Care Home: Nicholas House

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What the care home does well This small home provides a very individualized caring service for its residents in a homely and safe environment. There is a stable experienced and very well motiviated staff team who interact well with the people who use the service. The staff are able to offer continuity of care to the people who use the service. The standard of care provided for the people who use the service is good, the staff team interact well with them and the staff are supported with a good standard of training and management. All the staff are enthusiastic about their work and committed to the welfare of the people who live in the home. The manager leads by example in making sure that each person is able to express their own needs and wishes. What has improved since the last inspection? Since the last inspection the home has concentrated on improving the care plans into a person centered format so that the care provided meets the specific assessed needs of each individual in a person centered way. The home has benefitted from various works of refurbishment and new equipment and the environment is well maintained and meets the needs of it residents providing a homely environment. The requirements made at the last inspection have been met. What the care home could do better: The key standards were found to be met at this inspection. The manager knows where further improvements can to be made to the service and has realistic plans as to how such improvements can be achieved. Key inspection report Care homes for adults (18-65 years) Name: Address: Nicholas House Cairns Close St Albans Hertfordshire AL4 0EY     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: Jan Sheppard     Date: 0 8 1 2 2 0 0 9 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 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Nicholas House Cairns Close St Albans Hertfordshire AL4 0EY 01727839909 01727858742 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.dimensions-uk.org Dimensions (ADP) Limited care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Nicholas House, provided by PentaHact, is a residential care home for six younger adults with autism, severe learning disabilities and challenging behaviour. It is situated in a residential area, about two miles away from the town of St Albans. There are ample parking facilities nearby. It has been completely renovated internally to accommodate the assessed needs of the residents. There are six bedrooms. There is a large garden to the back of the building. It has a summerhouse, garden swings and garden furniture. The garden overlooks Highfield Park. The Statement of Purpose, Service User Guide and previous CSCI inspection reports should be available within the mangers office at Nicholas House. 0 6 0 2 2 0 0 9 7 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 27 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 last inspection of this service was made on 27/2/2007. This unannounced inspection took place over six hours on a weekday. This was a key inspection that focused on the key standards of the Care Standards Act 2000 relating to Adults. The report is written using accumulated evidence gathered prior to the inspection including information contained in the AQAA ( Annual Quality Assurance Assessment) completed by the Manager, information given in any pre-inspection questionnaires and also takes account of statutory notifications sent periodically to the CQC by the home. During the visit we made a tour of the building, had in depth discussions with the homes manager and were able to speak with the staff who were on duty. We also met and spoke with the service users as they returned to the home from their day activities.Staff helped us to communicate with the service users who did not have full speech. Spot checks were made on a number of the homes records and care plans. Care Homes for Adults (18-65 years) Page 5 of 27 Care Homes for Adults (18-65 years) Page 6 of 27 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 27 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 27 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 who use this service can expect to have an assessment of their needs prior to entering the home and to have an opportunity to visit and assess the services offered for themselves. They will also have access to sufficient information about the home to help them make an informed choice. Evidence: From the three care plans examined it could be evidenced that an initial assessment of the applicants care needs had been made before they entered the home and that this assessment had followed the homes admissions policy and procedures and was recorded with good detail. The resident group is very stable at Nicholas House and there have been no new admissions to the home for several years. However the records relating to the last new admission to the home were examined and these showed that a senior staff member went to visit the applicant in the Midlands where they were then living and that this visit took place over two days so that their needs could be fully assessed and to give the them time to get to know the staff member. They and their family were then invited to visit the home to view the accommodation Care Homes for Adults (18-65 years) Page 9 of 27 Evidence: and to meet the other residents and in total three visits were made before a decision about admission was made. The Manager reported that this resident did settle very happily into the home and this was confirmed by the discussions we had with them during this visit. Since the last inspection the homes Service Users Guide and Statement of Purpose have been updated and both are available in a visual easy read format. The Manager is aware of the need to include information concerning the Mental Capacity of any new applicant in any future initial needs assessment. Care Homes for Adults (18-65 years) Page 10 of 27 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. Each resident can be assured that they will have a written care plan which details for staff the care required and how to meet any individual needs in a person centred way. Evidence: Three care plans were inspected and were found to provide a good insight into each individuals needs.The plans were found to have up to date detailed recording and were generally signed and dated.Since the last inspection all the residents written care plans have been reviewed and recorded into a new person centered plan format.Individual sections of the plan