Care Home: Little Orchard

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What the care home does well People living in the home are provided with plenty of space which is comfortable, clean and personalised in some areas. The home has many adaptations and these are provided taking different needs into account. Health and personal care is assessed using external health professionals` guidance and support regularly. Staff show good knowledge of the needs of the people in the home and interact in positive respectful ways using different ways of communication based on individual needs and show that they listen to people. Activities are provided and individual wishes affect what people do. Families are encouraged to be involved and are welcomed into the home and involved in aspects of care. Food is based on the preferences of people. Staff have communication systems which keep them informed about changes in care. They are supported by the manager and have regular training relevant to their work. Staff are Provided flexibly to adapt to the changing needs of people. What has improved since the last inspection? We did not make any specific requirements following the last inspection but note that improvements to the environment have continued and at this inspection a shower room was being replaced by a bathroom having taken account of changing preferences of people living in the home. What the care home could do better: Person centred planning training has started but the rest of the staff need training and it has yet to be implemented. We have made a requirement that there must be more evidence that people`s goals and care is regularly reviewed through consultation. There is a new quality assurance pack but it has not yet been implemented.Surveys have now been sent out to people, but have yet to be collated and used to inform plans for the future. We have made a requirement that a quality auditing system must be in place to ensure that the service is monitored and is also influenced by consultation with others. Elements of the medication system have been raised in this report for attention, such as, ensuring the all `as required` instructions are recorded and staff receive specific training from health professional for a specific task. We have assurances that this will be followed up. We have made a requirement that all medication provided must be recorded when administered. We have also required that the home must demonstrate that action to minimise all risks to people living in the home are fully identified and monitored. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Little Orchard 17 Lavender Road Hordle Lymington Hampshire SO41 0GF     The quality rating for this care home is:   one star adequate 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: Sue Kinch     Date: 0 1 0 4 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: Little Orchard 17 Lavender Road Hordle Lymington Hampshire SO41 0GF 01425617217 01425617217 info@glyn-residential.co.uk 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) : Glyn Residential Ltd care home 6 Number of places (if applicable): Under 65 Over 65 0 0 learning disability physical disability Additional conditions: 6 6 The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD Physical disability - PD Date of last inspection Brief description of the care home Little Orchard, 17 Lavender Road is one of three homes owned by Glyn Residential Limited and now provides personal care and accommodation for up to six people with a physical disability including two people in the learning disability category. There are two bedrooms upstairs for ambulant residents with a learning disability. The home can also provide day care. The home is situated in Hordle, where there are a small number of shops and facilities. Lymington is the nearest town, and the city of Southampton can be accessed by car. The home comprises of a chalet-style bungalow. All people living in the home have Care Homes for Adults (18-65 years) Page 4 of 30 Brief description of the care home single bedrooms. Communal facilities include a kitchen/diner, lounge, activities room, which contains a kitchen, craft facilities [where people can cook, create craft projects and have physiotherapy]. Little Orchard is a non-smoking home. 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: one star adequate 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 the first unannounced key inspection of the home since 12th April 2007. For this inspection we considered a self assessment completed by the home and other information received.This included six surveys from people living in the home assisted by staff. This Visit lasted 6 hours and during this time parts of the shared and private areas of the home were viewed. We met the people living in the home and had help from staff with communication with three people. We talked with several staff, the senior carer and a manager from within the organisation. Some matters were discussed with the registered manager in a telephone call on the following day. At the visit we were told that current fees range from 450 -700 pounds a week. 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 Care Homes for Adults (18-65 years) Page 8 of 30 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 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to ensure that peoples needs are assessed before moving into the home. Evidence: At the last inspection we noted that assessments had been made before people had moved in. At this inspection we were told that there had been no new admissions in the last twelve months. We noted that there had been a care management assessment provided to the home before the last person was admitted and that care plans are in place for that person. There has been some updating of information but no further full review by social services or the home and the manager agreed to follow this up. Care Homes for Adults (18-65 years) Page 11 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. People living in the home are able to make decisions about their lives and staff are able to support them although this would be enhanced by regular reviews and more updates of care plans. Evidence: From conversations with staff,observations of care practises, records and communication with the people living in the home we noted that care continues to be based on individual needs. We noted friendly, caring approaches from staff on shift able to describe the varying needs of people including their communication needs. Staff are organised to support people to do the activities that they wanted to do. We had two separate discussions with staff and individual people about their care and support needs and the details given indicated that these are being met. Differences in Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: need is respected and we noted different arrangements for