Care Home: Larches, The

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What the care home does well People are given information about the home, and the chance to visit before they come to live at the Larches. People say they are well supported by the manager and the staff. People are given help and support to do the activities they choose. Everyone leads an active and interesting life. People who live at the Larches are supported to keep in touch with their families and friends. People can choose what they want to eat from the healthy menu that is available. The Larches looks after people well and writes down what help everyone needs. People are supported in their medical appointments. Staff are trained to help them understand how to meet people`s needs and give them the support they want. People who live at the Larches say staff treat them well and listen to them. The Larches makes sure that suitable staff are employed and that all checks are made to keep people safe. The manager has the skills and experience to make sure the home is well run. The management team supports staff. What has improved since the last inspection? There have been some improvements to the home. New units and ceiling have been fitted to the kitchen, an ensuite facility has been added to one of the bedrooms, and some new furniture has been bought. Paper towels and handwash are made available in all the bathrooms and toilets. What the care home could do better: Photographs of people who are prescribed medication should be included in the medication records. This will help to make sure the right medication is given to the right person. All staff should complete up to date accredited medication training to make sure everyone has up to date knowledge and information to give medication safely. Key inspection report Care homes for adults (18-65 years) Name: Address: Larches, The 59 Larches Road Kidderminster Worcestershire DY11 7AA     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: Dianne Thompson     Date: 1 7 1 2 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 30 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 30 Information about the care home Name of care home: Address: Larches, The 59 Larches Road Kidderminster Worcestershire DY11 7AA 01562829000 01562829001 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Sunnycroft Homes Limited care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 past or present alcohol dependence learning disability mental disorder, excluding learning disability or dementia physical disability Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia (MD) 6 Learning Disability (LD) 6 Physical Disability (PD) 6 Past or present alcohol dependence (A) 6 Date of last inspection Brief description of the care home The Larches offers accommodation and personal care for up to six adults. The home is registered to provide a service for the following categories of service users: Past or present alcohol dependence, Learning disability, Mental disorder excluding Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 0 0 0 6 6 6 6 Brief description of the care home learning disability or dementia, Physical disability. These conditions are most likely to be associated with an acquired brain injury. The home is situated in a residential area of Kidderminster on a public transport route. The town centre is approximately half a mile from the home. Accommodation is provided in single rooms, two of which are ensuite with one adapted for wheelchair use. Sunnycroft Limited operates the home, and the registered provider is Ian Currie. Ms Christine Reeves is the registered manager. The current fee for the service ranges from £800 to £2300 per week. The reader is advised to contact the service for more detailed information about fees. Care Homes for Adults (18-65 years) Page 5 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: 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: This inspection was carried out to see what the home was like for the people who live there. The last key inspection was carried out on 29th March 2007. We spent some time with the people who live at the Larches and some of the staff working there. We looked at some of the policies and procedures in the office. Policies are rules about how to do things. We spent some time looking at records in the office. We sent out surveys to get views about the service from other people. The registered manager completed an Annual Quality Assurance Assessment (AQAA) and sent this to us when we asked for it. Care Homes for Adults (18-65 years) Page 6 of 30 Care Homes for Adults (18-65 years) Page 7 of 30 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 30 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 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 10 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that they will be looked after by the staff at the Larches. This is because detailed assessments are completed to make sure peoples support needs can be met before they move into the home. Evidence: The Larches makes sure information is accessible to everyone who uses their service. We saw the statement of purpose, service user guide and copies of a contract agreement. The statement of purpose and service users guide is made available in formats that people can understand. We looked at the files belonging to 3 people living at the home, including 1 person who has moved into the Larches since the last key inspection. TWe saw detailed assessments have been carried out by the manager at the persons place of residence or hospital. This included finding out what their likes and dislikes were as well as their care needs. Other people such as their family, psychologists, and psychiatrists are involved if appropriate. We saw that copies of Local Authority Community Care Assessments were also available. Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: The Annual Quality Assurance Assessment (AQAA) tells us that there is a long, thorough, referral process which includes the receipt of relevant reports from care planning approach, including social and psychiatric reports. Visit to Service User in current placement to make full assessment and complete Strengths and Needs Assessment. Visits to the Home by the prospective individual are encouraged, supported by Social Worker and family. Opportunity to meet Staff, other Service Users, have a meal. Surveys completed by people who live at the Larches confirmed they were given information about the home and were involved in their assessment before they moved in. Care Homes for Adults (18-65 years) Page 12 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Larches keeps care plans up to date to make sure that people can be confident they will receive the support for their specific care needs. Risk assessments are in place to manage risks in a way that promotes independence. Evidence: Information obtained from care needs assessments is used to develop a care plan. A care plan tells staff about each persons care and social needs and the level of support required for maintaining their health and independence. The manager states in the services Annual Quality Assurance Assessment (AQAA) that they complete written documentation of decision making, risk taking and activities to promote and maintain independence; service user meetings, records of discussions to encourage choice and decision making; Involvement of family; Mental Capacity Assessments; Regular Internal Audit of Performance against all Standards. We case tracked the care for 3 people. This is where we look at what life is like at the Larches for the people who live there. This includes looking at care plans, and seeing Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: how health and social care needs are being met. Care plans are drawn up with the involvement of the person who uses the service together with family friends and any relevant agencies as appropriate. From the care plans we could see that regular reviews are carried out. Information provided in care plans covers areas such as likes and dislikes, diet, communication and personal care. Staff are provided with information to help them give the required support in a consistent way. Information about the methods of communication people use or understand, such as easy read or large print is also included where applicable. Risk assessments are completed for all areas where potential risk has been identified. The Larches also completes Mental Capacity Act assessments where people are unable to comprehend or make decisions for themselves through cognitive impairments or due to the nature of their head injury. The manager has implemented a structure to maintain regular dialogue to assist key workers with their role. The manager said in the services AQAA that Mental Capacity Assessments have been carefully undertaken for each Service User and our Consultant Psychiatrist and Neuropsychologist have been involved in this process. Best Interest decisions have been made for individuals only as required based on the above. Encourage individual Service Users to make their own choices as far as possible. Care plans set out any restrictions on choice and freedom in accordance with the Mental Capacity Act. We saw that these assessments are also reviewed regularly or as changes occur. Staff give people information they need to help them make decisions about their lives, and records demonstrate how people have been supported in their decisions. Care Homes for Adults (18-65 years) Page 14 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to lead active and interesting lives. Staff encourage people to maintain links with their families and to develop friendships. Dietary needs are well catered for with a varied and healthy menu provided. Evidence: The manager said in the services Annual Quality Assurance Assessment (AQAA) that service users have been encouraged to take part in art and craft activities within the Home and have displayed some of their artwork on the walls of the lounge. Daily access to the local community for all individuals, facilitated by staff, when they will agree to go out; Adapted wheelchair vehicle to assist; We plan and assist appointments for physiotherapy and hydrotherapy as well as daily in-house physical therapy; Encourage age appropriate activity and identity; Staff training in all aspects of equality and diversity; We shall continue to use skills to encourage those service users who are reluctant to access community facilities to do so where practical whilst Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: maintaining a balance between positive encouragement and freedom of choice. Time was spent talking with residents in the lounge. One person was getting ready to go out for the day with their relative and another resident was planning to do some Christmas shopping. Everyone appeared to be happy to talk about their life at the Larches and what they were doing. One resident talked about seeing their family at Christmas and what they liked about Christmas. It is evident that visits and contact with family and friends is supported. Staff support people to visit their family members where they are unable to visit at the Larches. Information given in surveys show that 2 people said they were able to choose what they want to do each day, two people said they were able to choose sometimes, one person said they were not able to choose, and this depended on what other residents wanted to do. Records show varied and nutritional meals are provided with alternative meals where these have been chosen. Peoples choice for lunch on the day of the inspection was sandwiches made with various fillings. Lunch was eaten at the table in the dining area. The manager states in the AQAA that menus are available offering variation and choice and that dietary intake records are maintained. Records examined confirmed this. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Larches has a medication policy and procedure for staff to follow so that all medication is administered and stored safely to keep people well and safe. Staff training in the administration of medication needs to be reviewed and updated so that everyone keeps up to date with current practice. Evidence: There are plans in place to help and support people with their health care and appointments. These plans sets out how individual health needs are to be met. The manager states in the services Annual quality Assurance Assessment (AQAA) that they provide individual, dignified, personal care to meet the assessed needs of the Service User in an unhurried manner. Provide detailed Care Plans of how to provide personal support to maximize independence, privacy and dignity. The provision of specialist support accessed privately by the Company for physiotherapy, hydrotherapy, psychiatry and psychology. Change care practice to meet the changing, challenging and deteriorating needs of the individual service user. Staff training includes moving and handling. Provision of aids and adaptations, including wheelchair access vehicle for one person based on assessment by Physiotherapist. Have a good, Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: safe, medication system which is regularly audited. People have good access to medical support through their doctor, clinical psychologist, behavioural team, community health care team, and dentist as required. Staff were observed providing support for people in a respectful way, making sure that each persons dignity and self esteem was important. Residents spoke about their health care and the support staff give them for their