were found to be clearly defined this to enable staff to easily access and understand the information that they require to enable them to offer appropriate care for each service user. Everyone living at Nicholas House is supported within the whole life review framework and regular reviews are held to ensure that changing needs are continuously assessed and reviewed. Risk assessments with actions points were seen to be regularly completed and recorded. People living at Nicholas House are supported to take risks as part of living an Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: independent life style with comments such as Allow X to do this for themselves as far as it is safely possible seen to be recorded to guide staff. The plans contained evidence to confirm that residents have been involved in their care planning with where possible signatures from either them or their family/representatives obtained. Reassessments of risks were seen to also involve the resident and their family. All the people spoken with during this visit seemed very positive about their life at Nicholas House and happy with the care that they received. One person told us I like living here we have lots to do and another said Its good and smiled happily at the member of staff who was accompanying them. The home works closely with the Community learning disabilities team based in St. Albans which provides specialist health care support. Care Homes for Adults (18-65 years) Page 12 of 27 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. People who use this service can expect that their rights will be respected that they will be given choices and will be encouraged to lead an independent lifestyle. They are able to participate in a range of activities based on their individual needs and choices and they will be supported appropriately by staff to use local community facilities. A healthy varied diet of freshly prepared food is provided in a manner which meets their varied needs. Evidence: The staff support and encourage the people who live in the home to develop and maintain their independence. The care plans have a focus on maintaining each persons independence, see Individual Needs and Choices. All the residents have an individually planned activity programme to meet their chosen needs and interests. All Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: attend a day centre during weekdays and on the day of this inspection everyone was at day care except for one person who had remained at home prior to keeping a medical appointment and then went on to the centre later. On the day of our visit when the residents returned from their day care during the afternoon some chose to relax in their rooms and listen to music or watch television and others were in the lounge with a member of staff enjoying a sociable atmosphere. One person who was to take part in a Christmas Church Service was practising their speech with a member of staff.Another person told us of the visits they make to a nearby cinema and of the long walks that they enjoy taking with the staff. Every resident has one day at home during the week when they enjoy one to one activities with the staff, such as going for a walk, going shopping or having lunch out.They also tidy their rooms and do their own laundry with support from the staff. All the service users have regular family contact and several are able to make regular visits to their family home. For one service user a staff member will accompany them to offer them the care that they need during that time and to enable their parents to spend relaxed quality time with them. The home maintains regular contact with all relatives and invits them to meetings and social events in the home. The provider also holds regular forum meetings which give parents and friends good opportunities for discussion and consultation.The cultural and religious needs of the people living in the home are recognised and met, including attending church for those who wish to. The menu is drawn up every four weeks with the involvement of the people in the home and there is a choice of meals each mealtime.Nutritional needs are adhered to and all meals are home cooked and fresh. The manager explained that people are encouraged to try out new dishes and notes are made of their individual likes and dislikes, some people have even decided that they like vegetarian dishes and all now follow a healthy eating diet plan. The special nutritional needs of under weight and over weight have been accommodated and one service user following a reducing diet has been very successful. Several people told us about the take-out meal that they enjoy at the weekends. All the service users were able to take a holiday last summer when visits were made to Disneyland Paris and to Devon and Cornwall. For one service user whose parent wishes to take them further afield involving a long flight,to visit other family members ,the home are helping them prepare for this by taking them on a number of short flights first. Service users we met during this visit spoke with us about their plans for christmas the craft activities that they had been doing and the party that they had planned. Care Homes for Adults (18-65 years) Page 14 of 27 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. The health and personal care that people receive is based on their individual needs and they are treated with respect and dignity with good consideration given to their individual choices and preferences. The home is proactive in addressing any health needs and there is an experienced and enthusiastic team of staff who have the training and skills to provide good quality of care for the people who live in the house. Evidence: The requirements made following the last inspection concerning the medication storage and administration arrangements have been met and the home now has sound systems in place to manage peoples medication safely. The home uses the MDS ( monitored dosage system) for medication and this is supplied from a local pharmacy who carry out an annual pharmacy check this last being done in November 2009 and found to be satisfactory. The medication cupboard is located in a corner of the main office and regular temperature checks recorded evidenced that even in hot weather the temperature had not exceeded 22 degrees. We discussed with the Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: manager her plans to relocate this cupboard to another more spacious area in the home where the controlled drugs cupboard and small medication fridge could all be located together.The MAR sheets