all areas of care including physical and personal support, communication, friendships, health and interests and hobbies. Staff are aware of peoples likes and dislikes and in our discussions and observations it was clear that this was taken into account on a day to day basis. At the last inspection it was noted that training in Person Centred Planning and implementation was needed. This was discussed at this visit and we were told that this is not yet in place. A member of staff had been trained but formal reviews of needs, wishes and goals had not been made. From the above conversations there was evidence that people do have some goals such as a particular holiday and that these are being worked towards. However reviews of care indicating, peoples priorities, were not recorded or indicating how people are consulted. The manager agreed that this needed to be addressed. We viewed two personal files for people living in the home and there is information in care plans and some risk assessments about the various needs of people and how some of them should be met. However, these still need to be developed to ensure that they are all up to date. Fire risk assessment sheets, nutrition and pressure sore risk assessment sheets were in one folder and we were told these were recently introduced but had not yet been completed. One person is on a diet and although there is guidance, there is no indication of that persons involvement in the decision. The care plan for that person had not been updated or the risk assessment reviewed following an accident. The manager gave details of the action staff had been advised to take and said that the information would have been recorded in the day to day book and agreed to update the care plan. We also noted other information in this folder about continence but this was had not been updated in the care plan. Periodic updates of the care plan are necessary to ensure that the most up to date information is easily accessed. We also noted in both care plans viewed that there was no information about how finances are managed, how decisions are made and peoples involvement. This was pointed out during our visit and was agreed to be addressed. Staff spoke of supporting people making decisions about a range of day to day matters and were noted to be consulting people and gave examples of how they do this. They demonstrated an understanding of how to support people using various communication methods and were doing so effectively. Systems for effective communication and decision-making are in place in the home. One example is the use of sign language. A discussion was held about the arrangements for one persons communication and there is evidence that staff are trained to develop their skills in to aid this supporting the persons right to effective communication. Care Homes for Adults (18-65 years) Page 13 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home benefit from being able to do the things that they like doing in the home and in the local community. They also benefit from support with family and other relationships and a healthy diet. Evidence: From discussion and observation of the activities taking place and staffing arrangements we noted that people are able to make choices about their lifestyles and the things that they do on a day to day basis. Staff were noted to be supporting people in their rights to enjoy their preferred hobbies and interests and people have many items in their rooms for this. Activity plans were in the files viewed and records show that these activities take place. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: From conversations and observations of records we noted that people are involved in educational and recreational activities in and out of the home and a minibus is available to the home for this purpose. Examples of activities we heard about were: of people, going to college, day services, shopping, pub meals, wheelchair dancing, swimming, and day trips. Some people prefer to go out more than others and this is respected. Support is also given to ensure that regular commitments are maintained. In discussion about rights of people one staff member referred to the right to be supported with religious practises and said that this is considered in the service provided. People are encouraged to keep in touch with their families and examples of how the families of most people are involved were discussed in our conversations during our visit. One person, for example has many photos of family friends and staff and is regularly supported in aspects of their care and activities by their family. Another person is considering a holiday with their family. A staff member said that five people have regular contact with relatives. An example was also given of how the friendship of two people living in the home is assisted by regular trips out together supported by staff. A staff member spoke about how the people living in the home are consulted regarding the food provided and said that they knew their likes and dislikes. One person had not enjoyed part of their lunch on our visit but had liked the rest of it. The menu for the week was discussed with that person who confirmed that they liked the rest of the things on the menu. Another member of staff showed that they knew that persons preferences and they agreed that these were provided. The discussion also confirmed that food agreed on the menu is provided. During our visit people were having, lunch and were able to choose where to have it. Lunch was provided in a relaxed environment. 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. People living in the home benefit from receiving regular support with health and personal care but this would be enhanced by ensuring that all medication practises are accurately recorded. Evidence: From talking with staff and people living in the home, observing records and care practises we noted that health care needs are monitored and records are kept. These show that peoples needs are recorded and followed up although the information is not always easy to find and care plans are not all up to date as referred to in the individual needs and wishes section. The management present said that this would be addressed. Staff are aware of the health needs of people and one person said that lots of professionals are involved, providing input and guidance that was recorded for staff to use. People involved included speech and language therapy, occupational therapists and the local community learning disability team. Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: Another staff member spoke of various health needs which they are monitoring including recent reviews of one persons wheelchair and a new inner seat to meet that persons need. This was viewed and the person was comfortable. We saw and discussed the support provided for one person for physiotherapy and clear guidance was available for a member of staff to follow. The senior carer said that the staff member was being trained to carry out this support by a health professional. Another person spoken with had had a recent accident and we had been informed of this and we noted that staff were aware of their needs relating to this and follow ups were recorded in the day to day book. We noted that one person has a specific plan for feeding and the local health team are involved in monitoring the dietary intake. We were told that training for some staff came from the company providing the equipment and subsequent training had been cascade trained. This was discussed with the manager who agreed to review the training to ensure that professional input is provided. In the personal files we noted that the day to day personal care and health needs of people are recorded with evidence of recent consultations with, for example, doctors, dentists and opticians. We noted that the home had records of recent reviews of need with the local health team and action plans were in place to be followed up. Medication was discussed and we note that there is a secure place to keep these. We sampled some aspects of the system and found that recording of medication given does take place. However, there were some gaps on the records sheets and this related to medication not in use or as required medication. Discussion with a staff member revealed that clear guidance for these medications were not available and it was agreed that they should be written. We also found that a record of one item prescribed was not recorded when given although we noted that this was given during our visit. We were given assurances from a senior worker that this would be addressed. 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. People benefit from a clear complaints procedure and are protected by the homes safeguarding policies and practises. Evidence: In the surveys from people living in the home completed with staff help, they said that they were listened to and staff acted on what they said. Communication with people during our visit and observations of care practises supported this. No complaints were reported to have been made since the last inspection and none have been received by the Commission. We noted at the last inspection that the complaints procedure had been given to people on admission to the home. At this inspection we asked about accessible formats considering the range of communication patterns used by people living in the home. We were told that there were pictorial aids regarding feelings in the communication books and we noted this in one of the books viewed. The home has adult protection policies. It was noted at the last inspection that staff had recently had training in adult protection and at this visit we were told that three staff and the acting manager had recently completed a training session on this including the roles of other agencies. Two members of staff confirmed that more Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: training is planned for them and we noted that plans for training in April 2009 for some staff were posted on the homes notice board. There are procedures in the home for dealing with peoples finances. Money is held for people and we sampled the record of transactions for two and found clear records. There was one small discrepancy which the acting manager agreed to follow up. We noted at the last inspection that there were plans to review procedures with the aim of increasing individual peoples independence in managing their money. In the personal records held for people we found no information about how money is managed or how decisions about spending are made. This was discussed with the acting manager and representative who agreed to address this. Discussions were held about Mental Capacity Act training and the manager and representative who said that the manager had completed this and that there were leaflets in the home relating to it but that staff training needed to be and would be organised. 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. People have the benefit of living in a comfortable,suitably adapted home for people with physical disabilities with attention to maintenance,improvement and infection control. Evidence: In all the surveys from people living in the home they said that the home was fresh and clean. The home was viewed and some shared and private areas were viewed on the ground floor. All the areas are clean and pleasantly furnished and decorated. The home is well ventilated and there is lots of natural lighting. Areas of the home viewed are in a good state of repair. There is a cleaner on the rota each day for three hours in the morning and the cleaner was present during our visit. We have been told by the management that they intend to provide more en suite facilities for people in the home. We noted that one shower room was in the process of being changed to a bathroom and we were told by the manager that this was due to the expressed preference of one of the people living in the home. Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: The home has a large open plan area including the lounge, dining room and kitchen. There is also another area of the home used for activities, meetings and cookery as additional kitchen facilities are available. Private rooms were viewed with two people and we noted that they had been adapted for people with physical disabilities including the en suite facilities to meet their needs. Ceiling hoists are provided and the home also has a mobile hoist. There is a large extension to the rear of the building accommodating some of the bedrooms and these have been provided with ramps. Discussions were held about the lifestyles of people whilst in their rooms and through this and observation there was evidence that these rooms are personalised and contain many personal possessions. The acting manager confirmed that there is a new book to be used to records action needed in respect of the environment and completion of work. The hoists are serviced regularly and electrical tests of equipment take place. Infection control training was discussed with two members of staff. One had not participated in specific training but had been given guidance about it and had completed general health and safety training. Another had completed a 12 day course over 12 weeks and the certificate was viewed. Training planned for staff includes infection control. Disposable gloves were noted to be in one of the en suite facilities and the person using the room confirmed that aprons were also used. 