Care Home: Meadow Bank

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What the care home does well People discussed with us their care plans and how these reflect their wishes and aspirations.They are supported to achieve these and said they enjoy going to college, workshops at Paradise House, holidays, concerts, swimming and using a local gym.People said they are supported to eat healthily and buy their own food to prepare snacks and their evening meal. Staff support people to learn new skills that increase their independence and build their confidence.Equality and diversity is promoted, people celebrate their different cultures. They said they are happy with the staff team and feedback from others said they `provide a safe and friendly and supportive environment in which to live and work.`Accommodation of a high standard is provided which is comfortable and `well presented`.Staff have access to a robust training programme and they say communication in the home is very good.People were being asked for feedback about their home at weekly house meetings and as part of the quality assurance programme. What has improved since the last inspection? This is the first inspection of this home since its registration with Novalis Trust. All requirements issued to the home when registered with Meadowbank Trust have been complied with. What the care home could do better: A report needs to be produced from information and feedback collected as part of the Quality Assurance System.Some minor improvements tothe administration of medication will make sure a robust system is in place. Key inspection report Care homes for adults (18-65 years) Name: Address: Meadow Bank Meadow Bank Kings Mill Lane Painswick Glos GL6 6SA Two star good service The quality rating for this care home is: 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: Lynne Bennett Date: 2 4 0 8 2 0 0 9 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Information about the care home Name of care home: Address: Meadow Bank Meadow Bank Kings Mill Lane Painswick Glos GL6 6SA 01452813647 01452813647 jl@cotswold-chine.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Novalis Trust Name of registered manager (if applicable) Ms Kelly Ann Lawson Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 5 0 care home 5 learning disability Additional conditions: The maximum number of service users who can be accommodated is 5. The registered person may provide the following category of service only: Care Home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning Disability (LD) Date of last inspection A bit about the care home Meadow Bank is a detached property that provides care and support for up to five people with a learning disability. The home has been substantially extended and re-developed to provide accommodation of a high standard. The home is owned by Novalis Trust who have another registered service, Paradise House nearby. It is situated on the outskirts of the village of Painswick and has good access to local amenities. The Statement of Purpose and Service User Guide are available from the office. Fees for the home are available from them upon request. 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 Poor Adequate Good Excellent How we did our inspection: This is what the inspector did when they were at the care home This inspection took place in August by one inspector and included a visit to the home on 24th August. The registered manager was present throughout. Time was spent with all people living in the home, joining them for lunch and a house meeting. We talked to 2 people using the service, and asked staff about those peoples needs. We also looked at the care plans, medical records and daily notes for these people. This is called case tracking. The registered manager completed an AQAA (Annual Quality Assurance Assessment) as part of the inspection, providing considerable information about the service and plans for further improvement. It also provided numerical information about the service (DataSet). We also looked at health and safety records, complaints and quality assurance audits including reports of monthly visits made on behalf of Novalis Trust. We had received surveys from 4 people living in the home, 2 health care professionals and 3 members of staff. What the care home does well People discussed with us their care plans and how these reflect their wishes and aspirations. They are supported to achieve these and said they enjoy going to college, workshops at Paradise House, holidays, concerts, swimming and using a local gym. People said they are supported to eat healthily and buy their own food to prepare snacks and their evening meal. Staff support people to learn new skills that increase their independence and build their confidence. Equality and diversity is promoted, people celebrate their different cultures. They said they are happy with the staff team and feedback from others said they provide a safe and friendly and supportive environment in which to live and work. Accommodation of a high standard is provided which is comfortable and well presented. Staff have access to a robust training programme and they say communication in the home is very good. People were being asked for feedback about their home at weekly house meetings and as part of the quality assurance programme. What has got better from the last inspection What the care home could do better A report needs to be produced from information and feedback collected as part of the Quality Assurance System. Some minor improvements to the administration of medication will make sure a robust system is in place. If you want to read the full report of our inspection please ask the person in charge of the care home. If you want to speak to the inspector please contact Lynne Bennett CQC South West Citygate, Gallowgate, Newcastle upon Tyne NE1 4PA Tel: 03000 616161 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website http:/www.cqc.org.uk/. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to the information they need enabling them to make a decision about whether they wish to live at the home. Admission procedures include obtaining assessments and other information to make sure that peoples needs can be met. Evidence: The Statement of Purpose and Service User Guide had both been reviewed and produced in a new format providing up to date information for people living in the home. The registered manager said that each person would have a copy and additional copies were available in the office. People also had up to date residential agreements in place. The AQAA stated, We have a comprehensive admissions procedure, which ensures that the needs and wishes of the prospective residents are at the heart of the process. A place would only be offered to a new resident if their needs can be met. A person was in the process of visiting the home with a view to moving in. They presently live at Paradise House and had requested a move to a more independent living environment. Assessments and care plans would be provided to the home from Paradise House. People said they were looking forward to the person moving in and had invited them to accompany them on day trips and on a forthcoming holiday. The persons parents had also visited the home. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are being involved in developing their care plans that reflect their aspirations and wishes. Risks are being managed safeguarding them from possible harm. Evidence: The care of two people living in the home was case tracked and other peoples files sampled. Each person had a holistic assessment of need from which care plans were developed for their physical, emotional, social and intellectual needs. Each person had been involved in an annual review which included representation from their placing authority. An assessment of need and care plan had been supplied by the placing authority. The needs highlighted in these were reflected in their care plans. People spoke with us about their key workers and how they were involved in the care planning process. One person described how their wishes and aspirations were reflected in their care plan and it was clear to see from daily records and their care plans that these were being respected and implemented. Comments from a parent as part of the Quality Assurance process included, their wishes are respected and achieved. It was clear to see that care plans were being reviewed every 6 months or sooner if changes in need had occurred. Some care plans identified objectives towards meeting goals which included a summary of the progress to date, the assessment of need, the objective and strategies to promote these. Staff and people spoken with were clear about how these goals would be met. Health professionals commented that a person centred approach to care was in place. Each person had care plans reflecting their culture and personal views and wishes. A care plan for one person indicated the importance of their room reflecting their interests and identity. The person said they had been supported to achieve this. Our observations confirmed this. Evidence: Daily records (Blue books) were well written and provided evidence of how peoples needs were being met on a daily basis and how they were being supported to manage their anxieties. For instance one persons care plan indicated they needed to be supported to manage their weight through diet and exercise this was due to health concerns. Daily notes recorded how they were supported with their healthy diet and how they had been supported to increase opportunities for exercise both within the home (using a fitness video) and at the local gym. A nurse had also talked to them about the importance of diet and exercise to improve their health. The person confirmed with us that they enjoyed using the gym and that they were having a healthy diet. The registered manager confirmed that there were no restrictions in the home. We were invited to join people at their weekly house meeting where they discussed the menu for the week, activities, holidays, the environment and any concerns they may have. A person was observed reading the minutes to this meeting later and signing them as correct. Each person had a communication plan indicating the support needed with the written word or expressing their feelings. One person was having daily consultation meetings with staff to talk about their feelings and anxieties. Staff were heard offering to read an article in a newspaper to one person. Another person had been referred to a Speech and Language therapist for an assessment and a copy of this was on their file. Staff were observed promoting positive communication with people during lunch and at the house meeting. People were supported to manage their own finances. They had just had a new bank account opened and were waiting for cash cards to be forwarded to them. The registered manager said that systems would be put in place to support people initially with their cards. People had access to advocacy. One person had been supported by an advocate and a contract was in place confirming this. The registered manager said that the advocate was providing support to discuss future plans for this person with their placing authority. The AQAA stated one person had commented, a great deal of effort is made in helping people achieve their wishes, by enabling them to make decisions for themselves. Care plans clearly cross referenced to any hazards which had been identified