for the Medication Administration Records were seen to be well recorded with no omissions and evidence of regular management reviews of the accuracy of these records could be seen. A record of the audit of the medication received into and disposed out of the home is also kept.The records of the medication administered were clear and complete with appropriate identification codes and written explanations of variations fully recorded on the reverse of the sheet. At the time of this inspection no Controlled drugs were being administered in the home. All staff who administer medication have been trained to do this and staff spoken with said that they felt well supported with this task.The home has a policy and procedures for when medication is taken away by relatives when residents are visiting them and staying at their homes.Parents and friends are asked to complete a short Home Visit report to that staff can be fully informed of the residents welfare when the are staying away from the service. Health records evidenced that the home maintains good contact with visiting health professionals doctors dentists opticians etc.and records of any visits the care given and actions planned were found to be well recorded. The care plans seen all contained a good level of detail about the actions required by staff to support the service users with their health and personal care needs. A section entitled My Health Action Plan was seen to contain good detail to have been compiled with the assistance of the service user themselves and in some cases to be partially presented in a pictorial format which could be more easily understood by them. Weights were seen to be regularly recorded and a section called How I made my Choices gave good evidence to the fact that service users are encouraged to make their wishes and requests known and how their rights and dignity are respected. Care Homes for Adults (18-65 years) Page 16 of 27 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 who use this service are able to express their concerns, have access to an effective complaints procedure and they are protected from abuse. Evidence: The home has a clear Complaints Policy and Procedures which are also available in easy read format. A copy of the document Making a Complaint and Speaking Out has been given to all the residents and to their relatives and a copy was seen in their individual care plans. The Manager explained that any complaint was acknowledged with a written reply stating what action would be taken and the date that this would be done by. She also explained that the home kept a Grumbles book where small issues were noted and treated in the same manner. Parents are given a Contact Sheet where they can record any comments positive or otherwise about the home and the services that their relative is receiving. There have been no formal complaints made since the last inspection. Since the last inspection refresher training has been attended by the staff on the protection of adults and the homes training records evidenced that training covering this subject is ongoing. Staff spoken with showed a good awareness of their roles and responsibilities in protecting the very vulnerable service users and of the diligence needed when working with service users who cannot speak for themselves. Staff spoken with also demonstrated their good understanding of whistle blowing Care Homes for Adults (18-65 years) Page 17 of 27 Evidence: procedures. There have been no incidents concerning adult protection since the last inspection. The Manager has recently attended traning concerning the Mental Capacity Act and agreed that it would be beneficial for all staff to undertake such training this to ensure the full protection of all the service users. Care Homes for Adults (18-65 years) Page 18 of 27 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 physical design and layout of the home enables people who use the service to live in a safe, well maintained and comfortable environment, which encourages their independence. Evidence: Since the last inspection routine works of maintenance and improvement to the home have been carried out and on the day of this unannounced inspection Nicholas House was found to be clean and tidy with a well kept appearance and a homely feel to it. The decorations throughout the home were seen to be bright and cheerful and staff told us that service users participated in the choice of colours and furnishings when ever these were renewed.The communal areas are of a good size and are comfortably furnished with sofas and bean bags offering good lounge accommodation in which it was seen the residents relaxed and the home has an attractive dining room an area which was also seen to be used for craft activities. Each resident has a good sized single bedroom and all were found to be very well personalised with furnishings and colours to suit each individual taste.Staff explained that some families helped with the development of their relatives bedroom. Since the last inspection the bath and shower rooms have been refurbished and now provide an inviting place in which to take a bath. Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: The home has a very well equipped snoozelem and a large exercise room these areas are on the ground floor and lead onto the enclosed garden. This has a patch for vegetable growing, flower boarders and a large lawn with patio area where bar be ques and other summer activities are held. A selection of garden furniture was seen to be stored in the summer house. Staff said that the garden area was being increasingly well used by the residents many of whom had enjoyed growing vegetables last summer.An area designated to recycling had also been established since the last inspection and service users are being encouraged to learn about the benefits of this activity. The homes kitchen is well appointed and has had new fittings which were seen to be maintained in good condition and were sufficient to meet the needs of the residents. The Laundry is of a good size and the layout and instructions evidenced that service users are encouraged to do as much laundry for themselves as is safe for them to so do.Evidence of infection control procedures could also be seen. The whole environment was found to be very clean and staff told us that the routine weekly cleaning carried out by the residents and staff is supplemented by the twice yearly spring clean undertaken by outside professionals part of which was being carried out on the day of this visit. Care Homes for Adults (18-65 years) Page 20 of 27 