Care Home: Nortonbrook

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What the care home does well One person who lives in the home we spoke with said they are happy living at the home; staff listen to them and act on what they say. Staff were seen to support people who live in the home is a confident and respectful way. The health and social care professionals who wrote to us said the home supports people to live the life they choose; they feel staff have the right skills and experience to support the people who live in the home. Nortonbrook provides a specialist service for adults with autism. The home ensures that people are supported to live a fulfilling life in the community. The home has a stable staff team who have been appropriately trained and remain well supported. People are supported to access a range of leisure and social activities both within the home and out in the community. The home provides transport to enable people to access community facilities. Nortonbrook provides a homely, comfortable and safe environment for people to live in. People have their own bedroom, which have en-suite facilities; they are encouraged and supported to personalise their rooms. What has improved since the last inspection? The issues relating to temperatures of the bath and shower hot water outlets and the seal around one bath have been resolved. This helps to ensure people are provided with a safe and clean home to live in. What the care home could do better: The Registered Person must improve care plans which explain how staff are to support people who present behaviours which may be perceived as challenging the service. This would ensure staff respond to these in a planned, safe and effective way. The Registered Person must ensure that detailed risk assessments are in place for each person who may require restrictive physical interventions. This would promote the welfare and safety of these individuals.NortonbrookDS0000045740.V378840.R01.S.docVersion 5.3The Registered Person must ensure a manager successfully completes the registration process with us. This would ensure people who live in the home are provided with a safe and accountable service. The Registered Person should ensure that the record of each monthly auditing visit is kept in the home and made available for inspection. Key inspection report CARE HOME ADULTS 18-65 Nortonbrook 6 Kingdom Lane Norton Fitzwarren Taunton Somerset TA2 6QP Lead Inspector David Smith Key Unannounced Inspection 11th December 2009 11:00 Nortonbrook DS0000045740.V378840.R01.S.doc Version 5.3 Page 1 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. 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 home adults 18-65 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. Nortonbrook DS0000045740.V378840.R01.S.doc Version 5.3 Page 2 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 Nortonbrook DS0000045740.V378840.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Nortonbrook Address 6 Kingdom Lane Norton Fitzwarren Taunton Somerset TA2 6QP 01823 336687 01823 270384 steveg@autismsolutions.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Autism Solutions Limited Manager post vacant Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Nortonbrook DS0000045740.V378840.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is 3. Date of last inspection 11th December 2007 Brief Description of the Service: Nortonbrook is situated in village of Norton Fitzwarren, approximately three miles from the county town of Taunton. The home is a large detached property situated in a small cul-de-sac in a residential area; it was originally registered in July 2003 to provide short breaks for younger adults. It now provides longterm placements for up to three people who are within the Autistic Spectrum. The home is staffed 24 hours a day. Two staff support the people who live in the home; one member of staff sleeps in overnight. The accommodation comprises of a large lounge, conservatory, kitchen and dining room; bedrooms have en-suite facilities and are located on the first floor. There is a large enclosed garden to the rear of the property. Given the layout of the home, it would not be suitable for people with mobility problems. The Registered Provider is Autism Solutions Ltd and Mr Clothier is the responsible individual. There is currently no Registered Manager. Fees are determined on an individual basis and are dependant on each person’s assessed needs. Transport is provided to enable people to access the community. Nortonbrook DS0000045740.V378840.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The last Key Inspection of this service was on 11/12/07. This was an unannounced visit to the home to enable us to complete a Key Inspection of this service. We spent five hours in the home on the day of our visit. The inspection was carried out by one inspector, but the term we is used in this report. This is because the report, and the judgments within it, are on behalf of the Care Quality Commission. The pre-inspection planning involved reviewing the report of the last Key Inspection completed in December 2007 and the Annual Service Review carried out in December 2008. We also looked at the service history, which details all other contact we have had with, or about, the home. We provided the home with their Annual Quality Assurance Assessment (known as an AQAA). This is a self-assessment, which focuses on how well outcomes are being met for the people who