appointments in a positive way. We saw detailed Mental Health Capacity Assessments (MHCA) had been completed in relation to personal health and welfare concerns where people have been assessed as lacking capacity to make their own decisions. We saw records that were contradictory to these assessments. Information clearly shows that a person lacks capacity to make decisions but we saw signed statements to say that an individual does not want a chair or does not want to have their photograph taken, as well as a signed consent form agreeing to staff administering medication. This was discussed with the manager. Although it is good practice to encourage people to make their own choices and document choices they have made, it is important to give further explanation to show where agreements fit in the context of the MHCA and the care plan. Medication is well managed by staff at the Larches. Medication is stored securely and given to people at the right time and full records are kept which show this. A medication policy and procedure is in place and provide guidelines to follow should any medication error occur. These policies and procedures are reviewed regularly, with the most recent review completed in November 2009. Although staff have been trained to administer medication we saw from records that for some staff this training took place many years ago. For example, one member of staff completed medication training in 2001. Medication administration training must be reviewed to make sure that people complete up to date, accredited training. This will make sure that all staff have knowledge of current practices and information so they can continue to give medication safely. We checked the records for administration of medication and found that all medication had been signed for when given. The manager was advised that photographs of all residents who are receiving prescribed medication should be added to their medication administration record sheets. This is good practice and helps to keep people safe by making sure that medication is given as prescribed to the right person. Ordering, disposal and audit records for medication were seen. Additionally, procedures advise that errors are to be reported to the Care Quality Commission Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: (CQC). The supplying pharmacist carries out annual audits of all medication stored in the home. Care Homes for Adults (18-65 years) Page 19 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. People are protected by the homes safe working practices and people can be confident the staff will give them the support they need to keep them safe. People are encouraged and supported to take risks in order to be as independent as possible. Evidence: There are systems and procedures in place to make sure that everyone who lives at the Larches is kept safe. Care records contained a number of risk assessments showing potential hazards and control measures to reduce or eliminate identified risks. For example, environmental risk assessments are in place to keep people safe in the home. In addition we saw a risk assessment to consider ways of keeping a person safe while maintaining their independence when they are out in the community. We saw from the records that these risk assessments are reviewed regularly or as needs change. Staff are able to access the Larches safeguarding policy. This policy tells staff how to recognise different forms of abuse and how to protect people. The Larches makes sure people are protected with their safeguarding policy, staff training, and by maintaining accurate records and daily notes. We looked at the complaints log and records show that no complaints have been received. The Care Quality Commission (CQC) has received one complaint about the Larches since the last inspection and this was resolved during the inspection visit. Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: The complaints procedure is made available in alternative formats as required. Everyone who uses the service is given a copy of the complaints procedure. Surveys told us that people would know how to make a complaint should they need to. The manager states in the Annual Quality Assurance Assessment (AQAA) that all staff have received training in the Non-Aggressive Physical Intervention Techniques as certified through the Crisis Prevention Institute and an annual certified refresher programme where required. The AQAA also states that the Larches safeguard vulnerable people from abuse by staff training and observation. Safeguards are in place to protect from abuse and exploitation. This includes reporting of physical assaults and other untoward events under Regulation 37 to the Care Quality Commission (CQC) and individual Social Workers. Robust policies and procedures [are in place] for dealing with concerns and complaints. Respond to complaints in a systematic and understanding manner, attempting to resolve any problems raised. Care Homes for Adults (18-65 years) Page 21 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. People who live at the Larches enjoy a comfortable and homely living environment. The home is spacious and is kept clean and well maintained. Evidence: The Larches is located in a residential area of Kidderminster close to local amenities with access to the bus route into town. There are two lounges, an additional small smoking lounge and a small separate kitchen. The large lounge has a dining area. There are six single bedrooms, two of which have an ensuite facility. There are two bathrooms, a separate shower room, six toilets and a separate laundry. There is an enclosed garden to the rear of the property with easy access. Bedrooms are individually furnished to residents own choices. The communal rooms are comfortable and well furnished and provide adequate space for shared activities. The premises are clean and tidy. Policies and procedures for infection control are in place and staff are provided with disposable gloves and aprons. Paper towels and liquid soap are available in the communal bathrooms. Staff records show that all staff receive training in infection control. There has been some refurbishment to the home since the last inspection. New cupboards and worktops have been fitted to the kitchen and the ceiling replaced. A Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: second bedroom has been fitted with an ensuite facility and some new furniture has been bought. Surveys confirmed that the home is always fresh and clean. The manager states in the Annual Quality Assurance Assessment (AQAA) that we provide a homely atmosphere for a small group of six people who all have individual bedrooms. Each service user is encouraged and assisted to personalise their own room to meet their own needs and requirements. The Home is accessible to all