Care Home: May Road (1)

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What the care home does well The management and staff of the home continued to work diligently to improve the quality of care and support that is provided at May Road(1). In so doing they are able to positively engage residents to pursue a lifestyle that suited to their individual choice, culture and interests. More importantly the team is quite adversarial in enabling residents to access specialist services such as:physiotherapy, community learning disabilities support and psychology, which has a significant impact on the overall quality of life they enjoy. With the staff and management support, significant opportunities are available to all residents to influence and/or have an impact on how the home is run. As a result most of the residents, if not all enjoy living at the home. The registered persons have moved up a gear in compliance with the Care Standards Act 2000 and the Care Homes Regulations 2001. What has improved since the last inspection? There has been improvements to the decor and furnishings in the building to include the window replacement, kitchen cupboards and carpets, which makes it a more comfortable and safer place to live and work. Residents now enjoy a better range of activities that they are happy with. Care plans, risk assessments and health action plans have all been improved in their coordination and quality for the benefit of all the residents. The health and safety of residents is better provided for through ensuring that where an individual`s needs cannot be met at May Road(1), then alternative options are vigorously pursued in their best interests. There are now phones in each of the four units in the home. What the care home could do better: Ensure that monthly provider monitoring (Regulation 26) visits are carried out more consistently with each record made available for inspection. The registered persons should prepare an annual development plan for the service in line with National Minimum Standard 39.2 for Younger Adults. They should also provide opportunities that would enable residents to take an active part in the recruitment of staff working in the home. This would enhance greater resident involvement in the home. Key inspection report Care homes for adults (18-65 years) Name: Address: May Road (1) 1 May Road Chingford London E4 8NB     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: Stanley Phipps     Date: 2 2 1 0 2 0 0 8 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 29 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: May Road (1) 1 May Road Chingford London E4 8NB 02085275258 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Annette.Baidoo@walthamforest.gov.uk London Borough of Waltham Forest Name of registered manager (if applicable) Annette Dorlin Baidoo Type of registration: Number of places registered: care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 22 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 Date of last inspection Brief description of the care home The home is operated by The London Borough of Waltham Forest and is subject to the policies of the authority. It is a purpose built facility providing accommodation, care and support for 22 residents with learning disabilities. The home is arranged into four units, three of these units are on the first floor and as there is no lift to access the first floor these units would be inappropriate for anyone experiencing mobility difficulties. The home offers permanent and respite care. It is situated in a residential location and Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 22 Brief description of the care home is close to the town centre, providing easy access to all local amenities, leisure facilities and transport services. Care Homes for Adults (18-65 years) Page 5 of 29 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 inspection involved two site visits on the 22/10/08 and the 27/10/08, during which discussions and interviews were held with the registered manager, staff, residents and relatives that were available during the course of the visits. It also consisted of : a tour of the building, observations of staff and resident interactions, an assessment of the facilities on offer to residents, assessments of: care plans, risk assessments, regulation 26 and 37 notifications, health action plans, health and safety records, staffing rotas, medication records, menus, accident/incident records, staff recruitment procedures and compliance with the requirements from the previous inspection report. The inspection further considered feedback from external professionals and from surveys completed and returned by residents living in the home. Care Homes for Adults (18-65 years) Page 6 of 29 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 7 of 29 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 8 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes admission process is robust, inclusive and ensures that residents are admitted, once it is determined that their needs can be met in the home. Evidence: Pre-admission assessments were carried out involving the residents that were admitted. A summary outlining the needs of the residents was also in place. Residents get, as a matter of course an opportunity to see the home and have access to information to enable them to make an informed decision with respect to going to live at May Road. The registered manager takes the lead in carrying the assesments and is qualified to so do. It was noted that there are opportunities for relatives to participate in the admissions process. This inclusiveness ensures that the process of admission is a comprehensive one. Care Homes for Adults (18-65 years) Page 9 of 29 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. Residents now experience a better quality of care and support with regards to their care planning, risk assessments and the quality of information generally that is held on them. They continue to enjoy being actively involved in most aspects of life in the home, which they value immensely, as their best interests are acted upon by staff and the management at 1 May Road. Evidence: Major improvements were noted in the quality of records in relation to care plans and health action plans. Both sets of records contained more detail and it was clear that they were linked to each other. Risk assessments were also in place for residents and they too were linked to the care plans. During the course of the first visit some of the care plans were being updated, but this had been completed by the time of the second visit. Residents continue to be involved in the development of their care plans. One resident had a review prior to the date of the first site visit and there was evidence that the changes were being updated to reflect the outcomes of the review. Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: Feedback taken from residents indicated that they felt a part of the process in developing their care plans and a key-worker system is in place to help with coordinating the care and support needs for each resident. Another improvement noted was in the recording of the weight monitoring of residents,which was part and parcel of enabling residents to lead a healthier lifestyle. The chronology of significant events log for each resident was also more consistently maintained and this, when read with the daily notes enabled one to get a good picture of the state of residents wellbeing.This is positive. Residents were observed taking part in household tasks around the home and this was carried out at a leisurely pace. There was a general sense of calm as you moved across the home with residents being occupied in various tasks of their choosing. They are able to determine through care-planning, their social, personal and health care aspirations and are empowered to do so by the management and staff in the home. From the feedback received, most people indicated that they get to do what they want to, including the activities or chores they contribute to. It was obvious that residents had mixed abilities and interests and residents reported that they are made to feel inclusive. This included residents who chose to spend time on their own. Residents views on living in the home was indeed positive and included comments such as; I am very pleased here, I enjoy watching Emmerdale and Coronation Street and I like it here. There was also evidence of how residents are consulted with regards to the running of the home and decision-making, which was primarily through: the use of advocates, residents meetings, reviews, feedback from relatives where possible and through the use of satisfaction surveys. Some residents had the experience of going to Canterbury and others to Lanzarotte in 2007, another group was looking forward to going to Sussex on the 1/11/08 for a week. It is in this respect amongst others that residents views are transformed into positive outcomes that impact on their life. As stated earlier risk assessments were in place for all the residents whose files were examined. They were specific to identifying and promoting residents safety and independence. It is also important to note that they covered both risks and actions required, as they relate to life in the home and the wider community. There was also evidence that they were kept under review and from the samples examined - all were found updated. Staff spoken to demonstrated a good understanding of service users needs, as well as the risks and triggers that would increase risk of harm to staff, residents and visitors in the home. As an example: staff were indeed on top of their professional responsibilties as they closely monitored one of the residents who had a close affinity to the registered manager, and is set off by the presence of visitors that Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: are unknown - engaging with her. Their knowledge and expertise in dealing with situations like this, on both of the site visits was exempliary in that, while there was a sense of calm they effectivley kept risks to a minimum, without compromising the independence and dignity of any of the residents. This is positive. Care Homes for Adults (18-65 years) Page 12 of 29 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. Residents are encouraged to participate in their community, in appropriate activities, and are able to develop social and personal networks of their choosing. Most times residents are supported to exercise their rights, which are respected and promoted by staff in the home. At 1 May Road staff provide meals that are of reflective of residents choice and nutritional requirements. Evidence: Residents continued to enjoy opportunities to take part in activities both in the home and the community, that were appropriate to their choices and lifestyles. Within the structure and design of activities in the home, residents also have opportunities for personal development. One of the key improvements since the last random inspection 6/11/07 was the introduction of a computer for residents use, which was placed in the dining area. The registered manager was in the process of acquiring speakers for the system, so that residents could use the audio without the use of headphones if they Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: chose to. This development would enable some residents to either gain an interest in Information Technology and for others enhance what skills they already have. It was clear from the records seen that most of the residents had continued with their activities both in the home and the community and just before the inspection there remained decorations from a party that was held in the home. Residents spoken to about the event, commented that they all had an enjoyable time, which is positive. From looking at the records residents activities had been recorded as part of daily logs and so various festivities including birtdays and seasonal events were celebrated reflecting both the choice and interests of the resident group. Some residents allowed the inspector to view their personal spaces, which in all cases were personalised to include pictures, personal effects and systems for entertainment. As one moved through the home, which is divided into units. it was observed that residents were engaged in a range of activities including things that they wanted to do. Residents are enabled to use community facilities such as the hairdressers, barbers, shops, the local authoritys day centre, the local cafe and in at least one case a college. Another resident recounted that he enjoys going to cinema using the local bus, which is positive. All the feedback received from residents clearly indicated that they were happy with the level and range of activities they enjoy while living at 1 May Road. Feedback received from residents indicated that they do engage with families and friends in maintaining their social networks. One resident wrote; I enjoy going to my family on weekends, while another stated that he enjoys meeting up with his friends in the community. There was also evidence that relatives where possible attend social events in the home, as well as reviews held for their loved ones. The staff and management do make a positive contribution towards encouraging families and friends to visit the home and from the feedback provided by some relatives - they indicated that they are always made to feel welcome in the home. It is therefore safe to say that residents have the benefit of engaging with, and maintaining their social and personal networks, which is positive. During