Care Home: Nsoromma House

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What the care home does well This is an excellent service that provides a very good standard of care to the people who use the service. The people who use the service, since living in the home, have shown improvements in their quality of life, and have benefited from the services provided by the service; this has been apparent in the move on statistics and when following up on those who have moved on to live in the local community. The mental health of the people who use the service is stablised when they come to live in the home and they are supported and encouraged by staff to manage their mental and physical healthcare needs. The service provides person centred care and support that meets the assessed personal, health and social care needs of the individual which can be complex with forensic histories and who are high risk and have been difficult to engage in any type of service provision. The support and encouragement offered by this service encompasses education and the development of life skills to enable them to aspire to semi/independent living in the local community. The service aims to manage and minimise risks effectively and successfully maintain the people who use this service safely in the community; this is backed up by feedback from the friends and family of the individual, the local PCT, CMHT, neighbours and the people who use the service. What has improved since the last inspection? The home has made improvements in the following areas, since the last key inspection:Introduced goal monitoring records to enable the individuals level of achievement to be assessed at the CPA reviews; and have produced a six monthly move on assessment tool. Made use of public transport when going on holiday and have incorporated more group discussions in the in house evening programme. Staff have completed training in medication acquisition, storage, administration, storage and disposal and mental health awareness. Introduced key performance indicators and implemented staff performance monitoring. Introduced an End of Life questionnaire for all the people who use the service. Introduced Quality Assurance Auditing in all areas of work practice. Introduced health and well being monitoring. Introduced Crisis Cards and Care Plans for everyone who uses the service. Staff have received a three hour in house training on personal development planning and preparation; they have also had in house training relating to challenging behaviors. The home has an annual plan relating to refurbishment and maintenance that is ongoing. All staff have completed their mandatory training and have undertaken training specific to the health, personal and social care needs of the people in their care. Involving the people who use the service in the decision making processes in the home. The is now an annual business and development plan for the service. There are now key performance indicators and recorded performance monitoring for all staff. The service has introduced Personal Development Planning for staff including SWOT and STAR analysis and CPD recording. What the care home could do better: Review the handbook for the people who use the service. Explore the issue of slow stream rehabilitation; recovery programme; placements for some of the people who use the service with the high support team and the PCT. Commence the use of the move on assessment tool. extend key performance indicators to cover accessing more community based activities by all care staff and involvement in local forums enabling more choice for the people who use the service. Step up the local recycling initiative involving the people who live in the home. Refine and formalise the annual development plan incorporating the views of the people who use the service and thereby improving Quality Assurance. Key inspection report Care homes for adults (18-65 years) Name: Address: Nsoromma House 15-17 Cobourg Road London London SE5 0HT     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: Susan Meaker     Date: 2 5 0 6 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 30 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 30 Information about the care home Name of care home: Address: Nsoromma House 15-17 Cobourg Road London London SE5 0HT Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Southside Partnership Type of registration: Number of places registered: care home 11 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 11 The registered person may provide the following category of service only: Care Home only - code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home 11 Over 65 11 Care Homes for Adults (18-65 years) Page 4 of 30 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 unannounced visit was made to this service on the 18th June 2009; this was part of a Key inspection. Before making this site visit we looked at information received since the last key inspection on the 8th and 9th of May 2007; and the Annual Service Review that was completed for this service on 23rd December 2008. We looked at the Annual Quality Assurance Assessment (AQAA) that gives CQC evidence to support what the service says it does well and gives them an opportunity to say what they feel they could do better and what their future plans are. We looked at how the service has dealt with any complaints and concerns. We looked at any changes that have been made by the organisation; and how the organisation views the way they look after the people in their care. We also take into account the views of the people who use the service, their family and friends, staff and the other professionals who visit the service. During the visit we talked to the people who use the service, the manager and staff Care Homes for Adults (18-65 years) Page 5 of 30 and visitors. Looked at information about the people who use the service and how their needs are met. Looked at records that must be kept. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for in the home. Looked around the building to make sure it was clean, safe and comfortable and checked what improvements had been made since the last visit. Before the inspection we sent out questionnaires for people who use the service to complete. Care Homes for Adults (18-65 years) Page 6 of 30 What the care home does well: What has improved since the last inspection? The home has made improvements in the following areas, since the last key inspection:Introduced goal monitoring records to enable the individuals level of achievement to be assessed at the CPA reviews; and have produced a six monthly move on assessment tool. Made use of public transport when going on holiday and have incorporated more group discussions in the in house evening programme. Staff have completed training in medication acquisition, storage, administration, storage and disposal and mental health awareness. Introduced key performance indicators and implemented staff performance monitoring. Introduced an End of Life questionnaire for all the people who use the service. Introduced Quality Assurance Auditing in all areas of work practice. Introduced health and well being monitoring. Introduced Crisis Cards and Care Plans for everyone who uses the service. Staff have received a three hour in house training on personal development planning and preparation; they have also had in house training relating to challenging behaviors. The home has an annual plan relating to refurbishment and maintenance that is ongoing. All staff have completed their mandatory training and have undertaken training specific to the health, personal and social care needs of the people in their care. Involving the people who use the service in the decision making processes in the home. The is now an annual business and development plan for the service. There are now key performance indicators and recorded performance monitoring for all staff. The service has introduced Personal Development Planning for staff including SWOT and STAR analysis and CPD recording. Care Homes for Adults (18-65 years) Page 7 of 30 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 8 of 30 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 9 of 30 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 excellent 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 given information about what they can expect while living at the home and this enables them to decide whether the service can meet their assessed health, personal and social care needs. People who use the service have their individual care needs assessed by an experienced senior member of staff; ensuring that the service can safely support and encourage them in the home and in the wider community. People who want to move into the service and their relatives are offered opportunities to come and visit the home. Once the person has been offered a place at the home; they have a series of trial stays so they can establish a rapport with the people currently living in the home and the staff and management of the home, ensuring that they feel comfortable and safe. Evidence: Prior to admission, prospective people who will use the service are given detailed information about what they can expect while living in the home; as well as information to help them decide whether they would like to move into the home. The people living in the home confirmed that, during the assessment and admission Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: process, they were treated with respect, their dignity maintained; and that they were reassured and given time to understand the information given to them without feeling pressured and overloaded. Individuals are fully assessed by senior staff prior to them coming into the home, to ensure that the service provided can properly meet their assessed personal, health and social care needs; that the service provided can manage their needs and safely support them in the home and the wider community. The people who will be using the service and their relatives are offered opportunities to visit the home to look around and speak to the people currently living there; speak to the staff who will care for them and discuss any issues and concerns they may have with the management team at the home. When an offer of a placement is made individuals have a series of trial stays to familarise themselves with the people currently living there, the staff and the environment to satisfy themselves that they have made the right decision. During these stays their is a continuous assessment of their needs and expectations and they are given further information about the home to ensure their comfort and to reinforce their expectations. Once the person moves into the home they receive a licence agreement which is read with them or to them according to their individual need; if there are any language difficulties the service is able to access the services of an interpreter; because of the staff matching process there is almost always someone who can speak the native language of their residents which is a positive outcome for the person and assists in allaying fears and offers reassurance. Care Homes for Adults (18-65 years) Page 11 of 30 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. People who use the service are involved in formulating their person centred care/support plan ensuring that the staff know what they need to do to support them to achieve their identified goals, and to meet the assessed personal, health and social care needs; the plans are detailed and reviewed in consultation with the individual on a regular basis. Risks are assessed regularly, individuals are encouraged and supported to take reasonable and appropriate risks and make their own decisions so they can develop and move into less supported accommodation. People who use the service are involved in the day to day operation of the home and are consulted about issues that affect them. People who use the service know that their personal information is securely stored and they are made aware of when it may be necessary to share it with other professionals. Evidence: Detailed person centred care/support plans are based on the initial needs assessment; they are formulated and agreed with input from the individual, their family and/or Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: advocate. The plans ensure that the staff know what they need to do to support and encourage the person using the service, on a day to day basis, to achieve their identified goals making sure that the individual knows what is expected of them. The plans focus on actions to be taken to meet individual needs and to manage and minimise risks. The care plans are reviewed on a regular basis with the individual, and staff ensure that they are supported and encouraged to make sure they exercise their right to make appropriate and achievable decisions. Risks are assessed regularly and individuals are supported to take reasonable risks and make their own decisions in order to develop or build on life skills and to manage their physical and mental health in working towards recovery and independence and moving on to less supported accommodation. The people who use the service are consulted about the running of the home and encouraged to discuss any issues and concerns they may have; this is done via the use of six monthly surveys, meetings with staff and management of the home and meetings with the responsible individual. People who use the service can be confident that information about them is held in confidence and stored securely in locked cabinets that can only be accessed by the care staff in the home. People who use the service are made aware of this issue from when they begin to live in the home and are reassured that information is shared only on a need to know basis and that they will be consulted as the need arises. It was evident from looking at the person centred care plans and from speaking to people living in the service that they have a good relationship with the staff and that they are consulted about all aspects of their care and on they way in which the home is run; this is evidenced by individuals meeting with staff on a one to one basis and in groups to ascertain their needs and how best to support and encourage them to lead purposeful, fulfilling and independent lives. Staff ensure they have contact with the people who use the service on a daily basis; key workers have one to one sessions weekly and reviews fortnightly. The people who use the service are given access to information stored about them, as part of this process they are asked to read their weekly one to one records ( or have it read to them) and sign them. People who use the service are consulted a CPA reviews regarding additional goals that they wish to achieve; the goals are then agreed and incorporated into the review record and subsequently in to their care/support plans. Additional goal monitoring records are kept to enable the level of achievement to be assessed at the next review. Individuals also discuss and agree in advance, directives that are recorded on their CPA reviews, should the need arise for them to be invoked. The people who use the service have access to independent advocates, solicitors and interpreters as appropriate to their needs; they are encouraged to have significant others present at their reviews, and with their agreement ,they are invited to attend Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: either by the staff of the home or their care co-ordinator. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are encouraged and supported to maintain and develop relationships ensuring their right to choose is respected. Staff support the people who use the service to develop and engage with the local community, to find work and to access education and leisure opportunities. Staff make sure that the people who use the service understand their rights and responsibilities; enabling them to use local advocates and solicitors protect those rights when necessary. People who use the service are offered meals they have chosen and enjoy; they are encouraged and supported in cooking for themselves to enable them to develop skills they will need when living in the wider community. Evidence: People who use the service are encouraged and supported to maintain and develop relationships as they choose and to welcome family, friends and visitors to their Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: home; with the agreement of the manager overnight stays can be arranged. Staff encourage and support the people who live in the home to develop and engage with the local community, find work and access education and leisure/faith opportunities ensuring that their rights are respected and their responsibilities recognised; this is done by putting the people who use the service in touch with reputable solicitors and advocates so they can make a choice of who they wish to represent their interests. The people who use the service are assisted to obtain Freedom Passes to enable them to access community services; they are enabled to exercise their rights to citizenship by registering to vote in local and general elections; they are also encouraged to have an annual holiday of their choice, to take day trips to places of interest to them, to attend evening leisure activities using public transport with staff support. The people who use the service are provided with meals they have chosen and enjoy; menus are discussed on a regular basis and decided on a four week cycle; they take part in cooking for themselves, as part of a programme to help them develop skills they will need when caring for themselves in the community; some individuals choose, as part of their goals, to cook using their own weekly menus while others choose to prepare meals once or twice a week. Individuals plan meals with their key workers and are supported to choose healthy foods, budget, shop and cook on Saturdays; the majority of these meals are ethnic and they buy their ingredients from specialist stores in the local area. Support is given during these cookery sessions and staff observe, evaluate and document the outcome of the session. People who use the service organise, with help and assistance from the staff, evening leisure activities to be enjoyed in the home. People who use the service are encouraged and supported to keep their personal space clean and tidy. maintain the standard of cleanliness in the communal areas; they are supported by staff