Care Home: Lavender Road (9)

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What the care home does well The home provides a highly individualised service to the people for whom it cares, and places their wishes and needs very much at the centre of everything the staff do in the home. It carries out comprehensive, holistic and personalised assessments of the strengths and areas of need of each person living in the home, and draws up very detailed support plans to meet those needs in the least institutional ways it can. Dignity and choice are central to these plans, which also acknowledge people`s rights to have good days and bad, and to change their minds. Staff are innovative in the ways that they employ to communicate with the people they care for and find out their wishes. Health needs are carefully monitored and met, and the staff work closely with health professionals to provide the best care. Appropriate aids and adaptations are in place. The people living in the home enjoy a stimulating lifestyle which encourages and supports personal development, a wide range of social activities, good community links and a good diet. Ongoing improvements have been noted in areas such as improved mobility and increased communication skills. The building is warm, clean, attractive and nicely furnished and decorated. Bedrooms are well-personalised. There is a stable staff group with little turnover. Support workers are well trained, well motivated and very committed to their work. They are given regular supervision and are encouraged to contribute new ideas to the running of the home. Staff are proud of their home and of the service they are providing, but also want to keep improving the service, wherever possible. The home is well managed, and is run in the best interests of the people who live there. What has improved since the last inspection? A number of staff commented on the general improvements in the home and the care being provided since the last inspection in 2007. Support plans are more detailed, more personalised, and are now being kept up to date on a regular basis. More detailed risk assessments are now in place for all persons receiving care and are now being reviewed annually. Communication with the people who use the service continues to improve, with a corresponding improvement in their quality of life. There is a wider range of social activities available to the people living in the home, both inside the home and in the community.Medication storage and recording is being improved. Menus are now recorded in good detail, and show the involvement of the people in the home in drawing them up. The home has been completely redecorated since the last inspection, and bedrooms reflect the personalities and choices of the people who live in them. There are now regular records kept of visits by the home`s line managers. Fire training has been arranged for all staff and a regular programme of in-house fire instructions has been introduced. A quality assurance system has been introduced. What the care home could do better: Better detail needs to be kept of any complaints or concerns. There is a need to update the home`s fire risk assessment. Financial risk assessments should be reviewed to improve clarity and accountability. The home`s quality assurance systems should be developed further so that they more clearly demonstrate and evidence improvements to the service made as a result of these systems. Some staff felt that they could do even better work with improved staffing levels. Key inspection report Care homes for adults (18-65 years) Name: Address: Lavender Road (9) Lavender Road (9) Whickham Newcastle upon Tyne NE16 4LR     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: Alan Baxter     Date: 2 2 1 0 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 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Lavender Road (9) Lavender Road (9) Whickham Newcastle upon Tyne NE16 4LR 01914960436 01914960436 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): None United Response Name of registered manager (if applicable) Mr Dennis Charlton Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: Date of last inspection Brief description of the care home The home can provide personal care for 6 people who have learning and physical disabilities. The home cannot provide nursing care. The home is situated in Whickham and is a large detached bungalow divided into two units, Lavender House and Rowan House all with single bedrooms. It is set within its own extensive grounds with car parking facilities to the front of the house. It is on a bus route, which makes it easy for relatives and friends to visit, and the home has its own transport. There is a variety of community facilities reasonably close by including churches, doctors surgeries and a large shopping area in the centre of Whickham. The bungalow is purpose built with all of the necessary facilities, The layout and design of the building provides easy access throughout and bathrooms and toilets are suitably adapted for physically disabled people. All bedrooms have an emergency call system. The weekly cost for care is Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 0 6 6 Brief description of the care home £99.36p. Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 is an overview of what the inspector found during this inspection. The quality rating for this service is 3 star. This means that people living in this home experience excellent quality of care. Before the visit we looked at information we have received since the last key inspection on 28th September 2007. We looked at how the service has handled any complaints or concerns since the last visit, and whether there have been any changes to how the service is run. We looked at the providers view of how well they care for people, and also the views of people who use the service, their families or representatives, and the staff. An unannounced visit was made to the home on 23rd September 2009. Finding nobody in, we returned, again unannounced, on the 8th October 2009, with a follow up visit on 22nd October 2009 to complete the inspection. These visits took eleven hours in total. Care Homes for Adults (18-65 years) Page 6 of 27 During the visit we talked with the people being cared for in the home, the staff and the manager. We looked at information about the people who use the service and how well their needs are met. We looked at other information