and risk assessments which were in place. These had been reviewed alongside care plans. It was evident that people were being supported to take risks as safely as possible enabling them to be independent around their home and when out and about in the community. One person was being supported to go on holiday without staff support. They had been supported to take a holiday in the same resort as others from the home. Thus they were able to try out a holiday on their own but in the knowledge that staff were nearby should they be needed. Staff had completed a report at the end of the holiday indicating the success of this. People were also supported to travel about locally using public transport without staff support. They had mobile phones and records indicated that if they had a problem they would contact the home. Evidence: A missing persons procedure was in place and each person had a front sheet on their file providing a description of them with a current photograph. When people went out independently they informed staff when they would return and had been encouraged to let staff know when they were back in the home. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff, support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home make choices about their lifestyle, and are supported to develop life skills. They have the opportunity to take part in social, educational and recreational activities and keep in touch with family and friends. People have a nutritional diet and their diverse needs are catered for. Evidence: People talked to us about their way of life and how they were supported to participate in a range of activities outside of the home. People said they liked to walk into the local village using the library and shop. They confirmed that they had registered for courses at the local college in Stroud and that they also attended classes at Paradise House. One person said they had been to a computer class and another had enjoyed a tapestry class. During our visit another person was supported to go to the gym. Each person had an activity schedule and daily records indicated that they had access to these. We sampled a two week period in August and during this time people had been out for day trips, to a Cat Protection Fete, shopping, swimming, the gym, walks, a bike ride, a garden centre, to Stroud and Cheltenham, to college and the library. People had also used the internet at home. During our visit people were planning holidays and a trip to the cinema. A Regulation 26 report for the home commented, residents continue to be introduced gradually to new experiences and appear to be gaining confidence in undertaking new activities and learning new skills. Feedback from a survey indicated that employment opportunities could be researched. Some people had televisions and DVD in their rooms. A DVD player was provided in one of the lounges. There were plans to turn a small room into a communications room with Evidence: access to a computer and internet. Staff, were supporting one person to explore and celebrate their cultural heritage. The person told us they were planning a holiday to Cyprus and that they would be preparing food for a forthcoming world cooking event at the home. During the house meeting they asked for support to find a flag of the country to display on the world map and staff had already helped them to find recipes. They said that staff had helped them to learn a few Greek words. Records indicated that they often bought Greek produce when shopping. People kept in touch with relatives and friends through visits, the telephone or by letter. Several people traveled independently using public transport to visit relatives. People said they helped around the house and were observed helping prepare lunch, set the table and clear away. They said they do their laundry and help clean their rooms. Lists were displayed in the home of each persons daily responsibilities. People also went shopping for items of food. Each person had a locker to store their own food and provisions to make snacks and their tea. These items were funded from the homes petty cash. We observed a meal of lamb chops and fresh vegetables being cooked for lunch. One person disliked mashed potatoes and boiled potatoes had been provided. Staff meeting minutes indicated that discussions had taken place about the quality of meals and the importance of producing freshly cooked meals rather than convenience meals. A healthy diet was being actively promoted and fresh vegetables and fruit were available. 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. Peoples health and wellbeing are being met helping them to stay well. There are some improvements in the administration of medication that need to be implemented to safeguard people from the risk of error or possible harm. Evidence: Peoples routines, likes and dislikes were recorded in their care plans providing staff with clear information about the way in which they wished to be supported. Plans indicated that people did not need support with their personal or self care routines and were able to manage these independently of staff help. Times for getting up and going to bed were highlighted in care plans. Each person had a health check annually and records indicated that they had regular access to a range of health professionals. Feedback from health professionals indicated there was good communication between themselves and the home. Robust records were being kept of each individuals appointments including a note of the outcome of the appointment. A summary of health care appointments was kept providing a tracking tool for appointments with their dentist and podiatrist. People were being referred to the local Community Learning Disability