Care Home: Misty Falls

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What the care home does well The registered provider maintains a very well run home that is centred on the two residents accommodated. Both residents have lived with the family for many years and they said they are very happy in the home. The home is well maintained, warm, clean and comfortable. The residents have some facilities that are separate to the family so they can have privacy. The residents are encouraged to be as independent as possible and live their lives as they choose. Any risk elements are assessed and documented. Both residents are independent and go out into the community to work and to socialise. They have an annual holiday and visit their family when they wish. Friends and family are also very welcome to visit the home and the residents can contact them by telephone. Each resident has an individual care plan that is reviewed every six months with the resident and a social worker then the family are given a copy to review. The plans are signed by the resident, their representative and a social worker. Relevant risk assessments are included with the care plan and reviewed regularly. A healthy diet is encouraged and residents have plenty of choice in what they eat. As they also eat at work or at clubs and this is taken into consideration when preparing meals in the home. Fresh vegetables and fruit are provided daily. Residents require minimal support with personal care and this is documented. The registered provider is the main carer supported by a part time care assistant / housekeeper. A second care assistant is in the process of being employed. The healthcare needs of the residents are well met and they have access to a doctor and other health professionals as required. Both residents spoke highly of the registered provider and said they are well looked after by the kind and caring staff. There have been no complaints made to the home or the Commission and staff have received training regarding the protection of vulnerable adults. The residents have information on how to complain and people they can contact if they need to. Residents house meetings are held regularly and staff attend sometimes. Quality assurance questionnaires are completed with the residents annually and these have been positive. The residents are actively encouraged to air their views at all times and they both spoke very openly about the home and the way they live. What has improved since the last inspection? The registered provider has addressed some issues relating to ageing and death and wills have been drawn up. A new medication cabinet and a key safe have been purchased and the registered provider has updated on the Safe Handling of Medication training. The outside patio area and the back porch have been upgraded; double glazed windows and door have been installed. The back porch and downstairs toilet floor have been re-tiled. A woodworm treatment has been undertaken in the roof space and garage. There are plans to replace the patio doors in the resident`s lounge/diner. The registered provider has registered with The Data Protection Service. The filing system is more organised. What the care home could do better: The statement of purpose is under review and a few additions were discussed. Ensure the care plans are detailed to fully inform new members of staff on the individual care needs. Improve the daily records to ensure they are informative to staff and include social and emotional issues. Key inspection report Care homes for adults (18-65 years) Name: Address: Misty Falls 22 Pendarves Road Penzance Cornwall TR18 2AJ     The quality rating for this care home is:   three star excellent 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: Diana Penrose     Date: 2 2 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 28 Information about the care home Name of care home: Address: Misty Falls 22 Pendarves Road Penzance Cornwall TR18 2AJ 01736360042 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): maxine64@talktalk.net Mrs Shirley Maxine Hoblyn Name of registered manager (if applicable) Type of registration: Number of places registered: care home 2 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The Home may accommodate the present two named service users beyond the age of 65 years. Date of last inspection Brief description of the care home Misty Falls, 22 Pendarves Road, Penzance, is a small care home providing accommodation and personal care for up to two adults with a learning disability. The Registered provider lives on site with her family and provides all the necessary care and support to residents with the assistance of two part-time assistants. The home is situated in Penzance within easy reach of transport routes, shops and local community facilities. Accommodation is provided in a mid-terrace, two storey house that is spacious, well decorated and domestic in character. Residents have their own bedrooms and share a bathroom on the first floor. They have the exclusive use of a lounge/ dining room downstairs, are able to access the large, well-equipped kitchen and have use of a well-maintained rear garden. The home is clean, tidy, well Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 2 Brief description of the care home furbished and maintained throughout. The residents currently living in the home go to work and attend weekday activities. The residents are given ample opportunities for socialising and visitors are openly encouraged. Information about the home is available in the form of a statement of purpose / residents guide, which can be supplied to enquirers on request. A copy of the most recent inspection report is available in the home. Fees are 346.13 pounds per week; this information was supplied to the Commission during the inspection. Residents pay for any private healthcare provision, hairdressing or personal items such as confectionary and toiletries. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent 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: An Inspector visited Misty Falls Care Home on the 22 April 2010 and spent four hours at the home. This was a key inspection and an unannounced visit. The purpose of the inspection was to ensure that residents needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus was on ensuring that residents placements in the home result in good outcomes for them. All of the key standards were inspected. On the day of inspection two residents were living in the home. The methods used to undertake the inspection were to meet with both residents and the registered provider to gain their views on the services offered by the home. Records, policies and procedures were examined and the inspector toured the building. This report summarises the findings of this inspection. People using the service are part of the family home, they are very independent and Care Homes for Adults (18-65 years) Page 6 of 28 they expressed a very high satisfaction with the care and services provided in the home. Care Homes for Adults (18-65 years) Page 7 of 28 What the care home does well: What has improved since the last inspection? The registered provider has addressed some issues relating to ageing and death and wills have been drawn up. A new medication cabinet and a key safe have been purchased and the registered provider has updated on the Safe Handling of Medication training. The outside patio area and the back porch have been upgraded; double glazed windows and door have been installed. The back porch and downstairs toilet floor have been re-tiled. A woodworm treatment has been undertaken in the roof space and Care Homes for Adults (18-65 years) Page 8 of 28 garage. There are plans to replace the patio doors in the residents lounge/diner. The registered provider has registered with The Data Protection Service. The filing system is more organised. 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 9 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a suitable statement of purpose that allows prospective service users to make an informed choice about the home. We have been assured that new residents will only be admitted to the home following an assessment of their needs to ensure the home can meet their needs. Evidence: We looked at the statement of purpose which was suitable but some minor adjustments were discussed with the registered provider who has told us she is reviewing the document. There have been no new admissions to the home for ten years. The registered provider said she would not accept anyone without a full assessment from the department of adult social care and support. She would also invite the prospective resident for a meal and then to stay overnight or for a weekend so that she could do her own assessment. We saw that both of the residents assessments had been recently reviewed. Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: We saw that each resident had a contract originally provided by social services, these were dated 2002. We were told that the provider had checked and these are open ended. We were shown annual financial schedule received for each resident. The homes terms and conditions of residency are included in the residents guide. Care Homes for Adults (18-65 years) Page 12 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual care plans are generated for each resident they are informative as to their needs and are reviewed regularly with the resident, family and social worker. Residents make decisions about their lives, risks are assessed and appropriate support is given enabling residents to lead a very independent lifestyle. Evidence: We were shown the care plans for both residents; these had been drawn up by the registered provider and a social worker. We were told that a copy was sent to the family representative for approval and we saw that all parties had signed the document. We saw that the care plans were reviewed every six months and were now due for a review. The provider is the main carer and she told us that personal care is rarely provided. We discussed the content of the care plans with the provider as they lacked detail to fully inform staff in some areas, for example how often baths are taken and how often residents change their bed linen. She agreed to improve the plans with the next review. Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: Relevant risk assessments were seen and had been reviewed. Daily records were seen in separate diaries for each resident, these need to be more informative on the care provision and social and emotional issues. The possibility of one resident writing a diary himself was discussed. We were told that residents were assisted to make decisions about their lives and the residents told us this was true. They both told us they do as they wish but they tell the provider when they are going out and where they are going. Both residents said they go to work. We saw the activity records which showed that one resident goes out and attends clubs and so on, moreso than the other resident. When we spoke to the residents they told us this was their choice. One resident went out on his own during this inspection and the other returned from work on his own. We were told that residents were encouraged to manage their own finances within their capabilities. Both residents showed the inspector how they managed their money and the records that were maintained. Both had bank accounts and lockable storage space in their rooms. The registered provider was appointee for one resident and we saw that she maintained suitable accounts. We saw the minutes of house meetings which take place every two months. They were very informative and showed that residents were enabled to make decisions; there was also evidence in the daily records. Both residents said there was a choice of food and the routines of daily living, such as getting up and going to bed, were flexible. We saw very good written risk assessments with the care plans that showed residents were encouraged to take responsible risks. The registered provider explained that issues involving a higher risk were regularly discussed with the residents, their representatives and maybe external professionals - examples were given. We saw a written procedure in respect of the action to be taken should a resident going missing from the home. Care Homes for Adults (18-65 years) Page 14 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents take part in appropriate activities and socialise in the local community, they are assisted with training and education to encourage their independence and individuality if they wish. Residents participate with household tasks according to their individual risk assessments, their rights and individual choices and preferences are respected. Dietary needs are well catered for with a varied selection of food available to meet their taste and preference. Evidence: Both residents told us they were in their late sixties but they both go out to work. They said they were actively involved in a range of activities in the community and attended various clubs. One resident told us about his church activities and the people he meets there. He also talked about the general election and that he was going out to vote. Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: The provider said the residents could undertake training as they wished; some training was provided at work placements. Both residents attended day centres and progress reports were issued and kept on file. Information on activities, advocacy, holiday options and local facilities was seen. The records showed that one resident still goes to organised cycling sessions and has shown an interest in other activities. The provider told us that both residents go on an organised annual holiday. This year they were also going on a weekend break to the Isles of Scilly and they spoke about this. Residents spoke about their families and friends and that they see them and go to visit when they like. We saw photographs of family and friends in residents rooms, one resident explained to the inspector who the people were in one photograph. The provider said that both residents had regular contact with their families by visits or telephone. We saw a record of visitors to the home. The registered provider said that both residents were independent, they assisted in the household tasks and they went into town and out walking at the weekends, for example. The residents said they take turns at washing and drying the dishes. The daily routines and house rules were seen with the care plans. Both residents said they had front door keys and are able to enter and leave the home as they wish. They said they did not need a key to their room. One resident told us he gets his own mail that he opens it himself. Both residents were addressed by their preferred names. They were provided with ample information on local resources in a box file in their dining / sitting room and on a notice-board in the kitchen. The provider said she supplied transport when required but they also used public transport. Arrangements for residents to be accompanied on activities outside of the home were available, where necessary. Both residents told us they enjoyed the food provided in the home and that they had meals at work or eat out sometimes. We saw food records kept in the daily records. Residents told us they could choose what they eat and there is always enough. We saw that a casserole was being cooked for their evening meal. A large bowl of fruit was available in the kitchen. The provider said the menu was very flexible and a special meal was provided for birthdays; friends were invited if the residents wished. Care Homes for Adults (18-65 years) Page 16 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal support is given according to peoples needs, residents have access to health care services as necessary and there is a suitable system and policy in place for dealing with residents medicines that assures their safety. Evidence: The registered provider said she ensured that appropriate support, care and encouragement were provided. Both residents said they were happy with the care provided and that their privacy was respected. They spoke highly of the staff and said they do not need any assistance. The arrangements for the provision of personal and healthcare support were stated in the homes statement of purpose and were detailed in residents care plans. We were told that both residents were registered with a GP and specialist health care workers were consulted when necessary, for example the epilepsy nurse, dentists and opticians. A healthy diet was provided and residents weight was seen recorded in their diaries each month The provider explained the medicines system. We saw that medicines were stored Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: securely in a locked cabinet. A monitored dose system was in use and appropriate administration and disposal records were maintained. Patient information leaflets were seen. The records showed that the provider and her staff had undertaken appropriate medications training. The medicines policy was seen, it was brief but referred to the guidelines provided by the Royal Pharmaceutical Society. The provider told us she has requested an updated copy of the guidelines. Care Homes for Adults (18-65 years) Page 18 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has suitable complaints and adult protection policies and staff have attended suitable training in respect of adult protection to ensure that people using the service are safeguarded. Evidence: We were shown a suitable complaints procedure that was available to residents and their relatives. The residents were relaxed in the home and aired their views openly to the inspector. There have been no complaints to the home or the Commission. We saw a written adult protection policy that was short but referred to the local authority guidelines which were held in the home. We saw a leaflet that had easy read guidelines for the residents. Various other leaflets on abuse were seen and the provider told us she had a training video. The records show that the provider and staff had attended the No Secrets training. A whistle blowing policy was seen. The AQAA told us that both residents had made wills with the assistance of family, advocates and solicitors as appropriate. There was a safe system for the management of residents money. Records were maintained of each transaction and receipts for expenditure were kept. The registered provider was appointee for one resident. Each resident had a lockable cash tin for the storage of money. Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and free from offensive odours, it is well maintained providing a safe and pleasant environment for residents, staff and visitors. Evidence: There had been no changes to the layout of the home since the last inspection. We observed that the home provided a comfortable, homely environment that was clean and tidy with no offensive odours. The grounds were tidy and attractive and they were accessible to the present residents. The home was not accessible to wheel chair users. The outside patio area had been improved since the last inspection. One resident told us he helped with the gardening. There was suitable heating, lighting and ventilation. The home was well maintained and there was a programme for re-decoration and refurbishment. The AQAA told us and we saw that the back porch had been upgraded with double glazed windows and a new door fitted. The back porch and the downstairs toilet floors had been retiled. The roof space and the garage had been treated for woodworm. The provider said they have plans to replace the patio doors in the residents lounge/diner. One resident showed us his room that had been refurbished with new furniture purchased. The laundry facilities were adequate for the size of the home and were situated in an outside building at the back of the home. The room included a games area with a pool Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: table and darts. Protective clothing was provided for staff for infection control purposes. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by caring staff who receive relevant training to maintain their skills, recruitment procedures are robust and offer protection to the residents. Evidence: The residents live as part of the family with the registered provider as the main carer. The AQAA told us that two care staff had been employed at different times, and both had left since the last key inspection. The provider told us that a part time housekeeper/carer (4 hours per week) has been employed for fifteen years and a new carer was in the process of being employed. Their roles were mainly house sitting and supervision of residents. The registered provider said the new carer was doing a diploma in health and Social Care. We examined the file for the new member of staff in detail and the documents required by legislation were held. Job descriptions were seen along with a list of typical duties to be undertaken on a shift. We saw that terms and conditions of employment were issued and that 6 monthly appraisals took place. We also saw a copy of the general Social Care council code of conduct in a staff file. The provider had reviewed and expanded the recruitment policy, which was satisfactory. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: Both residents said they got on well with all of the staff, they said they were kind and looked after them well. One resident told us that photographs of the staff were on the board and we saw them. The residents said they were very independent and required very minimal personal assistance. There was an induction programme tailored to the skills for care standards. We saw records of training undertaken and certificates of attendance. One member of staff had done person centred care and first aid training in the past year and was going to do equality and diversity training. The new carer was booked onto an epilepsy course and induction training in respect of working with people with a learning disability. Statutory training was up to date. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is very competent and knows the residents well, they benefit from a home that is run in their best interest with quality assurance systems in place for improvement. Appropriate service checks are undertaken to ensure the health, safety and welfare of residents, staff and visitors to the home. Evidence: The registered provider has shown she is competent and experienced to run the home. She has achieved the Registered Managers Award and said she told us she keeps up to date by attending relevant study days and reading care publications. She told us she had updated her training in, first aid, safe handling of medication and Health and Safety. She had also undertaken, person centred planning, Mental Capacity Act and Deprivation of Liberties trainaing. She had done equality and diversity training, via an e-learning package. She said she plans to complete Infection control and manual handling training in the coming year. We saw that the registered provider had a very good rapport with the residents and they interacted very well with her. Both residents told us that they were really happy Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: in the home and that the registered provider looked after them very well. Suitable quality monitoring systems were seen and the homes survey results were positive, as were those received by the Commission. The Commission received the following comments from staff and external professionals, Misty Falls is a small care home with two male clients - being so small it is just like a family home and the clients are treated as such, the clients have plenty of freedom of choice to do what they want to do as far as their disability allows, The client we support from Misty Falls is very settled and happy. He has a good relationship with the owner. No outstanding issues with us, Service users from Misty Falls are always well presented, polite and happy where they live and We have 6 monthly reviews to update any needs, medication changes. risk assessments etc. We were told that the provider had regular contact with relatives and their comments were welcomed. We saw the minutes of house meetings, that were attended by residents and staff, sometimes. The provider told us that the handover period was extended if there were issues to discuss. We were told that supervision was informal and that appraisals took place every six months. We saw the environmental risk assessments for the home. Statutory training for staff was up to date and included food hygiene and first aid. We saw that fire drills took place every six months and that residents were aware of the fire procedure. We saw that hazardous substances were stored safely and data sheets were available for staff to refer to. We saw the certificates for servicing and maintenance of equipment and these were up to date. The provider told us she was now data protection registered. Accidents were few and were recorded appropriately. The provider was reminded that admissions to hospital including accident and emergency need to be reported to CQC. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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