Care Home: Liverpool Grove, 26

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Liverpool Grove, 26 Liverpool Grove, 26 London SE17 2HJ two star good service The quality rating for this care home is: 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: Sean Healy Date: 1 4 1 0 2 0 0 8 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. They reflect the things that people have said are important to them: 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. 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. Internet address www.cqc.org.uk Information about the care home Name of care home: Address: Liverpool Grove, 26 Liverpool Grove, 26 London SE17 2HJ 02077031935 F/P02077031935 admin2@plus-services.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): PLUS (Providence & Linc United Services) Name of registered manager (if applicable) Robert Agrawal Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 5 0 care home 5 learning disability Additional conditions: The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD The maximum number of service users who can be accommodated is: 5 Date of last inspection 2 6 0 7 2 0 0 7 A bit about the care home Liverpool Road is a Care Home providing personal care and accommodation for four people with a learning disability. The home is run by PLUS (Providence and LINC United Services), a voluntary organisation. The property is actually owned by Hexagon Housing Association and managed by Choice Support. The home is located in Camberwell, close to bus routes, shops, post office, pubs, and most amenities. The home consists of two floors, two bedrooms on the ground floor, one bedroom and an independent flat situated on the first floor that has recently been moved into after a long period of being vacant. There is no passenger lift; the ground floor is designed to be wheelchair accessible. Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home The inspection was carried out in one-day on the 7th October 2008 and ended on 14th October 2008. (The last key inspection took place on 26/7/07) The assistant manager facilitated the inspection in place of the manager who was on holiday. I spoke to two staff and observed three residents being supported by staff. I examined care assessments and care plans for three residents, and examined three staff employment files. Inspection surveys were completed by or on behalf of all residents. What the care home does well The home is well managed and staff say that if you are supported, and are giving good direction and training by the manager and the organisation. Staff are a sensitive and capable in the way at they provide support, and have had good training and supervision to do their jobs. A good range of activities are provided, and residents despite some transport difficulties are supported to go out in their community and to a range of activities on a daily basis. Residents are others speaking on their behalf has said that the home is well managed, with good staff who understand them, and that they are happy to live there. What has got better from the last inspection What the care home could do better The home should review risk assessments more often, at least every six months and record these reviews. At this inspection they were being reviewed often but each had not had a written record of being reveiwed every 6 months. Efforts should be made to see if the home could make the home more user friendly for residents who cant see well, so that they may be more easily able to find their way around by themselves. The manager must make sure that each of the staff have a good record of their training so that they can receive training when they need it, and must keep information at the home proving the identity of staff, such as copies of passports. This will better protect residents. The manager must make sure that all staff have their training and work performance discussed every year so that plans can be made for developing in their work. The home must give the residents and families written feedback on any surveys they carry out with or about residents. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Sean Healy Caledonia House 223 Pentonville Road London N1 9NG 02072390330 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535 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 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 . Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have all the information they need to make an informed decision about living at the home. All residents are provided with full assessments of their care needs and these are regularly reviewed. Evidence: There is an up to date Statement of Purpose and Service Users Guide available at the home which was reviewed in September 2008. This contains all of the information necessary to help residents understand the service they are entitled to and how the home is managed. I spoke to the assistant manager of the home and I inspected three residents files for information regarding care assessments. The home has a good system in place for ensuring that assessments are done prior to residents starting to live at the home. All of the residents have learning disabilities support needs and have high levels of personal care support. There are curently five residents living at the home, three male and two female and of the three files examined all had very good assessments of health, personal care, social care and development needs. Communications support needs and challenging behaviour also are areas where support is needed and assesments show that there is a good level of involvement from the multidisciplinary team, speech and language and psychology and that all assesments are reviewed at least annually. 