live at Nortonbrook. The home sent us their AQAA when we asked for it; it was clear and gave us all the information we asked for. One person who lives in the home and two health and social care professionals completed a survey for us. Their views have been included in this report. We spoke privately with one person who lives in the home; they told us how they felt about living at Nortonbrook. The other person who lives here has communication difficulties; staff communicate with them using some speech but they also interpret body language and gestures, but this needs to be learned over time. It was therefore not possible for us to ask them about life in the home. We viewed all communal areas of the home and each of the bedrooms used by the people who live here. We gathered additional information for this report by looking at a number of records within the home such as people’s care plans, risk assessments, accident reports, medication storage and administration, staffing records and some health and safety procedures. Nortonbrook DS0000045740.V378840.R01.S.doc Version 5.3 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The Registered Person must improve care plans which explain how staff are to support people who present behaviours which may be perceived as challenging the service. This would ensure staff respond to these in a planned, safe and effective way. The Registered Person must ensure that detailed risk assessments are in place for each person who may require restrictive physical interventions. This would promote the welfare and safety of these individuals. Nortonbrook DS0000045740.V378840.R01.S.doc Version 5.3 Page 7 The Registered Person must ensure a manager successfully completes the registration process with us. This would ensure people who live in the home are provided with a safe and accountable service. The Registered Person should ensure that the record of each monthly auditing visit is kept in the home and made available for inspection. 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. Nortonbrook DS0000045740.V378840.R01.S.doc Version 5.3 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Nortonbrook DS0000045740.V378840.R01.S.doc Version 5.3 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are given the information they need about the home to enable them to make an informed choice about where to live; they have their needs assessed before they are given the opportunity to move in. EVIDENCE: There is sufficient information available about the care and support the home is able to offer; there is a Statement of Purpose which was last updated in August 2009. The one individual who wrote to us said they did have enough information to decide if this was the right home for them to live in and they were asked if they wished to move here. There have been no new admissions to the home in the last 12 months; there are no vacancies. However, if a vacancy were to arise, the home has a thorough assessment process which would show whether the home would be suitable for any person interested in living here. Nortonbrook DS0000045740.V378840.R01.S.doc Version 5.3 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual’s needs and goals are met and each person has a plan that they, and people close to them, have been involved in making. Each person is supported to make decisions about their lives and to take risks to enable them to live as independently as possible. EVIDENCE: We looked both people’s care records during our visit. Each has a detailed ‘life plan’ which describes the care and support they require and how staff should provide it; information is also included about their life history, who the important people in their life are, how they communicate, what daily routines they may have and what goals they may be working towards. Each individual and members of their family have helped to develop these plans and are involved in reviewing them. Nortonbrook DS0000045740.V378840.R01.S.doc Version 5.3 Page 11 Staff write daily records which give an overview of each person’s day; each person’s keyworker also writes a monthly report which covers a variety of topics such as the activities each person has taken part in, their health and their weight. Formal reviews are held each year. The records we looked at show that each person is supported to attend their review if they wish to do so, together with their relatives, staff from the home and a representative from their Funding Authority. All aspects of their care and support are discussed and reviewed; care plans are then updated and a copy sent to the Funding Authority. One person who lives in the home who wrote to us said staff ‘always’ treat them well and they ‘always’ listen to them and act on what they say. Interaction between staff and people who live in the home was observed informally during our visit. These show that staff have a good knowledge of each persons support needs and how to communicate with them effectively. Both the people who live here and staff appear relaxed in each others company and at no time did staff appear rushed or unable to give people their attention. The health and social care professionals who wrote to us said they feel people are supported to live the life they choose and that the home responds to the diverse needs of each individual. Care and support is provided within a risk assessment framework, to enable each person to be as independent as possible and to identify areas where the support