the course of the inspection staffing interactions with residents were appropriate and more importantly respectful. Residents were addressed by their preferred names and staff were observed checking with them - their preferences around various things such as preferred snacks, activities and to a lesser extent personal support. Advocacy information is made available to residents and the key worker system is used as a means of ensuring that the rights and needs of residents are respected and provided for. There was also evidence of advocates actually being used by residents, which is positive. It was reported that residents are encouraged to take part in the electoral processes, but the uptake on this is quite variable. It is Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: positive however that they have information on which they could make informed decisions about their involvement in the civic processes. A range of menus, which were also in pictorial formats were available on the day of the site visit, and from the records seen, meals consumed were duly recorded. Residents confirmed that they choose what they want to eat and that they are given advice on eating healthy. From the menu plans and the actual meals provided there was good evidence that residents enjoyed a range of diverse and cultural foods. All residents spoken to and those providing written feedback, were very happy with the content and quality of the foods provided in the home. This included a fresh supply of fruits and vegetables that were observed during the course of the inspection. Although the home is serviced by a cook, where possible some residents are supported and encouraged to prepare meals as a part of enhancing their skill development, which is positive. This is more the case for those wanting to go on to a more independent form of living, which would be a part of their individual plan. A good supply of food was available in the home and residents informed that they could eat when they liked. Food storage in the home was good including items stored in the small kitchens in the home. Care Homes for Adults (18-65 years) Page 15 of 29 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 enjoy personal support in a manner that is generally best suited to them. Good arrangements are in place to provide for their physical and emotional health needs. This is as a result of the staffing ability to maintain effective links with external professionals in achieving positive outcomes for them. Residents healthcare is enhanced by the safe handling of medication by staff in the home. Evidence: In examining the care plans, health action plans, risk assessments and daily records, they provided a clear audit trail as to how the personal and healthcare needs of residents are met. In general residents needs are coordinated through the key-worker system in consultation with them. while some residents are able to manage their personal care independently, quite a number of others require varying levels of support to which the staff embrace effectively and professionally. All feedback received from residents were indeed positive about the staffing support around their personal and healthcare needs. It was also clear that the system for determining residents preferences and dislikes was key to fostering positive relationships between both parties.From observation during the course of the inspection, Residents had their preferred style of dress, which was consistent with their choice, personality and Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: culture and this was promoted by staff in the home. It was conclusive from the evidence gathered from records speaking to residents, staff along with feedback from a sample of relatives that residents are given good support in promoting their health. All residents were registered with a General Practitioner and records bore evidence of residents engagement with services provided by: the community nurse, dentist, opticians, chiropodist, physiotherpist, psychologist as well as the community learning disability team. Some feedback obtained from external professionals indicated that the staff and management take positive action in ensuring that residents get good healthcare, which is available to them. This extremely important given the sometimes complex range of healthcare needs of some resdents. There was also evidence to confirm that it worked well in ensuring that residents are supported to attend their external appointments. In one of the cases examined there was clear documentation around how the pyschological needs of the individual were managed, which included the use of mood and behavioural monitoring charts. Staff worked well in ensuring that any vulnerability arising out of the complex presentation of needs by an individual - do not present them with any harm. It was also useful to note that support with healthcare is provided in a dignified manner and this ranges from support to an individual with weight management to say someone that may be a diabetic. At the time of the visit, all residents were reciving support with their medication, as they were unable to independently manage this task. an updated policy was in place to guide staff in the safe handling of medication. This safety is enhanced by ensuring that all staff receive appropriate medication training prior to supporting residents in this area. Medication storage in the home was good and this includes the disposal of any sharps, where this is used. The medication recording systems in the home were appropriately maintained and monitored by senior staff and the registered manager of the home. Residents are therefore assured that their healthcare needs with regard to medication - are well-provided for. Care Homes for Adults (18-65 years) Page 17 of 29 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. A satisfactory complaints procedure is in place and widely available to all residents and staff. Safeguarding adults policy and practices within the home generally protect from residents from abuse. Evidence: A satisfactory complaints procedure that is also in pictorial format remains in place and is accessible to both residents and staff. The registered manager welcomes complaints and from the records seen has been dealing appropriately with them. In the feedback over ninety-five per cent of the respondents knew how to complain and who they could complain to. There was also an overwhelmngly positive response from resdents in relation to whether they would complain, should they be unhappy with any aspect of the service. Some of their comments included: I am never unhappy here and if I am, I would let the staff or manager Know, I would go straight to L( Staff member named) and *I would tell the manager and my social worker. It was clear that residents felt