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 . This judgement has been made using available evidence including a visit to this service. Assessed and changing needs are fully reflected in all residents care plans and they are supported by staff to make decisions about their lives. Risk assessments are in place to protect residents and understood by staff. Evidence: There was a requirement made at the last inspection to ensure that residents care plans be reviewed every six months. This is now being done and this requirement is now met. I examined three residents care plans, finance records and risk assessments, and spoke with two residents and three staff. All of these files had a care plan that reflected each individual care needs assessments. Care plans, including health and social and development plans, and risk assessments are well written in a way that enables residents to understand them and are reviewed every six months. The last reviews of care plans for residents took place in May 2008. There was full involvement from social services and from a number of relevant health care professionals. Residents have high levels of support needs in the areas of personal care, and communications, and all residents have learning disabilities support needs with some including autism. There are also challenging behaviour needs supported by staff who have had relevant training and experience. The home uses pictures as an aid to residents to understand their care plans, and each resident has a Care Support Profile showing their history, healths and medication needed and daily/weekly activity routines. Each resident has a seperate Health Action Plan and Person Centred Plan Evidence: showing goals such as swimming, gardening, using public transport, trying new food, massage and using a flotation tank as a means of therapeutic activity to help with difficult behaviours. Activities such as swimming, music, aromatherapy and visits to parks and pubs also feature on a weekly basis for residents. There is a good syatem for planning these activites weekly and for recording the sucess rates of activities and outings. Healths action plans show a full range of health needs are being met with full involvement from health care professionals both in developing plans and interventions and in care reviews. All of the residents finances are managed by the home with the manager as appointee. This is done by agreement with the residents and their relatives and by social services. Money and valuables are kept safe and good records and receipts are maintained. Residents files showed that risk is well managed with a range of risk assessments for support available in each residents care plan. Risk include using the kitchen, cooker, eating, travelling in the car, going to shops, using the swimming pool. This not only that risk is well considered by the home but also that there is a positive and safe approach to supporting residents in taking reasonable risks to enable them to have a full range of social and leisure activities. Risk assessments were generally reviewed every six months but not all were. It is recommended that the home ensure that all risk assessments are reviewed at least every six months as a matter of routine. (Refer to Recommendation YA9) 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 . This judgement has been made using available evidence including a visit to this service. Residents are able to take part in age/peer and culturally appropriate activities, They are part of their local community, and are supported to have relationships. Residents rights are respected, and good meals are provided. Evidence: There was a requirement made at the last inspection for the home to record residents activities for the purposes of the review, so that it can be seen that residents are consistently given the opportunity to take part in activities of their choice. There is now a very good system in place for recording when activities happen, or when planned activities do not happen. This requirement is now met. Each resident now has an individual activities participation record, which is completed by staff at the end of each shift. This system is being consistently completed by staff, and is being used to review the success of supporting residents to take part in activities. Residents surveys carried out by the CSCI as part of the inspection showed that residents are being asked about activities they would like to do, and are receiving support from staff to do them. One residents plan showed music sessions, hand and foot massage, visits to the park, visits to a spa bath house, cooking and shopping, as activities they are participating in a weekly basis. All residents weekly plans showed similar detailed activities are being planned for them. Discussion with the deputy manager and two other staff suggests that it may be beneficial for some residents to be more involved in doing their own laundry, either partially or fully, as a means of Evidence: being more involved in the running of their own home, and to ensure that when staff are busy doing these tasks they are not lacking in attention. (Refer to Recommendation YA12) The home supports residents to keep up family relationships and the homes policy is to place no restriction on visitors and to welcome residents friends and family. Not all residents have family available and the the home has done work to develop relationships with existing families at whatever level they wish to be involved, and to develop other relationships for residents. The home has now had consistent involvement from citizens advocacy for residents who dont have family available. There was a requirement made at the last inspection for the home to ensure that records of meals taken by residents be maintained to monitor that healthy food is being provided. This requirement is now met. Food is bought from local shops and there was a good supply of fresh fruit and vegetables in the kitchen. The menu was varied and nutritious and the food eaten by each resident was recorded in their daily diary. The deputy manager described how over time staff had got to know what residents liked and staff comments showed that residents seem to enjoy their food. 