Care Home: Markham House

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What the care home does well The home has implemented systems to closely monitor staff training and supervise staff to ensure this is being completed. This includes fire safety and safeguarding adult training There is improved stability in the staff team with staff turnover over the past year being significantly reduced. Staff told us there is good morale in the home and that they generally enjoy going to work. Residents and staff were confident that they could raise any concerns and there appeared to be an open culture in the home where anyone could air a view if they wished What has improved since the last inspection? There are systems to ensure pre admission assessments on residents are completed and the level of information was well documented. The healthcare needs for residents was well documented with clear recording and provision of healthcare services was well established for ongoing needs. Where specialist healthcare was an assessed needs referrals had been made to enable residents to access this. Residents tell us that the home is a `very good` place to live, that they feel safe in the home and one resident told it `its the best place I`ve been`. The accommodation offered is spacious with some rooms having separate kitchen/lounge areas. These allow the residents to have privacy and facilities which promote independent living skills What the care home could do better: Systems for ensuring there were robust recording of complex medication arrangements required improving to ensure the resident received the right dosage and complete records of this was in place. The number of staff who have achieved national vocational qualifications has improved a little however the home is still someway off of ensuring at least 50% of staff have achieved this. Key inspection report Care homes for adults (18-65 years) Name: Address: Markham House 80 Moorfield Avenue Bolsover Derbyshire S44 6EL     The quality rating for this care home is:   two star good 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: Bridgette Hill     Date: 1 4 0 1 2 0 1 0 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 28 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 28 Information about the care home Name of care home: Address: Markham House 80 Moorfield Avenue Bolsover Derbyshire S44 6EL 01246822285 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: chesterfieldabi@yahoo.co.uk Voyagecare.com Voyage Ltd care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia physical disability sensory impairment Additional conditions: The maximum number of service users who can be accommodated is 13. Voyage Ltd may provide the following category of service only: Care home - code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - code MD. Physical Disability - code PD. Sensory Impairment code SI. Date of last inspection Brief description of the care home Moorfield Avenue is a purpose built care home that specialises in providing personal care for service users with acquired brain injury. Nursing care is not provided at the home. The home is in the process of a name change and is to be known as Markham House. Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 0 0 13 13 13 1 1 0 2 2 0 0 9 Brief description of the care home 11 bedrooms are located in the main part of the building and bedrooms have varying facilities including 3 bed-sit type rooms with a separate lounge/kitchenette area. All bedrooms have large en suite shower rooms. In the grounds of the home are two bungalows which provide facilities for service users to be supported by staff whilst living largely independently. The home is built and furnished to a very high standard and has a large well tended garden with seating area. The home is located in a residential area approximately 10 minute walk from the centre of Bolsover. Some local shops and pubs are nearby. The fees charged at the home start at £1400.00 per week but can be higher depending on assessed needs. Some residents have individually funded care arrangements with some dedicated one to one staff included. This information is included in a pack which is provided for all service users. A range of information is provided to service users in an easy to read format accompanied by pictures. Healthcare information leaflets are also available for service users on a range of topics. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections, undertaken by the Care Quality Commission (CQC), is upon outcomes for people and their views of the service provided. This process considers the Homes capacity to meet regulatory requirements, minimum standards of practice, and focuses on aspects of service provision that needs further development. This inspection visit was unannounced undertaken by Bridgette Hill and an Expert by Experience Terrie Riley. An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. In order to prepare for this visit we looked at all of the information that we have received, or asked for, since the last key inspection of the Agency, which took place on 11th February 2009. This included: The Annual Quality Assurance Assessment (AQAA). This is a document completed by Care Homes for Adults (18-65 years) Page 6 of 28 the home that focuses on how well outcomes are being met for people using the service. The previous Key Inspection Report. Relevant information from Other Organisations, and what Other People have told us about the service. Surveys returned to us by people using the service, and from the staff working in the service. What the service has told us about things that have happened in the service, these are called Notifications and are a legal requirement. During this visit to the service case tracking was used as a system to look at the quality of the care provided. This involved the sampling of two peoples records, two of these were looked at in detail. The Expert by Experience spoke to all of the residents in them about what it was like to live there. The services care plans and care records were also examined. Discussions were also held with staff. In addition, discussions were held with the Acting Manager Adrian Robinson (known as Rob) about the service about its general operation. Care Homes for Adults (18-65 years) Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. 