Team with copies of their reports in place. Health Action Plans were being introduced but were not in place at the time of our visit. There were plans to develop a team of health professionals within Novalis Trust to provide therapeutic support for people and staff. Systems for the administration of medication were mostly satisfactory. The registered manager confirmed she would be receiving training in the safe handling of medication so that she could cascade an open learning pack to staff. Staff said they had completed training in the administration of medication with a local pharmacy. Most of the medication was administered in a weekly blister pack. Stock control was maintained on the medication administration record. A protocol was in place for as necessary medication Evidence: and an additional stock book was in place. Homely remedies had been authorised by the General Practictioner. The temperature of the medication cabinet was not being monitored. The home did not have a copy of the most recent Bristish National Formula. Some handwritten entries on the medication record had been signed but not countersigned. The registered manager said this would usually have been done. Several people were being supported to self medicate and a risk assessment was in place for one person. The registered manager said a risk assessment would be put in place for the other person. The AQAA indicated that people were supported to manage their own medication in a staged approach and the registered manager said that lockable facilities had been provided in their rooms. She described how a best interests meeting was being held to discuss whether a person had capacity to consent to learning how to self medicate. Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident in the knowledge that any concerns they may express will be listened to and acted upon. Systems are in place that should safeguard people from possible harm or abuse. Evidence: All respondents to our surveys said they knew how to make a complaint. People spoken with during our visit confirmed they would talk to their key workers or the registered manager. We observed people during a house meeting and it appeared that they would bring up any concerns in this forum. The complaints procedure was accessible to people in the home and some people had chosen to use one of these forms. The DataSet indicated that the home had received 4 complaints this year. Records were being kept for each complaint and letters to complainants provided a summary of the outcome and the action taken. The home had also received one compliment. The AQAA stated that Novalis Trust has made it mandatory for all staff to have refresher training in the protection of adults. Staff confirmed they had completed this training. They had confidence in the management of the home and that any concerns would be dealt with effectively. The registered manager had completed the enhanced training in safeguarding as well as the Mental Capacity Act and Deprivation of Liberty Safeguards. All staff completed training in CALM (Crisis, Aggression Limitation and Management) and discussed their understanding of how to help people with their anxieties and fears. Daily records and incident records indicated there were few incidents in the home. Staff confirmed statements in the AQAA that physical intervention had not been used in the last twelve months. Emotional and behavioural development plans were supplemented with De-escalation and Physical intervention plans providing staff with clear guidance about how to support people. Daily records indicated that staff, were effectively following these guidelines. Financial records were examined for those people case tracked providing evidence that people were receiving their weekly personal allowances. People were managing their finances independently. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home which is light, airy and comfortable and have access to a high standard of accommodation both in communal and private areas. Evidence: We completed a walk around the home with the registered manager and also with people living there. A high standard of accommodation was provided. The internal decor of the house was light, airy and comfortable. Surveys indicated that people thought the home was well presented and usually clean and fresh. Communal areas included two lounges and a kitchen with a dining room. A patio area overlooked the large garden, which people said they helped to take care of. The registered manager confirmed that the home had access to a maintenance person for day to day repairs and that a door had been repaired that day. At the time of our visit the home was clean and tidy. A cleaner had recently been employed to work part time in the home. A good standard of fixtures and fittings were provided in communal areas. People had decorated their rooms to reflect their interests and lifestyles. Inventories were not seen at this inspection. The laundry provided colour coded cleaning items and personal protective equipment. A hand wash sink did not have a supply of liquid soap or paper towels. Other communal hand wash sinks were supplied with liquid soap and paper towels. Bath and shower rooms were of a good standard and clean at the time of our visit. Hand sanitizers had been provided around the home. 