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 . This judgement has been made using available evidence including a visit to this service. Respectful and sensitive support is provided for Residents regarding personal care, health and emotional needs. Residents are supported to retain administration of their medication and medication is well managed. Evidence: For all the residents living within the main house there was detailed information within their personal care profiles about all their support needs and individual preferences. Specific cultural needs had also been addressed in these plans. For the resident living in the independent flat support staff were meeting with them weekly to discuss their needs and to address any concerns they may have. In addition, a weekly schedule had been drawn up in an accessible format using pictures and photographs to inform the resident which staff member would be supporting them on each day of the week. The resident confirmed that they were happy with the support they had received since moving into the home. A key worker system is used at the home and staff spoken to generally had good knowledge of residents needs. Residents were well dressed and looked well cared for. There was a requirement made at last inspection for the home to ensure all residents health care needs were addressed specifically in relation to monitoring one residents weight. This requirement is now met and simple clear charts are now being used to monitor all residents weight every two weeks. As mentioned in Standard 6 of this report, residents personal care profiles all included information about their health care needs. Generally, evidence within the personal files indicated that these had been addressed with contact with a range of health professionals including the GP, dentists, dieticians; district nurses chiropodists, physiotherapists and psychologists. In addition, where required there were detailed guidelines in place for staff to follow in respect to Evidence: specialist interventions, for example one resident has to have daily exercises carried out with them. A number of residents have sensory impairment support needs, and for at least one resident being able find their way around the home by sight is an issue. Discussion with staff and the assistant manager suggests that doing some work on the environment to make it more user-friendly for residents with sight impairment may benefit these residents. For example the use of contrasting colours in different areas of the home, may help to easily distinguish one area from another. It is recommended that in consultation with a relevant professional such as an occupational therapist, this be discussed and action taken if appropriate to adapt employment more closely to the needs of these residents. (Refer to Recommendation YA19) There were four requirements made at the last inspection regarding management medication. These require the hall to ensure that staff enter quantities of medication received on each residents individual medication records, that instructions for administration be clearly recorded on medication sheets, that medication be administered as prescribed by the GP, and that staff are always sign the medication sheets when medication is administered to residents. All of these requirements were met and bought the assistant manager and the staff interviewed were able to describe the processes for the administration of medication in the home. The home has an up-to-date medication policy which was last reviewed in October 2007. The Boots blister pack system has been in use of the home since August 2008, and both staff and the assistant team manager said that they find this more appropriate for residents, and easier to use. Four of the six staff and the manager are trained to give medication and only trained staff administer medication. Medication balances are checked weekly and administration recording is now good. 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 . This judgement has been made using available evidence including a visit to this service. The Residents feel their views are listened to and acted on, and that they are adequately protected from abuse and neglect. Evidence: The home has an up-to-date complaints policy. Neither the home nor the commission has received any complaints since the last inspection. The home has a copy of the Southwarks adult protection policy and both the manager and all of the staff have had the necessary training. Complaints and safeguarding within the home is well managed. Two staff interviewed showed a good understanding of this policy. There has been one allegation and referrals made under the adult protection policy since the last inspection. This involved an allegation against a member of staff for taking sums of money ranging from 15 pounds to 30 pounds from four residents. This was reported to social services quickly and efficiently, and following investigation the member of staff was dismissed and the money was repaid to residents. The registered manager confirmed that this was formally referred to POVA for inclusion in their register. The residents has support from independent advocacy to help make important life decisions and to advocate their rights. 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 . Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall, the home is well maintained, homely and comfortable. Residents bedrooms suit their individual needs and toilets and bathrooms provide sufficient privacy and meet their individual needs. Communal areas are spacious and complement service users individual rooms. The home is clean and hygienic. Evidence: There was a requirement made at the last inspection for the kitchen worktop which was damaged to be replaced. This is has now been done and there is a firm plan to have the whole kitchen replaced. Therefore this requirement has been met. All residents have their own individual rooms that are a good size and are furnished to required standards. Two of the bedrooms have en -suite bathrooms, one on the ground floor and one upstairs although this is shared with the other resident whose bedroom is upstairs. All the bedrooms have been nicely decorated and all of them have been personalised to reflect their individual needs, interests and culture. Also, as mentioned upstairs there is a self- contained flat that is now occupied. This had been decorated and furnished taking into consideration the residents personal wishes and choices. There are sufficient bathrooms and toilets to meet the needs of the residents. The home has accessible communal areas with a large spacious lounge/dining area on the ground floor that has patio doors that lead out to a good- sized garden that is very attractive and well maintained. The kitchen is spacious and there is a small table where residents can sit and eat that is in addition to a table situated in the dining area. Following discussions with the homes assistant manager it was agreed that the Evidence: following recommendations should be considered by the homes management. 