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 8 of 28 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 9 of 28 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. There are suitable systems in place to assess residents needs, this ensures the home is able to meet the needs of new residents. Evidence: The Annual Quality Assurance Assessment completed by the home told us that We employ Regional Assessment Managers (RAMs) who identify and match potential residents with potential services. We try to ensure that the choice of home is the most appropriate from the outset of the referral process. The process that we follow from referral would lead into a transition period where visits to the persons home and visits to the service and overnight stays allows us to have insight into there wants and needs. In each residents file there was an individual copy of the home Statement of Purpose and Service User Guide. The format of the information about the home was in a large print and easy read style and was accompanied by some pictures to help all residents understand this. We were also told that information could be made available to residents in alternative languages if required. Each resident had also been issued with Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: terms and conditions of residency agreement to inform them about what to expect from the home. The Expert by Experience spoke to residents about what it was like to live in the home, one resident told us this is the best place Ive been. The surveys we received gave mixed opinions from residents about whether they had received enough information on the home before they moved in. There were written assessments for each prospective new resident and a comprehensive report was completed prior to anyone new being admitted to the home. The quality assurance assessment completed by the home told us that new residents were given opportunity to visit the home and have trial stays prior to moving in. Care Homes for Adults (18-65 years) Page 11 of 28 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. Care plans were well detailed and residents were involved in the care planning process which ensured the care received met their needs. Evidence: Each resident had a plan of care in place that was well documented and organised. We examined a sample of care plans and found that all the residents assessed needs were recorded and the level of detail recorded promoted a consistent approach from staff. For a newer resident all aspects of the care plan had yet to be completed as this was recorded over time as staff got to know the resident however key aspects of care delivery were recorded. Staff told us they did read the care plans and that they considered that they were informative. They told us they could contribute to any changes they considered were needed. Each residents care plan recorded their preferences, likes and dislikes and their preferred routines. Where residents had some communication or understanding difficulties detailed descriptions were in place on how to establish clear communication Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: with the residents. The Expert by Experience spoke to residents about their care plans and one resident told us they knew what their care plan was and said that they discussed this care regularly with staff and management. Another resident told us they didnt know what a care plan was but said they did discuss their care with staff. Each plan of care was supported by assessment of risk. These were comprehensive and covered a range of areas such as smoking, risk of going missing and health and safety risks. Each care plan we looked had been reviewed within the last two months and appeared to be up to date. Staff told us in house reviews were completed if changes occurred or on a 6 monthly basis. Multi agency reviews had also been conducted and involved the residents and their relatives. Ongoing log records were written for each shift to monitor how the residents were. A weekly record of activities and leisure opportunities were also part of each care plan with each resident have individual activities offered to them. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home enables residents to develop individual lifestyles and offers opportunities to enable them to develop skills and work towards improved independence. Evidence: As part of our visit we took along an Expert by Experience to talk to residents about what it was like to live in the home. Each residents file had a schedule of weekly activities these were also on display on a board in the dining room. Each residents activities were different to reflect their choices. Staff on surveys told us that they felt individualised support and an excellent activity schedule was in place to meet individuals requirement. During our visit the Acting Manager told us of the homes ethos of promoting residents independence and self development. All staff in the home got involved in organising activities and leisure opportunities for residents. One resident told us the staff help me be independent as Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: they have helped me get my passport and helped me organise my holiday. Other residents in the home had also been on holidays. Another resident told the Expert by Experience that they enjoy going out into the community and was encouraged to do so. They also told us they were going to go to college to learn to read again. Staff accompanied some residents to go to college to explore starting courses during our visit. The feed back from the visit was positive on the range of courses available and residents had identified courses they were interested in. Transport was available and staffing levels allowed residents to access the community supported by staff where this was required. Some days trips and outings had been enjoyed and photographs of these were on display in the home. The Expert by Experience felt residents had plans and aspirations for the future that they were being supported to work towards. It was felt that the positive attitude of the Acting Manager was a key factor in. One resident told us they felt staff could help motivate residents to take part in more in house activities. One resident on a survey told us that the home lets me do my own thing. Another resident gave examples of where they went out alone and another resident told us that staff get me out and about. At the residents meetings which were held regularly residents were consulted about what activities they would like to see offered. At each meal a choice of foods were offered and the menu was written on a board in the dining room. The main hot meal was served at teatime but hot and cold options of food was served at lunchtime as well. Some residents cooked meals for themselves and had stocks of food in their own kitchen areas in the room thus either maintaining or developing cooking skills Care Homes for Adults (18-65 years) Page 15 of 28 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. Residents health care needs are well promoted and accounted for in a manner, which best promotes and safeguards their health and wellbeing and individual rights to dignity, privacy and respect. Evidence: Each resident had a healthcare file with well organised details of all healthcare needs and how these were being met. We were told that where possible residents are encouraged to take responsibility for organising their own healthcare appointments but support is given where residents need