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. People who use this service are supported by well trained and supported staff. They can be confident that they will be safeguarded by the robust recruitment policies and procedures in place. Evidence: During this unannounced visit it was seen that there were sufficient staff on duty to meet the needs of the service users in an individual manner and that the number of staff working tallied with the planned staff rota. The home has vertual full staffing and the manager said that they are fortunate in being able to retain a stable staff group who know the residents and understand their needs very well.Three or four staff are on duty in the mornings and five each evening. At night there are one waking and another sleeping staff member. Periodic unannounced spot checks on the night staffs performance are made by the provider company managers and one such check had been made during the night prior to this inspection and this was reported to have been a successful check visit. The manager explained that the home did not have to use agency staff as the company had its own team of bank workers two of which had particular knowledge of this home and of the residents needs. Staffing levels at the weekends vary and are planned to meet the particular needs of each weekend as many of the service users go away to stay with their families at the weekends. Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: The recruitment records for new staff that were examined were found to contain all the required checks and references which should give the proper protection to the service users. The home now has over 70 of its staff holding professional NVQ qualifications and in addition two trained nurses also work as support workers in the home.The home as a good ratio of male to female staff in preportion to the mix of the service users and enabling there to always be male and female staff on duty. Staff spoken with all confirmed that they got very good training opportunities and the manager maintains a training needs profile for each individual and for the home as a whole. Staff routinely undertake training in Autism,Maketon, and Symbols and Skip this to enable them to meet the particular needs of their residents. Care Homes for Adults (18-65 years) Page 22 of 27 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 using this service receive a well managed service. Standards of administration and management are well maintained for the benefit of the people who use the service. Evidence: The manager has the required qualification, (NVQ level 4 Registered Managers Award), and experience and is competent to run the home.Prior to taking up this post she had worked at the home for several years and so knows the service users and their families very well. Since taking up the managers post she has undertaken training in the Mental Capacity Act and training relating to the management of staff disciplinary issues.She told us that she regularly meets with other home managers and participates in the companys In-Service Managers training programme. The Manager has a clear understanding of the key principles and focus of the service at Nicholas House and an open door approach to the management of the service. Her aim is to continually improve the quality of life for the service users and to enable them to maintain their independence and this has become part of the homes ethos Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: and is embraced by all the staff. She has a calm and open management style and supports her staff to develop themselves.She told us that to enable her to keep a clear understanding of how the home is operating she regularly undertakes a night duty and also works a day support worker shift each month.She said that she feels well supported by the company and the records of the monthly regulation 26 visits they make to the home provided evidence of this.In a recent Health and Safety Audit undertaken by the company the home achieved 96 . Quality Monitoring is also undertaken by the company who seek the views of service users and relatives and arrange forums to meet with them for discussion. The home gives good priority to promoting the health safety and welfare of the service users and staff through the regular maintenance of safety checks, training and record keeping. Health and safety checks are regularly undertaken and records relating to fire testing the monitoring of water temperatures, servicing and safety checks of the homes equipment were found to be well maintained. The home has a contingency evacuation plan and recently improved its Fire Evacuation Pack which now includes fire blankets,torches ,extra keys and a First Aid Kit. Risk assessments for the environment were seen to be compiled and periodically updated. The home has policies and procedures to ensure the protection of the service users finances and three spot checks made on finances held found that the amounts and the records and receipts kept did all tally.Since the last inspection the home as been subject to an external Audit from the local authority Commissioning team who fund several of the service users. The homes records evidenced that all staff have regular supervision and an annual appraisal. Staff reported to us that they were well supported by the manager and that being quite a small home there was always someont to consult with if ever they were in any doubt. During our visit it was seen that the staff team worked well together sharing the duties so as best to meet the changing needs and requests from the service users. The home has appropriate systems in place to enable good communication between the various staff something that the manager recognised as being very important to ensure the smooth running of the service. Regular staff meetings are planned ahead and were seen to be well recorded and to have good staff involvement. The home gives good priority to promoting the health safety and welfare of the service users and staff through the regular maintenance of safety checks, training and record keeping and those examined during this visit were found to be well maintained. Care Homes for Adults (18-65 years) Page 24 of 27 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 25 of 27 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 1 23 It is recommended that to ensure the full protection of the service users that all staff complete training on the implications of the Mental Capacity Act. Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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