empowered in coming forward and raising issues if they are unhappy. Staff spoken to were also well aware of the importance of supporting residents to complain when and if they become aware that an individual becomes unhappy with any aspect of their care and support. It was noted that the registered persons had complied with a previous requirement to provide all staff with Safeguarding Training, which is positive. Staff spoken to demonstrated an understanding of their role in safeguarding residents. They have Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: access to the London Borough of Waltham Forest policy and procedures on safeguarding vulnerable adults. They also had access to the General Social Care Councils (GSCC) code of conduct, which reinforces their role in safely proving care and support to residents. The recruitment practices undertaken by the registered persons are effective in ensuring that unsuitable staff do not obtain access to vulnerable residents. Sound arangements are in place to ensure that an accident/incident log is accurately maintained in the home and the registered persons are generally proactive in notifying the Commission of events that adversely affect the welfare of residents (Regulation 37) in the home. Policies and procedures are also in place for the safe handling of residentsfinances and valuables and records checked confirmed this. In essence the registered persons are proactive in ensuring that the risks of residents coming to harm from abuse - is kept to a minimum. Care Homes for Adults (18-65 years) Page 19 of 29 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. Major improvements to the physical environment now ensure that residents live in a more comfortable, safe and homely environment. They are happy with the facilities both private and communal. The home is clean and hygenic, which residents remain quite pleased about. Evidence: During a tour of the building, it was clear that some improvements that were long outstanding, had either been undertaken or receiving attention with regard to improvement. That aside, although the inspection was unannounced - the home was clean, airy, without odour and pleasant to walk through. All the residents seen, appeared comfortable in their home despite the limitations of not having a lift. There were spaces apart from residents bedrooms where residents could enjoy some peace and quiet if they wanted that. In that respect residents had options that they could use dependent on what they chose, for example: if they wished to relax, watch television or engage in an activity of their choice. The rear garden was also a viable option and this was in a satisfactory condition at the time of the inspection. Some of the improvements that were noted included; the bedroom windows that were inoperatve. However,since the site wisit, the Commission has been informed that the Kitchen cupboards had been replaced in 2009, the Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: ventilation system in the kitchen has been looked at, and the carpets has been changed throughout the home. The registered manager provided evidence of other areas in the home that were identified for maintenance upgrades and in this respect records, including those held electronically, were made available for inspection. These records demonstrated that she was taking action to ensure that the quality of the environment improves. Her actions and that of the staff team were pivotal in promoting not only a better but safer environment for the residents living there. The laundry area was also examined during the course of the inspection and this was generally well-maintained. An infection control policy was in place and residents and staff were encouraged to work within it for example-handwashing. The laundry equipment is designed to cater for soiled linen and appropriate arrangements were in place for their maintenance. The layout of the home is such that soiled linen is kept away from food preparation to minimise the risk of spreading infection. The services and facilities do comply with the Water Supply Regulations 1999. It must be noted that the feedback received from residents and external professionals was positive about the cleanliness and hygiene of the home. Care Homes for Adults (18-65 years) Page 21 of 29 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. Residents receive care and support from a staff team that is competent and motivated to work with them. Their welfare and best interests are promoted by ensuring that staff receive appropriate training and supervision, and are at suffucient levels to meet residents needs. Recruitment practices are robust, which ensures that residents are not at risk of having staff that are unsuitable - working with them. Evidence: During the course of the inspection the staff rotas reflected that the staffing levels were matched against the needs of the resident group. This was the case over a twenty-four periods and from speaking with residents and relatives - they were quite satisfied with the availability of staff in the home. Staff spoken to - were also satisfied with the numbers on duty, which they felt confident that they would be able to meet the needs of residents. The management structure included a team of four i.e. the registered manager along with three deputy managers. The current structure allowed for residents to enjoy a wider range of activities, which they were quite pleased with. Throughout the course of the visit staff were observed positively engaging and interacting with residents. From the records viewed and speaking with residents, staff were capable of taking appropriate action when emergencies occurred including making appropriate referrals to external professionals e.g. GP or the community nurse. They also have a good understanding of the service aims as well as their role in Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: achieving them. There was evidence of a staff training profile in place and this is key to ensuring that staff delivering the service to a resident group with wide-ranging needs. Over fifty per cent of the staff have achievd their NVQ Level 2 in Care and they all receive a structured induction that is line with current guidance. They also have a good understanding of the General Social Care Councils code of conduct, which underpins their knowledge in relation to their obligations in delivering good quality care to the resident group. Staff spoken to felt that they are given good training and support to do their jobs, which is positive. Key pieces of training which has been provided included: Safeguarding Vulnerable Adults, Risk Assessments, Challenging Behaviour (working with), Mental Capacity Act, Dementia Awareness, Learning Disability Award Framework training, Moving and handling and Food