this. Wherever possible comunityhelathcare servcices were accessed. The records for healthcare told us there was good recording where services such as podiatry, chiropody and dentistry had been accessed. Arrangements were also in place to enable residents to access routine health checks and vaccinations. Where needs had been identified specialist healthcare was required from Occupational or Speech and language Therapists referrals had been made and appointments kept. Part of the healthcare provision also included a therapist employed by the Provider to work with residents. An example of where this was being used was to aid residents to come to Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: terms with bereavements. The care plans for residents considered their privacy and dignity and also recorded if residents had any preferences regarding the gender of staff who assisted them with personal care. One file had a record of the residents weight on a regularly basis but another file didnt. The Annual Quality Assurance Assessment told us that no staff had received training in malnutrition care and no screening tools to identify nutritional risk were being used. Some residents did have dietary preferences and assessed needs such as diabetic diets which were catered for. We examined the storage and administration of medicines during our visit. The majority of medication administration records had well documented dosage instructions and recorded however administrations. For one resident however a gradually increased dosage was being implemented which was clearly documented in a letter from the specialist doctor. On the medication administration record for this resident small pieces of post it notes were stuck on to record the current dosage. The administration part did not detail what actual dosage had been given on what day and it was not possible from records or amounts of tablets available to establish if the regime prescribed had been followed. Some improvements to medicines had been made with topical preparations being dated to ensure they were used within set dates and balances of controlled drugs were accurately recorded. There were some residents in the home who were supported and supervised to manage at least some of their own medications. Care Homes for Adults (18-65 years) Page 17 of 28 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. Policies and procedures are in place which assist in ensuring the welfare of residents was safeguarded. Evidence: The Annual Quality Assurance Assessment told us there were comprehensive safeguarding adult and whistle blowing procedures in place. Staff we spoke to told us they would speak to senior staff if they had any concerns. They also told us they had receiving training on safeguarding adults. Each resident was able to access the complaints procedure through the Service User Guide and I am Worried comment cards, procedures were available in various communal areas of the home. These allowed residents to post off concerns to relevant people outside of the home should they not feel able to approach staff directly. The expert by Experience spoke to residents about how they raised concerns. Residents told us they felt safe at the home and usually gave the names of staff they would approach should they wish to raise concerns. One resident told the Expert by Experience I would either speak to the person I have a problem with or I would speak with the manager. The home kept records and complaints and safeguarding adult concerns. Where complaints had been received these had been promptly acknowledged and a full Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: investigation undertaken with written responses being given within timescales stated of 28 but usually much quicker than this. For safeguarding adult concerns the home had followed established local procedures to ensure that there was multi agency consideration of the allegations and subsequent investigation findings. The homes management team have received training on Deprivation of Liberty Safeguards (DOLS) and have followed procedures correctly where there has been a deprivation was considered to be in place. The application to restrict liberty had been granted and was included in the care plan. Staff we spoke were aware of restrictions being in force but were not wholly clear on what the actual restriction was and they said they had not received training on deprivation of Liberty Safeguards. We discussed this with the Acting Manager who informed us this was being sought through Derbyshire County Council. The home had systems in place for storing residents money. Care plans considered what skills or assistance residents needed to manage their monies. A robust recording system was in place and where purchases had been made receipts were retained. For many residents families were involved in the arrangement of residents monies. Care Homes for Adults (18-65 years) Page 19 of 28 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. Residents live in a home which is clean and well presented accommodation and that has varying facilities to suit the individual needs of a range of residents. Evidence: The home is a purpose built one with spacious single rooms each with en suite shower and toilet facilities. There is a nearby shop that residents use to buy newspapers and other items and the town is 10 - 15 minute walk away. Each resident was encouraged and supported to take responsibility for their own rooms and one resident told us they were very independent making their own food and helping with the housework around the home. The rooms that residents showed us were found to be personalised and individual. Some rooms were like bed sits with separate lounge/kitchenette area and one resident told us they made many of their own meals in the kitchenette which was equipped with a fridge and cooker. One resident told the Expert by Experience they liked the fact that they can decorate the room as they wanted and have privacy within their room. Some residents had pets in their rooms which they cared for. The Expert by Experiences impression of the home was that it was clean and free of any odours, but would benefit from some personal touches such as pictures on the Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: walls. The home has great facilities with a gym and a resource room where there health information and books made available to residents. This includes a range of audio and large print books. Arrangements for the management of fire safety systems and staff training were in place to ensure all possible measures to prevent and give early warning of any fire were in place. Documented Personal Evacuation Plans for each resident were also on file. We found all areas of the home to be clean and tidy. Most staff had received infection control training and infection control procedures were in place with posters around to remind staff and residents about good practices