1. The carpet in the staff sleepover room is stained in and needs to be cleaned or replaced, and the room needs redecoration. 2. The paint in hallways is consistently lightly coloured, and given the number of residents have sight impairment considering better colour definition in consultation with an occupational therapist is recommended. (see also standard 20) 3. The Bath in the first-floor bathroom is very low and staff say that this can cause difficulty in supporting residents to have a bath as they have to bend down very low to do so. As this may present a potential risk to the staff the provider should consider changing the bath to one of a normal height. 4. The nonslip flooring in one residents bedroom on the first-floor has come unstuck and presents a trip hazard. The housing officer attended to this immediately on the day of inspection. The manager should ensure that this is checked to ensure the work has been successful. 5. Communal areas are devoid of pictures, mirrors and decorative objects, due to the risk presented by the behaviours of some residents. The manager should consider exploring options for using unbreakable picture frames which may be fixed walls at higher levels to avoid risk. 6. One residents room cupboard door needs to be properly painted. 7. The light in one residents room on the ground floor is quite dim, and has a resident has a visual impairment it is important at this is reviewed to establish whether the lighting is adequate. (Refer to recommendation YA24) The home was clean and hygienic on the day of the inspection. The home has appropriate laundry facilities that are sited away from the preparation of food. 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 . Quality in this outcome area is good.This judgement has been made using available evidence including a visit to this service. Staff are supported by the home to achieve relevant qualifications to ensure they are able to meet the needs of residents effectively. There are sufficient staff on duty to provide adequate support . Residents are now protected by the homes recruitment practices. Staff have been given opportunities for training to ensure that residents individual and joint needs can be met, and they receive regular supervision. All staff do no yet have annual appraisals. Evidence: All permanent staff are required to complete the Learning Disability Award Framework (LDQ) Units 1-4 in their probationary period. Staff are then supported to undertake a National Vocational Qualification (NVQ). At present, five of nine permanent staff working at the home had achieved NVQ Level 2/3. The home has met the required target as specified within National Minimum Standards (NMS) as more than 50 of staff have completed a relevant qualification. The day the inspection was held there were sufficient staff on duty and all were working consistently providing support for residents. Between 8 a.m. and 7 p.m. there are between three and five care staff on duty. There are always a minimum of two staff on duty later in the evening, and Night support is provided by one sleepover staff. There are currently three staff vacancies and it is recommended that at least one of these posts be filled to help consistency in service provision. (Refer to Recommendation YA33) Discussion with staff and the deputy manager during the inspection suggests that they are very consistent disturbances at night-time which may affect the sleepover staffs ability to carry on into the daytime shift. It is recommended that the registered provider and manager consult with staff regarding these disturbances to establish Evidence: whether any changes need to be made in how night-time support is provided. (Refer to Recommendation YA33) There was good interaction between the staff and residents and staff communicated well with residents, making eye contact, providing hand on hand support and ensure that residents were included in the activities in the home. Some residents were supported to go out, and staff said that they are confident in going out with residents and that good risk assessments were in place to enable them to do so. There was a requirement murder last inspection for the home to ensure that recruitment information as required by CSCI, be kept at the home on forms provided. This requirement has now been met. The home has good detailed forms available which have largely been completed recording the information about staff recruitment, police and POVA checks, references, and health checks. There are detailed induction schedules completed for each member of staff and held on the file, showing a good and detailed induction has taken place. the staff employment information held that the home has improved significantly and now is of a good standard, and better protects residents. However the home needs to keep copies of staff references references and a copy of their passport or birth certificates to evidence staff identity. (Refer to Requirement YA34) Interviews with three staff, and examination of three staff files showed that the good level of training is provided for staff which is appropriate to the needs of the residents. however it is recommended that the home consider including the following training in the homes training schedule for staff. Skills teaching, autism, breakaway, Person Centred Planning. (Refer to Recommendation YA35) While there is good training provider for staff there was not an individual staff training and development plan for each member of staff available at the home. The home must ensure that each member of staff has such a plan on file. ( Refer to Requirement YA35) Staff confirmed that they are receiving regular supervision from the homes manager and deputy manager at least every six weeks but usually more often. Examination of staff files showed that this is the case and good detailed supervision note are being maintained which had been agreed by the supervisee. However the staff records and staff themselves confirmed that annual appraisals and are not yet happening consistently for all staff. The homes management need to ensure to all staff have appraisal annually, and that written records are kept of these. (Refer to Requirement YA36) 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 . Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Residents do now benefit from a well run home and they are consulted by the management and staff regarding their views. The health and safety of residents are now protected by the homes practices. Evidence: There was a requirement made at the last inspection for the home to ensure that there is an effective quality assurance system in place based on seeking the views of residents and their families, and also to ensure that monthly unannounced visits to the home are carried out by the responsible individual and that there are copies of these visit reports are available at the home for inspection. To date inspection showed that these requirements are now met. The manager of the home is experienced and has substantial training in working the people with learning disabilities and in the management of staff. He also has the NVQ4 qualification in care and management appropriate to this post. Feedback from residents and from staff stated that the home is well managed by a manager who is able to listen, and was willing to act to sort out any problems. Staff are consistently supervised and this service to feel well supported by the manager to do their work. Monthly visits to the home are carried out by a person appointed by the registered provider, and reporting are kept at the home showing a reasonable level of detail of what was looked at and what needs to be done to make necessary improvements. The home now carried out surveys of residents and their families views on how the home is run, the last survey been done in July 2008. the service included comments from health care professionals who visit the home. Comments received were very positive Evidence: about how the homes is run. However it is recommended that the feedback on findings from surveys and any proposed action to be taken be more clearly fed back to residents and their families in writing to outline findings and any proposed action for improvement. (Refer to Recommendation YA39) The registered provider ensure is that finance inspections are carried out by an external manager every two months and records kept at the home of their findings. These records showed the homes finances to be well managed, was a good records being kept of any expenditure on behalf of residents, including receipts. Health and safety within the home is well managed, and all residents have appropriate risk assessments in place for their protection. There is good clear documentation in place regarding health and safety, fire safety, food hygiene, staff training, and electrical and gas certification. All of this documentation is up-to-date. There have been no health and safety incidents or concerns raised by residents of staff. Are there any outstanding requirements from the last inspection? Yes  No  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 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 Description 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 Description Timescale for action 1 34 19 The registered provider and 31/07/2009 manager needs to keep copies of staff references and a copy of their passport or birth certificates at the home to evidence their identity and work history. This is in order to evidence that the registered provider has obtained staff references and the homes manager is easily able to check the identity of staff and thus better protect residents 2 35 18 The registered provider and 31/07/2009 manager must ensure that all care staff have an individual training and development plan on the file showing the training they have completed, and and any training proposed. This is to ensure that there is a clear record of the training that staff have had and to enable the manager to more easily monitor individual staff training needs. 3 36 18 The registered provider and manager need to ensure to all staff have appraisal annually, and that written records are kept of these. 31/07/2009 This is to ensure that staff performance is regularly monitored and that staff have fair opportunity for personal development. 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 8 The registered manager and provider should routinely review residents risk assessments every six months instead of annually The registered manager and provider should consider for each resident whether being more involved in doing their own laundry would be beneficial and where appropriate include this activity in their daily routines. The registered manager should in consultation with a relevant professional such as an occupational therapist, discussed how the environment could be more appropriately adapted for residents with a sight impairment, and action be taken if appropriate to adapt employment more closely to the needs of these residents. The registered provider and manager should fully consider addressing all of the areas listed under Standard 24 of this report, to ensure that the residents have a comfortable home. The registered provider and manager should consult with staff regarding night disturbances to establish whether any changes need to be made in how night-time support is provided. The registered provider and manager should consider filling 2 12 3 19 4 24 5 33 6 33 at least one of the staff vacancies in order to ensure consistency of service provision to residents 7 35 The registered provider and manager should include the training outlined under Standard 35 of this report in the homes training prospectus for care staff The registered provider and manager should ensure that full written feed back is provided to residents and their families regarding any surveys carried out by the home on their behalf. 8 39 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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