of the staff is essential in keeping people safe. Each of the person centred risk assessments we looked at were detailed and have been regularly reviewed. Nortonbrook DS0000045740.V378840.R01.S.doc Version 5.3 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 11, 12, 13, 14, 15, 16 and 17. People using the 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 person is treated as an individual and has opportunities and appropriate support to develop and access leisure and educational facilities. Each persons rights are respected. Individuals are able to keep in touch with families and friends. People have healthy, well presented meals which they are involved in choosing. EVIDENCE: The people who live in the home are supported with activities and courses which meet their individual needs. One person said they are able to do the things they wish during the day, evening and at weekends; they told us about Nortonbrook DS0000045740.V378840.R01.S.doc Version 5.3 Page 13 their stable management course which they were attending on the day of our visit and said ‘I like living here. I like watching sports on TV and I have Sky Sports in my room. I love horse riding and I’m going there today; I watch TV in the evening and play on the Wii or my PS3. Staff help me to see my Dad and family’. People are given the opportunity to visit the ‘Triad Centre’; this is a centre operated by Autism Solutions Ltd where people can choose from a range of activities in an ‘autism friendly’ environment. The records we looked at show that people who live in the home do go out regularly, take part in activities of their choice and are supported on holidays. One person chooses very limited activities, but staff have supported them to develop and they now go for regular drives in the home’s care and are able to use the garden area independently. Each person is supported to maintain close links with their family and friends. Families are contacted regularly and updated on their relative’s progress. Visitors to the home are welcome and people can meet with relatives in private if they wish. The people who live in the home are supported to visit their families if they wish to do so. Staff told us that one person was going to visit their family on Christmas Day; the other individual was expecting his family to visit Nortonbrook as this better suited their needs. We noted that the home has had compliments from both individuals’ parents. One parent said their relative had not been as happy in a number of years and they liked living at Nortonbrook; this was due to the support staff had provided. People have a choice of meals, which are cooked in the home. Individual likes and dislikes are known and special diets are catered for. People usually eat their meals in the dining room, adjacent to the kitchen. During our visit we saw lunch being served; people were given a choice and were able to eat their meal at a time and pace which suited them. Nortonbrook DS0000045740.V378840.R01.S.doc Version 5.3 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People using the 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 receive personal support in they way they prefer and their healthcare needs are met. The home supports each person with their medicines in a safe way. EVIDENCE: Care plans provide clear guidance for staff on how they should support those living at the home with their personal and healthcare. Each person registered with a local G.P, dentist and optician; a psychiatrist and psychologist also support the home. Staff support individuals to attend any appointments they may have. The monthly reports completed by people’s key workers ensure that each individual’s health care is monitored; any changes or concerns would be picked up by staff and acted upon. Nortonbrook DS0000045740.V378840.R01.S.doc Version 5.3 Page 15 Each person has their own en-suite bathing facilities so that any support staff need to provide with personal care can be carried out in a way which respects the privacy and dignity of each individual. The health and social care professionals who wrote to us said people’s social and health care needs are properly monitored and met by the home; they felt their advice was sought and acted upon. One told us the home ‘looks after its clients as individuals’. The home uses a monitored dosage system of medication administration, which is well managed. Each person has their medicines described in their care records; these give staff clear instructions to follow, such as how and when people prefer to take their medicines and also explain what the medicines are for. Staff support each person to take their medicines; no one self medicates. Some individuals take medicines ‘as and when required’ and there are guidelines for staff to follow. The people who live at the home have reduced the amount of medication they take since they moved in; this is a positive development for both individuals. Staff always make sure people take their medicines and only sign the records when they have done so. Each member of staff who supports individuals with medication is trained to do this in a safe and effective way. Nortonbrook DS0000045740.V378840.R01.S.doc Version 5.3 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If individuals who live in the home, or people close to them, have concerns about their care they know how to complain; their views would be listened to and acted on. People are generally safeguarded from abuse, neglect