Hygiene. Feedback received from residents and some relatives spoken to, indicated that they were satisfied with the staffing ability in meeting their (residents) needs. Written evidence was available to confirm that the staffing recruitment process is robust and thorough. It was clear that staff were not recruited to the service unless they had satisfactory Criminal Record Bureau checks, two appropriate and satisfactfory references, and POVA first checks. Staff spoken to confirmed that they had been interviewed as part of the recruitment process. Their recruitment files forms part of their personnel file, which is retained by the human resources department in the London Borough of Waltham Forest. By robustly screening staff, residents could feel assured that they would be safe from coming into contact or harm with staff that may be unsuitable to work with them. It however remains unclear as to how residents are involved in this aspect of the homes operations - a recommendation that had been made back in 2007. The registered persons should engage and/or enable residents to take part in some aspect of the staffing recruitment process. This would enhance their level of involvement in the homes operations, as well as increase their ability in making decisons in key areas of the home. Care Homes for Adults (18-65 years) Page 23 of 29 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. Good managment systems are in place to provide a quality service at 1 May Road. Although there are quality assurance systems are in place they need to be more robustly effected to ensure improved outcomes for residents. Improvements to the building, as well as in the logistics of moving on residents with complex needs - now ensure that both residents and staff are safer in the home. Evidence: The registered manager is experienced and hold appropriate qualifications to carry out her role and functions. During the inspection she demonstrated a sound understanding of the needs of the resident group. It is recorded that she holds a nursing qualification, an NVQ Level 4 in Management and has completed the Registered Managers Award (RMA). From observation she held the respect of the staff seen on duty as well as most of the residents spoken to. Some of the residents comments included:I like Annette because she takes her job seriously, Since Annette came here, you can see the difference and Annette knows us all and we are well looked after. Staff spoken to, felt supported to carry out their functions at 1 May Road. The registered manager provided evidence of the work carried out in conjunction with the Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: external professionals in getting residents appropriate alternative placements that were better suited to meeting their needs. She has a long term vision for the service and operates a very much open-door policy. There was also evidence provided that she was active in staff disciplinary procedures to ensure that the staff remain fit for their roles at 1 May Road. Evidence was provided of the quality assurance systems used in the service, some of which included: relatives and residents meetings, annual residents, relatives and stakeholders surveys, including external agencies e.g. Mencap,and monthly provider (Regulation 26) visits. At the time of the visits residents and relatives surveys had been sent out and only a few had been returned. The inspector was shown some of the comments made about the service and they were mostly positive, as people including relatives and residents felt that the service was improving. From the regulation 26 reports seen, although they were carried out generally in line with the regulations, the frequency was not consisitent. The impact of this is that vital changes in the quality of the service could be missed, denying residents an opportunity to meet and comment on the quality of the service they receive from month to month. This needs to improve. There was evidence that the quality of the service is also measured from resident reviews and the progress they make as well as random spot checks carried out by the registered manager. Staff views are also gathered during staff meetings and in their supervisions, which also feeds into the assessing the quality of the services provided at 1 May Road. At the time of the visit an annual development plan for the service was not available, which in real terms would reflect the improvements planned given the findings of reviews, surveys and feedback about the service. This should be available for inspection as outlined in National Minimum Standard 39.2 for Younger Adults. As stated earlier the registered manager was instrumental in getting two residents moved to alternative provision. as concerns had been raised at the previous inspection (6/11/07) about the homes ability to safely meet their needs. One other resident had passed away since that visit and so further risks to those individuals had been removed. During the inspection the inspector was mostly satisfied that the residents living in the home were generally safe. The health and safety records held by the home were examined and all records on: gas, electrical, appliance and fire safety were satisfactory. There was also evidence that all staff have as part of their induction health and safety training. Safety signs were appropriately displayed throughout the environment and the home was accessible to the residents living there. Risk assessments were in place for all residents in promoting both their independence and safety. One initial concern identified at the visits was around the inconsistent pattern of monitoring the fridge/freezer temperatures. Since the inspection the registered Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: manager has provided hard evidence over a prolonged period of the improvements made in this respect. It must be noted that the registered persons did much better in complying with the Care Standads Act 2000 and the Care Homes Regulations 2001 in ensuring that ensuring that 1 may Road is a safer place to live and work. Care Homes for Adults (18-65 years) Page 26 of 29 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 29 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 39 26 The registered provider is required to ensure that Regulation 26 monthly monitoring visits are consistently carried out with the records available for inspection. To improve on quality assurance monitoring to ensure that there are improved quality outcomes for residents. 05/04/2010 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 34 The registered persons should engage or enable residents to participate in some aspect of; the staffing recruitment process for the home. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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