to do their own laundry on a rostered basis. The service caters for African and Caribbean men, and staff ensure that local services and programmes (including the Bradon Course that develops interview skills/confidence and helps with putting together CVs to ultimately gain employment) are accessed to meet their diverse individual needs. Care Homes for Adults (18-65 years) Page 16 of 30 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. All the people who use this service have their assessed personal, health, social and emotional needs met by the management and staff at the home, and by accessing the services of healthcare professionals within the local community; ensuring that they receive an excellent quality of care. Medication is managed, stored and dispensed safely and correctly. Staff make sure that each individual has their medication reviewed regularly and they are encouraged and supported to self medicate with the correct risk assessments in place. Evidence: The complex assessed personal, health and social care needs of the people who use the service, are met by the staff in the home with support from other healthcare professionals within the local community. Specialist professional services such as physiotherapy and occupational therapy are accessed as required to meet the individuals needs. The people who use the service are given guidance and support relating to their personal hygiene according to their assessed needs; they choose their own clothing independently or they can ask for help from the staff; the service caters for a particular ethnic group of people and the staff recruited reflect the cultural, religious and gender of the client group and can usually speak their native language. Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: To maintain the consistency and continuity of care the people who use the service are able to choose their own key worker within the staff team; key workers and the homes managers encourage individuals to keep in contact with their families and friends and to actively communicate with them, so that their family and friends can offer support and encouragement to them. Management and staff at the home work in partnership with a wide range of professionals, such as advocates, solicitors and interpreters, and support the people who use the service to access them should the need arise. The care co-ordinator for the home is from the High Support Team and through him the home is able to access the services of the community mental health team including forensic and social worker input. The people who use the service have been consulted on the carrying of Crisis Cards and Care \plans agreed at CPA reviews; they all agreed to do this so that in the event of an emergency they can receive appropriate attention immediately. All the care support staff are trained to recognise relapse indicators and or symptoms to assist them in monitoring the individuals mental health and well-being they then know when to invoke crisis and contingency plans. The people who use the service are supported and encouraged to take part in general health programmes and as part of the initiative health and well-being monitoring forms part of the six monthly CPA review. The initiative includes health education, sexual health, physical health monitoring as well as the body mass index; also included is healthy eating, dietitian referrals and in house activities relating to managing physical health and any health problems or concern identified. All the people who use the service are registered with a local GP, podiatrist, optician and dentist all have regular check ups as well as an annual health check. All diabetics are registered with the diabetic specialist nurse who works closely with the staff team. In house all diabetics are educated about their condition and are supported to monitor their blood glucose level and to care for their feet; they are also registered with the local hospital for their annual checks and any other outpatient appointments they may have relevant to their condition. Medication in the home is managed, stored and dispensed safely and correctly; this was evident when observing medication being given during the visit to the home. Staff make sure that the people who use the service have their medication reviewed regularly and they are supported to safely selfmedicate when they are sufficiently able, based upon risk assessments and the acquisition of skills and training offered by staff. During the process of self-medication, random checks are made by staff and records are dated and signed; any discrepancies are addressed immediately with the individual and appropriate action is taken to ensure safety; people who self-medicate are required to sign when they collect their medication and they have a locked cupboard in their bedroom enabling them to store their medication safely. The local pharmacist and hospital pharmacist are consulted regarding any issues relating to medication; if there are any concerns about any individuals medication the care co-ordinator and psychiatrist and the GP are consulted. Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: All the people who use the service are encouraged and supported to complete an end of life care questionnaire which then becomes part of their personal file and these wishes will be implemented when the time comes. Care Homes for Adults (18-65 years) Page 19 of 30 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 the service are given information about how to complain formally; and their day to day views and concerns are taken seriously and can be confident that these issues will be resolved appropriately. People who use the service are protected from abuse by th home having in place clear policies and procedures; staff being aware of the policies and procedures, and that they receive training in all areas relating to the safeguarding of vulnerable adults. Evidence: The people who use the service are given information about how to complain formally, their day to day views and concerns are taken seriously and action is taken to try to resolve any issues that may arise. People who use the service have the complaints