and self harm and the home would take action to follow up any allegations. Care planning and risk assessments must be improved in this area to ensure people remain safe. EVIDENCE: The home has a formal Complaints Policy, a policy on how to recognise and respond to abuse (known as ‘Safeguarding’) and a Whistle Blowing Policy, which staff can use in confidence to raise any issue or concern they have regarding the service. The one individual who wrote to us said that they know who to speak to if they are unhappy and know how to make a complaint. They are clear on who they would approach and feel they would be listened to and their views taken seriously. There have been no complaints made to the home in the last 12 months. The home also keeps a record of any compliments they receive; they have had four Nortonbrook DS0000045740.V378840.R01.S.doc Version 5.3 Page 17 in the last year relating to the management and general improvements which have been made in the service. Due to the complex needs of people the home is set up to support, they can provide a service to people who may present behaviours which may be perceived as challenging the service. The records we looked at and discussions with staff showed staff do need to respond to behaviours such as physical aggression (sometimes between people who live in the home) and attempted damage to property. The care plans and risk assessments should clearly describe the behaviours they could present and how staff are to respond in a consistent, safe and effective way. The plans we looked at did not contain clear information; there were no risk assessments in place which specifically assess the risks involved in staff physically intervening to keep individuals safe. The home has a policy on physical intervention and staff are trained in responding to challenging behaviour, including physical interventions where these are necessary. It is not clear from reading behavioural care plans or risk assessments which interventions can be used for each individual; it is clear from some reports staff complete that they do need to physically intervene and therefore care plans must specify which techniques can be used and assessments which specifically relate to physical interventions must be written. Accidents which occur in the home are clearly recorded; staff also know what type of event which needs to be reported to us. Nortonbrook DS0000045740.V378840.R01.S.doc Version 5.3 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28 and 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Nortonbrook provides a homely, comfortable and safe environment for people to live in. EVIDENCE: Nortonbrook is a spacious four bedroom house which is situated in a quiet residential area; it blends well with neighbouring properties. There are car parking spaces at the front of the home and a small garden. At the rear of the home is a large back garden, which is secure so people can use this independently; this was well kept. Communal areas are on the ground floor; there is a spacious lounge, dining room and a conservatory. These areas are comfortably furnished and have been added to since our last visit which makes the environment more homely. Nortonbrook DS0000045740.V378840.R01.S.doc Version 5.3 Page 19 There is a small kitchen next to the dining room; the laundry area is located in the garage. People have their own bedroom with en-suite toilet and bathing facilities; they are encouraged to personalise their rooms, choose the colour schemes and have personal items. One person’s room now has more furniture; this is a positive development as they have previously refused to have furniture. We looked at all communal areas of the home and in each persons bedroom; all areas of the home were clean and tidy. One person who wrote to us said their home is ‘always’ kept fresh and clean. There have been some improvements since our last visit; carpet has been laid in the lounge and new sofas purchased, people’s bedrooms have been redecorated and a vegetable plot has been established in the back garden. There is a very homely feel at Nortonbrook; the people who live here were seen using their own rooms and the communal areas freely during our visit. Nortonbrook DS0000045740.V378840.R01.S.doc Version 5.3 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. People using the 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 persons needs are met and they are provided with safe and appropriate support by competent and trained staff. Thorough checks are carried out on new staff to ensure they are suitable to work in the home. EVIDENCE: Nortonbrook has a small staff team of eight people to support individuals who live in the home. Two staff are on duty during the daytime and evening and one of them then sleeps-in. Staff who work in the home may also support individuals during their day activities. This ensures a consistent approach in the support provided to person and may help to reduce anxiety for some individuals. Nortonbrook DS0000045740.V378840.R01.S.doc Version 5.3 Page 21 One individual who wrote to us said staff always treat them well, listen to them and act on what they say. Health and Social Care professionals who wrote to us said they feel the staff have the right skills and experience to support people. The staff we spoke with, and those we saw working, appeared confident in their roles and we seen to support people in a professional way. Staff told us that they had been able