inspector that this is a well managed home. Record keeping is of a good standard, and appropriate health and safety and quality assurance systems are in place. Evidence: Since the previous inspection the home has had a new manager appointed. At the time of inspection they were not yet registered with the Care Quality Commission, but they informed the inspector that it was their intention to apply for registration in the near future. The manager has worked at the home for a number of years, including in the capacity as deputy manager and acting manager. Staff and service users spoken to informed the inspector that they found the manager to be approachable and accessible, and on the day of inspection service users were observed to interact with the manager in a relaxed manner. Record keeping in the home was of a generally good standard, and up to date. Confidential records are stored securely, and staff and service users can access their Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: records as appropriate. The home had policies and procedures as required by the National Minimum Standards. Those checked by the inspector, including admissions, medication and adult protection, were of a satisfactory standard. Staff meetings and staff supervisions contribute to the quality assurance within the home. Copies of previous inspection reports were available to view in the home, and there was evidence of monthly Regulation 26 visits taking place. The home has issued questionnaires to service users and their relatives to gain their feedback on the running of the home. Completed questionnaires seen by the inspector contained generally positive feedback. One relative wrote of the home on their survey that It is homely and friendly. Fire extinguishers were situated around the home, these were last serviced in June 2009. Fire alarms in the home are tested weekly, and were last serviced on the 22/10/08. COSHH products in the home were stored securely, and the home tests fridge/freezer and water temperatures. The home had in date certificates for gas safety, electrical installation and PAT testing. The home had in date employers liability insurance cover in place. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 The registered person must 30/09/2009 ensure that care plans are subject to regular review, at least once every six months. To help ensure that the home continues to meet the changing needs of service users. 2 19 13 The registered person must ensure that service users have access to routine dental care as appropriate. To help ensure that the health care needs of service users are being met. 30/09/2009 3 34 19 The registered person must ensure that two written references are in place for all staff working at the home, at least one of which must be from the staff members most recent employer. references should include details of who has written the reference, and 30/09/2009 Care Homes for Adults (18-65 years) Page 28 of 30 what their relationship is with the staff member. o help ensure that suitable staff are recruited to work in the home. 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 2 8 22 It is recommended that the home holds regular service user meetings, at least once a month. It is recommended that the home considers installing a new kitchen. Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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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