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. People living in the home benefit from suitably trained and skilled staff and are protected by the homes recruitment policies and procedures. Evidence: People, in the surveys received before the inspection said that they were always treated well. People mainly rely on signing and non verbal communication. During our visit to the home we observed staff supporting and talking with people living in the home and in discussion they demonstrated good knowledge of individual needs and wishes of people. They supported people to make their own decisions in a friendly and caring manner and were respectful and taking note of their wishes using communication aids in individual ways. From observation, talking with staff and viewing the tasks to be completed and the rotas we noted that there are enough staff deployed to make sure that people needs are met flexibly. We noted that there are additional cleaning and catering staff deployed during the week and weekend so that care staff can focus on providing care. There are usually a minimum of three staff on a shift in the day time identified on the rota and we saw that a records of who actually worked on each day is noted. Comments from staff about activities and staff deployment indicated that staff levels Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: are varied depending on what people are doing and that the organisation has enough staff to ensure that needs can be met. Recruitment was discussed with the senior staff member and a representative from the management. We had received comments when we did our Annual Service Review in 2008 that there had been a high turnover of staff. We were told on our visit that the home now had only one vacancy soon to be filled. We noted that the two most recent staff members had been recruited in the last nine months indicating that the staff turnover has reduced. We looked at the records of recruitment and found that they are in place and indicate that pre employment checks required are being completed before employment. The one exception to this was where a verbal reference had not been backed up with a written one so that people are properly vetted before working in the home. Training was discussed with the staff. We also viewed some records and training plans. These indicate that a regular system of training is in place offering people a range of courses and in house training. The evidence noted included induction, NVQs, adult protection, communication, medication, Health and safety, fire,first aid, and infection control. A number of training sessions were planned for staff over the March to May period and these were posted on the noticeboard allocating staff to specific sessions. Staff said that they felt that they were supported to do their jobs and had regular supervision and staff meetings. Some of the courses were of greater depth for example one day a week for twelve weeks in medication and infection control. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The quality assurance system does not currently fully respond to the needs, wishes and preferences of of people living in the home or ensure that all risks are fully assessed, care regularly reviewed or that medication is well managed. Evidence: The home has an experienced registered manager and a senior care support worker second in charge. Although they said that the manager is in the home regularly and is planned to be in the home on the rota four days a week there is insufficient evidence to support this. The manager has agreed to address this. A staff member said that they feel supported and that it is a good company to work for. Staff spoke of regular supervision, support and training. From communication with people living in the home, conversations with staff and observations of day to day records we found evidence that people are able to affect the service provided. An example is the change to a bathroom referred to in the section on environment. Staff said that people have meetings regularly and holidays Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: are currently being considered. At the last inspection in 2007 it was noted that the home was developing a quality assurance system with plans to consult people living in the home and other stakeholders. At this inspection we found that this has just started and the management are waiting for more responses. People do not know the outcome or planned changes as a result of this consultation. The home has also purchased an audit system of which pieces are being implemented such as the cleaning audit and aspects of health and safety but it has not yet been fully established. Consequently the quality audit system has not yet ensured that all processes are in place such as full care reviews, an up to date household risk assessments or an up to date fire risk assessment. We spoke with staff and viewed some records regarding health and safety. Staff say that they are receiving health and safety training and annual moving and handling training. We saw plans for further training in these areas. Fire training is happening in the home and this includes with an external trainer and in house training. The records of the in house training was not in enough detail to show what is covered. We sampled records of checks of the fire system and drills and found that these are taking place. The manager agreed to check the frequency of one check. One member of staff has been identified as the fire marshall and we were told that there are plans to carry out another fire risk assessment following recent training, we noted the last review to was recorded in 2007. Although some risks to people are identified in individual plans,the household risk assessment could not be found. We noted that some radiators through out the home were covered and others were not and the home was not able to demonstrate how the safety in respect of these was managed. The manager said in a telephone conversation after our visit that she though there was a household risk assessment and agreed to address this. 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 14 There must be more evidence that peoples goals and care is regularly reviewed through consultation. This is to demonstrate that care provided is kept under review. 03/06/2009 2 20 13 All medication provided must be recorded when administered. This is to demonstrate that correct records are held of administration. 03/05/2009 3 37 24A A quality auditing system 03/06/2009 must be in place to ensure that the service is monitored and is also influenced by consultation with others. This is so that systems are regularly reviewed and altered in light of changing needs. Care Homes for Adults (18-65 years) Page 28 of 30 4 42 13 The home must demonstrate 03/06/2009 that action to minimise all risks to people living in the home must be fully identified and monitored. This is to ensure that there is evidence that risks to people living in the home are kept under review. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 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. 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