such as hand washing. The laundry room was fitted with 1 washer and 1 dryer. Residents told us they got involved in doing their own laundry. Care Homes for Adults (18-65 years) Page 21 of 28 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. There are suitable arrangements for staff recruitment, induction, training and deployment, which promotes a person centred approach to residents care and support and also their safety and protection Evidence: The home had 8 residents at the time of our visit with typical staffing levels of 4/5 staff for day shifts plus Managers and at night 2 staff. The levels of staff generally allowed for residents to go out with support if required. Absences due to holidays or sickness were covered through existing staff doing extra shifts or bank staff, some of whom worked regularly at the home. A review of information over the past year indicated that the turnover of staff had significantly decreased and a stable staff team was becoming established. The home monitored staff training in individual files and on an overall matrix. We were told that the Deputy Manager has a specific role in overseeing this and follows up at staff supervisions where training gaps are evident. This was evidenced in the supervision records we viewed where dates had been set for staff to complete some areas of training. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: A range of training had been completed largely through the Provider Electronic Learning modules. Some gaps for moving and handling training were evident though this was planned for the coming weeks. As well as a range of mandatory training such as safeguarding adult and food safety some service specific training was completed such as Acquired Brain Injury, Diabetes and Epilepsy. The majority of induction and staff training was undertaken through staff accessing on line learning modules. Some staff told us they would like training delivered to them in more varied methods in particular by a trainer where there was increased scope to interact and ask questions. Staff who administered medications had received training and there was also a number of staff who were trained in first aid. The Acting Manager was a trainer in Non Violent Crisis Intervention and all staff had received this training. The home had a staff group of 25 with 4 of these staff having achieved at least national vocational qualification level 2 or above. An additional 4 staff are enrolled on courses. Generally slow progress has been made over the past year to improve the proportion of staff who hold this qualification or equivalent. Staff all told us they had completed a range of training whilst being at the home and that they received regular supervision from members of the management team. They told us they felt supported and management were approachable and an on call system was in place for out of hours support. Staff told us surveys that they regarded the home as friendly and welcoming. Staff told us that there was a good team spirit at the home and the staff team worked well together. A number of staff surveys told us that it was a pleasure to go to work and that they enjoyed their job. The Expert by Experience considered that Staff morale seemed high with positive body language and good interaction with residents. Residents surveys said of the staff group they were all patient and caring and deserve a pay rise. During our visit one resident told the Expert by Experience they were very happy here and the staff are good. Care Homes for Adults (18-65 years) Page 23 of 28 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 has an effective management team that ensures it is consistently run in peoples best interests and that there health, safety and welfare is promoted and protected. Evidence: The home has been managed since October 2008 by an Acting Manager. Formal registration for the Manager to register has yet to be applied for however we were told that forms to apply for this were complete. We were given information from the Acting Manager after our visit that the first step towards applying for registration had been completed. The staff team we spoke with us that the Management team in the home was supportive and approachable and that there would be no hesitation about discussing anything with them. The quality assurance assessment was well completed by the home told us that staff and residents meetings were held regularly and systems to monitor quality in the Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: home were in place. We looked at the minutes for the meetings at our visit. Staff told us there was an open culture in the home and at the meetings there was two-way communication between staff and management. Opportunities were given at the residents meetings to discuss menus, outings and activities and other aspects related to living at the home. The Provider monitored quality at the home through Operations Managers who visited at least monthly and recorded their assessment of the home. The visits undertaken included examination of records including reviews of any complaints or safeguarding adult concerns, discussions with residents and staff and a review of any Care Quality Commission requirements from previous visits. Where there had been accidents and incidents these were recorded and records gave details of what actions had been taken. The actions recorded for each appeared to be have been taken quickly and appropriately. The Annual Quality Assurance Assessment completed by the home told us the dates service checks on equipment and systems had last been completed, these were all within accepted timescales. Suitable checks and monitoring of water temperatures and a legionella risk assessment was in place. Each month the Acting Manager told us they undertook a range of health and safety checks in the home and completed records of these which we were shown. Care Homes for Adults (18-65 years) Page 25 of 28 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 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 Robust systems must be in place to record escalating/decreasing dosages of medications This will ensure the dosages to be administered are clear and exact records will be in place to record the treatments the resident has received 26/02/2010 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 20 20 Where medication records are handwritten they should be doubly signed and checked by staff to ensure accuracy The home should consider having staff trained to administer medication on night duty to prevent potential delays in medicines being given should residents have to wait for on call staff to arrive Consideration should be given to increasing the number of staff on NVQ courses or equivalent 3 32 Care Homes for Adults (18-65 years) Page 27 of 28 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. Care Homes for Adults (18-65 years) Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!