people including one individual who has restricted mobility. There are ample lavatories, baths and showers and external garden available to all individuals. The Home is clean and well maintained, systems are in place for hygiene and the control of cross infection. There are a number of communal areas and external garden available to all individuals. Adaptations for one individual who has mobility problems are discrete and aid his independence but also meet his care needs. Staff Training has always had a high commitment, Staff are knowledgeable in all areas of health and safety. Care Homes for Adults (18-65 years) Page 23 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that the support they receive will be delivered by well supervised and skilled staff to help maintain their health and independence. People are supported by staff who have access to regular training and supervision, and are supported to do their jobs well. Evidence: The Larches has a committed and stable staff team. The Manager said she covers any additional shifts where needed to ensure that consistency of support is provided for everyone. The manager said the staff team are very well motivated and always look to improve the lives of the people who use the service. The Larches provides regular staff training. Staff complete mandatory training such as Health and Safety, Fire Safety, First Aid, Food Hygiene, Moving and Handling, Infection Control and Vulnerable Adults. Staff said that the training provided is very good. Training records confirmed that regular training takes place, including induction training for new staff. The manager said in the services Annual Quality Assurance Assessment (AQAA) that all documentation is reviewed and given to staff at the time when they commence, during Induction or at the completion of the probationary period. Staff receive regular Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: supervision and an annual appraisal. Staff selection is a careful process to attract the appropriate people. References, CRB and PoVA checks are carried out prior to taking up the post. Staff receive Induction to Skills for Care standards plus regular in-house and external training. Most staff hold an NVQ II, III or IV or are working towards these. Manager holds appropriate managerial qualifications. A range of specialists are employed by the Company to compliment the staff team and add to the ability to meet the needs of the individual service user. The AQAA tells us that the Larches has robust staff recruitment and selection procedures. We looked at staff personnel files which confirmed that appropriate safety checks have been made to make sure staff are suitable to work with vulnerable people. These checks include a Criminal Record Bureau clearance (CRB) and two written references. These checks are completed as routine and records are well maintained. All staff are required to work a probationary period. Surveys confirmed that staff always treat people well and include comments I like the way I am treated, everything is fine, I am happy. Care Homes for Adults (18-65 years) Page 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and staff receive the leadership and support they need. The Larches monitors and evaluates their service to protect the health and welfare of people they support. Evidence: The home has an effective management team to make sure the home is well run. The registered manager Christine has experience and a qualification in care management; she is qualified to NVQ level IV and as an assessor. Management responsibilities in the home are shared with and assistant manager and two senior support workers. The assistant manager is qualified to NVQ level IV in care, and the senior support workers are qualified to NVQ level 3. The manager, the assistant manager and senior support workers are involved in organising day-to-day activities, health and safety promotion, staff supervision and induction. The Annual Quality Assurance Assessment (AQAA) was completed and sent to us when we asked for it. The manager said in the services AQAA that the Home is competently managed by a Registered Manager who has been employed by the Company for over Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: seven years. There is a comprehensive system of Quality Assurance in operation within the Home. This includes gaining the views of other people with use of a Questionnaire. Policies are comprehensive but succinct; they are regularly reviewed, signed and dated, and available to staff and service users. There is a comprehensive Home Management system in place to ensure that all records are maintained as detailed in the Care Standards Act, 2000, Care Homes Regulation, 2001, Schedules 2, 3 and 4. There is a comprehensive system to ensure and maintain the health and safety at work for service users, staff and visitors. The manager confirms in the AQAA that regular monthly checks are carried out on the service provided. A monthly Directors Report under Section 26 of the Care Standards Act, 2000. Quality Assurance is managed in a number of ways involving service users, staff, family and friends and stakeholders views. Monthly in-house Inspections take place following the format of the National Minimum Standards. A Business and Financial Plan is available which explains the Company accountability and responsibility to budgeting, human resources and financial accountability. An Annual Development Plan for the Home has been produced. Staff confirmed that the manager is approachable and supportive. Surveys completed by people living at the Larches confirmed that the manager and staff always treat them well and listen and act on what they say. Health and Safety is being well managed within the home through staff training, regular monitoring and safety checks. The Health and Safety folder contains copies of all policies and procedures together with a signing sheet for staff when they have read the information. Records show that monthly checks of the fire safety system and equipment, water temperature and storage, fridge, freezers and electrical appliances are completed. Generic risk assessments are in place. Care Homes for Adults (18-65 years) Page 27 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 28 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 20 12 All staff must complete up to 12/04/2010 date accredited medication training to make sure everyone has up to date knowledge and information to give medication safely. 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 20 Photographs of people who are prescribed medication should be added to the medication records. This will help to make sure the right medication is given to the right person. Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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