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. Peoples needs are met by a competent staff team who has access to a comprehensive training programme that provides staff with the opportunity to gain knowledge about the diverse needs of people living at the home. Robust recruitment and selection procedures should protect people from possible harm. Evidence: The registered manager said that there were no staff vacancies at the home. The staff team had worked together for some time and their surveys indicated they worked well together and that communication between the team was good. Feedback from health professionals said the team was positive and stable and people living in the home said, the staff are good at looking after us. New staff would have access to a comprehensive induction programme for the first six weeks of employment. This was equivalent to the Skills for Care Induction programme. This included mandatory training and training in CALM. The DataSet indicated that 66 per cent of staff had a National Vocational Qualification in Health and Social Care. The registered manager confirmed that a programme was in place and staff had been registered to start their NVQ awards. Novalis Trust had become an accredited Centre for the delivery of NVQ Awards. Recruitment and selection files for staff employed by Novalis Trust had been inspected during July at the inspection of Paradise House. Robust systems were seen to be in place and new staff would not be appointed until all information required by us was obtained and verified including satisfactory references and a Criminal Records Bureau check. There was no evidence that people living in the home were or would be involved in the recruitment and selection of staff. Evidence: Staff confirmed they had access to regular training and that they had recently completed mandatory training and further training was scheduled for the autumn. A Regulation 26 report indicated that staff needed to access training. The registered manager confirmed this was being done. They also have the opportunity to attend training in Autistic Spectrum Disorder and courses in why do they behave the way they do and responding to people in distress. All courses were relevant to the people they support. Equality and Cultural Diversity training was being provided by Novalis Trust. The training department at head office maintains a training matrix and individual training records for staff. The registered manager had a copy of training needs for staff at the home. 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. People living at the home benefit from a manager who is providing clear direction and leadership. The Quality Assurance system is developing and includes feedback from people living in the home and other people involved in their lives. Systems are in place to maintain and monitor the health, safety and welfare of people. Evidence: The registered manager has considerable experience supporting people with a learning disability. She has a Level 3 NVQ in Health and Social Care and is completing a Degree in Social Work. She is registering for the Leadership and Management Award. She had comprehensively completed the AQAA and returned it to us by the deadline. A valid, employers liability insurance certificate was displayed in the home. The new registration certificate was being put into a frame at the time of our visit and the registered manager said this would be displayed in the hall. Evidence: Management had received training in the Mental Capacity Act and Deprivation of Liberty Safeguards and said this training would be cascaded to staff. As mentioned there was evidence that IMCAs or advocates were being involved with people where appropriate and the necessary assessments and records were being completed by the home. No one in the home was subject to a Deprivation of Liberty Safeguard at the time of the inspection. A quality assurance manager had been appointed and was conducting unannounced visits to the home with an external auditor as part of the Regulation 26 visits. Copies of reports were examined and confirmed that people living in the home were part of this process. The quality assurance system was being developed and included surveys of people and other people involved in their care, health and safety and financial audits. The registered manager said that this information was in the process of being collated. A report needs to be produced which is accessible to people living in the home. A health and safety manager oversees the systems in place at the home. A current fire risk assessment was in place for the home. Fire drills and checks on fire equipment were taking place. Staff were monitoring and recording temperatures for cooked food, fridges and freezers. Food probes were being cleaned with wipes after each use. Items in fridges were labeled with date of opening or production. Water temperatures were being taken and recorded and water tested every three months by an external contractor. This was being completed on the day of our visit. Monthly health and safety checks were being completed. The AQAA indicated that servicing and testing of equipment and utilities was taking place and sampling of records in the home verified this. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 39 24 The registered person must 31/12/2009 make sure that as part of the quality assurance system a report is produced to give feedback to people living in the home. This is to demonstrate continual improvement and development of the service. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 4 5 20 20 30 34 35 The temperature of the medication cabinet should be monitored and recorded daily. An up to date version of the British National Formula should be in place. Consider supplying liquid soap and paper towels to the hand wash basin/sluice in the laundry. People living in the home should be involved in the recruitment and selection process. Staff should maintain their knowledge and skills in areas specific to people living in the home, such as Autistic Spectrum Disorder. Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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