that must be kept. We checked that the staff have the knowledge, skills and training to meet the needs of the people they care for. We looked around parts of the building to see if it was safe, clean and comfortable. We checked what improvements have been made since the last inspection. We told the registered manager what we found. Care Homes for Adults (18-65 years) Page 7 of 27 What the care home does well: What has improved since the last inspection? A number of staff commented on the general improvements in the home and the care being provided since the last inspection in 2007. Support plans are more detailed, more personalised, and are now being kept up to date on a regular basis. More detailed risk assessments are now in place for all persons receiving care and are now being reviewed annually. Communication with the people who use the service continues to improve, with a corresponding improvement in their quality of life. There is a wider range of social activities available to the people living in the home, both inside the home and in the community. Care Homes for Adults (18-65 years) Page 8 of 27 Medication storage and recording is being improved. Menus are now recorded in good detail, and show the involvement of the people in the home in drawing them up. The home has been completely redecorated since the last inspection, and bedrooms reflect the personalities and choices of the people who live in them. There are now regular records kept of visits by the homes line managers. Fire training has been arranged for all staff and a regular programme of in-house fire instructions has been introduced. A quality assurance system has been introduced. 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 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in Lavender Road have their needs, wishes and preferences assessed on a regular basis. Evidence: The homes Statement of Purpose stresses the individuality of the people who live in the home, and the need to take into account their needs and preferences. Although the original assessments of need have long been archived, there is an annual review of each persons needs, attended by the person himself or herself, their relatives, social worker and any other involved professionals. This ensures that all parties are kept up to date with the care required and any changes that have taken place. There is clear evidence of the opinions of the people living in the home being listened to and taken into account in their plan of care. Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person living in the home has his or her individual needs and wishes clearly established and each is encouraged to make decisions as to their daily lives. Evidence: At the beginning of each persons care record there is a photograph of that person, along with a list of what is important to that individual, with an emphasis on their strengths and positive attributes. This sets the tone for a highly individualised approach to meeting their personal and care needs, as demonstrated in their ongoing support plans. There is a detailed and very informative pen picture, which gives a balanced and holistic overview of each persons strengths and needs. The use of the first person style of recording (as in I like......I wish....., etc) was debated. It was agreed that a record of who had been involved or consulted in the drawing up of these first person statements would be added to the pen picture, along with an assessment of how aware each person being cared for is about what is in their pen picture. Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: Support (care) plans make good use of the annual assessments, and are updated accordingly. They are positively phrased, emphasising each persons strengths and wishes, rather than using a problem-based approach. They identify appropriate objectives and achievable outcomes. They are detailed and holistic, and very personcentered. Personal choice is built in at every stage of the plan, not only accepting that the people being cared for can change their minds, but positively encouraging this as an important part of personal autonomy. Typical good days and bad days are described with both being equally accepted. Colour coding is used in the support plan to highlight what each person can do for his or her self; for what the person and the carer can do together; and for what only the carer can do. This approach demonstrates a great respect for the people living in the home. There is cross-referencing of related support plans and risk assessments, and each persons support plans are reviewed quarterly. All staff are required to read each support plan and to sign that they understand the contents. There was ample evidence that the people being cared for are assisted to make decisions as to their daily lives, using a range of tools such as pictures and graphics. Examples of choice include menus, holiday destinations and arrangements, attendance at day centres and birthday arrangements. Risk assessments have improved since the last inspection, and are now fully completed on each persons file. They are signed by all staff and are reviewed and updated annually. The clarity and accountability of the financial risk assessments was discussed. Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home enjoy a stimulating lifestyle which encourages and supports personal development, a wide range of social activities, good community links and a good diet. Evidence: The support plans appear to be working well and to be promoting the personal development of the people being cared for in the home. In particular, the emphasis on What I can do for myself in the support plans has been translated into significantly improved mobility for one person, a much greater vocabulary for another person, and a third person moving from being reactive to staff interventions to becoming proactive and starting conversations. This has been achieved through good planning, positive staff actions, and the use of a range of aids such as photos, graphics, and a voice box system that enables one person to communicate vocally for the first time. All staff are fully involved in the process of developing such systems, and in Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: generating new ideas to assist personal development. The home makes use of community resources such as a hydrotherapy pool, sensory and sound rooms, and is planning to engage a sessional music