to build very good relationships with the people who live in the home. The home has a good system when new staff are recruited. The personnel records of staff who have recently joined the team contain copies of their application form, documents proving their identity and eligibility to work in the UK, two satisfactory references and Enhanced Criminal Record Bureau Disclosure. The staff team meets each month; the records we looked at show that attendance at these meetings is good and a wide range of topics are discussed. New staff are given a thorough induction to the home. They are then provided with mandatory courses such as first aid, infection control, food hygiene, fire safety and safeguarding. Other courses which help them to meet individual’s needs are provided including medication administration, person centred care, supporting people who are in the Autistic Spectrum, total communication and how to support people who may display difficult or aggressive behaviour. Staff are supported to attain a National Vocational Qualification (NVQ). At present three staff members have attained an NVQ; five are working towards a Level 3 award and two towards Level 4. Each member of staff is provided with regular formal supervision; they are also appraised once each year. Clear records of each meeting are kept; staff members said they feel supervision helpful and supportive. Nortonbrook DS0000045740.V378840.R01.S.doc Version 5.3 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 42 and 43. People using the 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 well run and each individual benefits from how it is managed. The views of the people who live in the home, or those close them, are sought to help the home review their practice. Each person is safeguarded as health and safety practices are carried out. EVIDENCE: The last Registered Manager no longer works at the home. The home has been managed by an acting manager for over a year; they did apply to register with Nortonbrook DS0000045740.V378840.R01.S.doc Version 5.3 Page 23 us but this has not been successful. They are in the process of re-applying; they have continued to manage the home during this time. The manager is supported by one Deputy. The management structure is clear and straightforward; out of hours management support is always available for staff, as the home has an ‘on call’ system every day of the year. The acting manager was not due to be working on the day of our visit, but did kindly support the inspection process, together with the Deputy Manager and the Registered Services Manager. There are annual Quality Assurance reviews; the people who live in the home, and those close to them such as their parents, are asked to complete a questionnaire. The responses to them are then reviewed and any areas for improvement are acted on. We looked at the review carried out in September 2009; the questionnaires were very positive about the care and support provided by the staff at Nortonbrook. A representative of the registered provider makes regular auditing visits to the home, and produces a report of their findings. We looked at the reports for 2009; all of these were in order apart from May, June, September and October. We were assured they had been carried out; a copy of each report will be located and sent to the home for filing. There are recording systems in place to support Health and Safety within the home, which are used consistently. The home’s ‘AQAA’ confirmed that the safety checks on portable electrical appliances, gas appliances, electrical wiring and fire safety equipment were all up to date. There are general risk assessments in place which identify risks to staff and how these may be reduced. There is information on hazardous products used in the home and risk assessments to support their use; these risk assessments were last reviewed in May 2008 and should therefore be reviewed as soon as possible. Nortonbrook DS0000045740.V378840.R01.S.doc Version 5.3 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 3 3 X X 3 3 Version 5.3 Page 25 Nortonbrook DS0000045740.V378840.R01.S.doc Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA23 Regulation 13 Requirement The Registered Person must improve care plans which explain how staff are to support people who present behaviours which may be perceived as challenging the service. This would ensure staff respond to these in a planned, safe and effective way. 2. YA23 13 The Registered Person must ensure that detailed risk assessments are in place for each person who may require restrictive physical interventions. This would promote the welfare and safety of these individuals. 3. YA37 9 The Registered Person must ensure a manager successfully completes the registration process with us. This would ensure people who live in the home are provided with a safe and accountable service. 11/03/10 Timescale for action 11/03/10 11/03/10 Nortonbrook DS0000045740.V378840.R01.S.doc Version 5.3 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA43 Good Practice Recommendations The Registered Person should ensure that the record of each monthly auditing visit is kept in the home and made available for inspection. Nortonbrook DS0000045740.V378840.R01.S.doc Version 5.3 Page 27 Care Quality Commission Care Quality Commission South West Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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. 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