therapist. People living in the home are supported to attend day centres, friendship groups, dance groups, discos and football matches. The home actively engages with its local community and holds coffee afternoons and garden parties, with guests invited by the people living there. Daily planners ensure that there is structure to the day, but stress the need to be flexible and to respond to peoples wishes and moods. Each person also has a weekly activities plan, and these are interesting and wide- ranging. Examples of activities include manicures and foot massages, shopping trips, pub lunches, gardening, games, exercises, swimming and aromatherapy. Staff also active seek out employment opportunities, paid and unpaid, for those they are caring for. Internet access has been provided since the last inspection. Those living in the home are encouraged and supported to keep in regular contact with their families, in person and by use of telephone and e.mail. Staff make sure that there is at least monthly contact with relatives, and a newsletter is sent to all families every two months. Staff respect the privacy of the people living in the home, and dont enter bedrooms without permission. Each person has a key to his or her room, and is addressed by the recorded preferred name. Mail is passed on unopened by staff. People can also choose to spend time alone in their bedrooms, and can join in activities, or not, as they choose. They usually help with keeping their bedrooms clean and tidy, and also in other household tasks, such as bringing their laundry, helping prepare meals and setting the table. All these are undertakes voluntarily, and no-one is obliged to do any chores. There is a four week menu that takes into account the known and recorded likes and dislikes of those living in the home, with consultation with them and their relatives, and using staff knowledge. The menu is constructed using a variety of methods, including picture cards and by pointing to actual items of food in the kitchen, until a consensus is reached. Even then, individuals may decline the agreed meals and will be offered the alternatives of their choice. Nutritional assessments are carried out, where required, by the relevant health Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: professional. Special diets are catered for, including a person on a weight loss programme, and another who requires PEG feeding. Detailed support plans are in place for these, giving good guidance to the staff. Wherever possible, normal cutlery and crockery is used, but adaptations are also supplied, as necessary. Care Homes for Adults (18-65 years) Page 16 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal support is given in the ways prefered by those being cared for, and their health care needs are properly assessed and met. Evidence: The staff provide sensitive and flexible personal support to the people being cared for, and this is recorded in very good detail in their support plans. Personal care needs are fully documented, including areas often overlooked such as hair care, nail care and skin care (including make up preferences for the ladies). As already noted above, the opinions, views and wishes of those being cared for are central to the care being given, and they are treated with great respect by the staff. The home is taking advice regarding pressure area care from a physiotherapist and a district nurse. Meetings are held between Lavender Road staff and day centre staff to co-ordinate the care given, and maximize consistency between carers. The local Primary Care Trust has recently introduced Health Action Plans for people Care Homes for Adults (18-65 years) Page 17 of 27 Evidence: receiving its service, and Lavender Road has co-operated fully with their introduction into the home. These action plans cover medical history, medications, skin care, breathing, sleeping needs etc and are used to keep the health care support plans up to date. Staff are also proactive in seeking out information about any relevant health condition, and bring that research to the support plans. Medications are clearly recorded in the Medication Administration Record (MAR), and, wherever possible, two staff sign each entry. No gaps were seen in the MAR. The home is introducing a list of staff names and the initials used in the MAR to improve accountability. Only staff who have received the appropriate training are permitted to administer any medications. No-one self-medicates. One person is prescribed for a controlled drug, and the manager is in the process of obtaining a controlled drugs recording book and has ordered more secure storage. Care Homes for Adults (18-65 years) Page 18 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people being cared for at Lavender Road are listened to very carefully and the staff act appropriately on any concerns or complaints. Evidence: No complaints have been recorded in the past year. Three minor concerns have been logged in that time, all of which were responded to promptly by the manager, and remedial steps taken. However, there was insufficient detail recorded, as it was not always clear who had received the complaint/concern, who had investigated, what the outcome was, and whether the person raising the complaint/concern was satisfied with the outcome. All the previous documentation reviewed during this inspection demonstrated that the staff listen very carefully to what the people being cared for say, and use all possible methods of observation and communication to be sensitive to how they are feeling. Also, there is ample evidence that staff act quickly to address any discomfort noted. All staff have been trained in the recognition of, and the correct response to, any form of abuse or mistreatment. Staff have also received training in Deprivation of Liberty and Mental Capacity legislation and guidance, and in Whistle blowing (exposure of bad practice). No safeguarding referrals have been necessary. Care Homes for Adults (18-65 years) Page 19 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in Lavender Road enjoy a safe, warm, clean, comfortable and attractive physical environment. Evidence: The home was purpose built for its current service user group, and has the full range of aids and adaptations necessary to meet the needs of the people who live there. The whole building has been redecorated over the past two years, and each persons bedroom has been individualised to reflect his or her hobbies and interests. Corridor carpets are due to be replaced shortly, as is a sofa. All areas seen were clean and hygienic. There were no obvious safety hazards. Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in Lavender Road benefit from having a stable, consistent and well motivated team of support workers, who have been carefully selected and properly trained to meet their needs. Evidence: Staffing levels in the home are appropriate to the assessed needs of the people who live there. There has been very little staff turnover in the past year, and the people being cared for have enjoyed consistency of care and the ability to build relationships with staff. Although the home uses agency staff when necessary, it has a good relief staff pool, and staff will often work extra shifts to cover any gaps due to sickness or holidays. Study of the care records and support plans, and discussions with individual staff, showed that the team have a high level of knowledge about the people they care for, and that they are able to demonstrate the necessary skills to meet their needs. There is real awareness of the fluctuating needs of the people in the home, and of the importance of encouraging choice. Staff are obviously highly motivated and fully committed to ensuring the highest standards of individualized care. The staff team is also able to demonstrate a high level of competence, with nearly all Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: support workers having achieved National Vocational Qualification (NVQ) level 2 in care. Several have gone to achieve NVQ level 3, including four of the five senior support workers. Four seniors are also starting an NVQ course in leadership. All support workers have Developing Excellence folder, and can evidence training, supervision, appraisal, an individual development plan and staff competencies. All staff have also received equality and diversity training. A small number of gaps were identified in mandatory training, but the company runs regular courses and the manager has put in bids for the appropriate training for his staff. Staff recruitment records showed that the company has robust policies and practices when hiring new support workers. All the necessary components, such as written references, criminal record checks, and proof of identity, are in place, and the people who live in the home have a genuine input into who is selected, being represented both in the interview stage and in meeting prospective new workers. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is being run in the best interests of the people who live there, and staff listen very carefully to their views. The home is well managed. Evidence: The manager, Mr Dennis Charlton, holds both the Registered Manager Award and the Diploma in Social Work, and has many years experience in the care sector. He and his senior support staff are all undertaking a Leadership and Development training programme to further improve their skills in this area. There is a key worker system that allows for individual members of staff to develop particular knowledge for the people for whom they care, and increases consistency of care. Support staff take an active role in developing the service, and have been given a range of delegated responsibilities such as developing community links, researching employment opportunities, and various aspects of the running of the home. This has helped keep staff enthusiasm high and there is a very welcome sense of active team work in the home. Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: All support workers get formal supervision at least every two months, and annual appraisal is being phased in. There are regular team meetings. In addition, every seven weeks the whole staff team has a full day together away from the people they care for, to reflect on their work and plan further developments. This was described as being very productive. The manager has introduced a quality assurance system since the last inspection. One of the main elements of this is an annual quality survey, the most recent of which was still being collated at the time of this inspection. Some comments were noted, such as, [My relative] gets good support. He is able to make choices in his life and decide what to do. Another relative said that the home was very good. Other aspects of the quality systems are the regular audits carried out by managers of other homes in the company, and the monthly visits to the home by its line manager. Annual reviews with social workers, relatives and the persons being cared for are also carried out, and the home responds to any change in the support plans that result from these reviews. An annual development plan is in place. Although there has been noticeable improvements in the homes quality assurance systems, there is still a need to develop them further so that they more clearly demonstrate and evidence improvements to the service made as a result of these systems. The companys health and safety section advises the home on risk assessments and other pertinent safety issues, and carry out health and safety audits at the appropriate intervals. There was a lack of clarity about the required frequencies of in-house fire instruction to staff, but once this was discovered the manager immediately booked an external trainer to bring all staff up to date, and put in place a programme for future in-house instruction. Servicing and maintenance records showed that all systems and equipment were being checked and serviced at the appropriate intervals. Accident records were properly maintained. Accidents are rare in the home. The homes fire risk assessment needed to be updated. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 42 23 The home must ensure that 31/12/2009 its fire risk assessment is up to date and that it reflects current best practice. This is to make sure that the people living in the home have the safest possible environment. 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 3 9 22 39 Financial risk assessments should be reviewed to improve clarity and accountability. Concerns and complaints should be recorded in full detail. The homes quality assurance systems should be developed further so that they more clearly demonstrate and evidence improvements to the service made as a result of these systems. Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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