policy and procedure explained to them and they have a copy of these documents in their handbook, which clearly states the stages and time frame for a response. People who use the service are reminded, at meetings and in one to one meetings, of the procedure should they have any concerns and are reassured that they can approach any member of staff, of their choice, with any problems and concerns they may have, confident that these issues will be resolved to their satisfaction. people who use the service are aware , that if they wish, independent advocates/interpreters can be accessed on their behalf via the staff at the home and their care co-ordinator. The home, has in place, clear policies and procedures for dealing with allegations of Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: abuse they also have a whistle-blowing policy and procedure and the department of Health No Secrets guidance as well as policies and procedures, in place, relating to managing the monies and financial affaires of the people who use the service. All the staff at the home are aware of the policies and procedures and they have all received training relating to safeguarding vulnerable adults ensuring that the people who use the service can feel safe and protected at all times. Staff at the home also receive training in the procedures for managing challenging behavior and there are frequent staff discussions and debriefing sessions following any incidents of this type of behavior. Care Homes for Adults (18-65 years) Page 21 of 30 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 communal areas of the home are clean, bright, comfortable and homely; well decorated, equipped and furnished providing a pleasant home for the people who live there ensuring that they feel safe, protected and comfortable. The people who use this service are supported and encouraged to personalise their bedrooms enabling them to reflect their own taste, interest and hobbies with decoration, furniture, ornaments, pictures, photographs, DVD player, TV, computers and music centres Evidence: The premises are suitable for its stated purpose; it is safe, well maintained, comfortable and homely. The communal areas of the home are kept clean and tidy and are bright, airy, well lit adequately heated and cheerful; theses spaces are kept clean and free from offensive odours by the daily cleaner; the people who use the service are encouraged and supported to keep their bedrooms clean and tidy. The kitchen and all the communal areas are deep cleaned and recorded weekly to maintain a good standard to hygiene within the home. There are Food Hazard Analysis and Critical Point Control policies and procedures in place complemented by risk assessments that cover the use of gas and electrical cooking appliances; food handling and preparation ; fire safety and the use of step ladders. Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: The people who use the service and the homes staff have access and implement the homes policies and procedures relating to infection control and they also refer to the Department of Health Infection Control Guidance for Care Homes. Individuals are supported to do their own laundry on a rostered weekly basis and according to need at other times. The laundry facilities are situated in the basement and comprise of a washing machine that meets infection control standards and are large dryer; there are also hand washing facilities and protective aprons and gloves are available. The home has an annual maintenance programme in place; repairs are carried out as and when needed, the repair is reported, logged, prioritised and carried out within an agreed timescale. Maintenance records are audited on a monthly basis; weekly health and safety checks are carried out by the homes staff and all faults and repairs needed are reported to the maintenance department. Individuals have their own room, which is carpeted and equipped with a wash hand basin, bed, chest of drawers, wardrobes, desk, lockable storage space, a coffee table and two comfortable chairs; there is good lighting and heating for each room; they are encouraged and do personalise their rooms to reflect their taste, interests and hobbies. They are all given a key to the front door and to their bedrooms, their privacy is respected by the homes staff and entry to their personal space is dependent on individual risk assessed needs and by agreement, in order to support with cleanliness and health and safety requirements. There are three bathrooms on each floor and two additional toilets all of which are lockable; the communal space in the home complements and supplements the individuals personal space, there is a designated smoking area, which is the summerhouse in the garden; the small garden is well used by the residents and fro social events. There are risk assessments for each individuals personal space, the communal areas and the building as a whole. Care Homes for Adults (18-65 years) Page 23 of 30 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. The orgsanisation ensures that there are enough staff on duty, at any time, to meet the personal, health and social care needs of the people who use the service. The staff at the home undertake NVQ training, mandatory training and specialised training relating to the specific needs of the people who use the service; making sure that they have an effective staff group who understand the complex needs of the people in their care. Recruitment and Selection policies and procedures are effective ensuring the correct checks are undertaken to make sure that the staff are who they say they are, ensuring that the people who use the service feel safe and protected at al times. Staff receive regular supervision from their manager ensuring that the people who use the service know the staff receive ongoing management advice and support. Evidence: The staff of the home have clearly defined job decriptions and understand their own and others roles and responsibilities. The organisation operates a key worker system with ethnic matching that enables staff to establish a good relationsip with the people who use the service especially around their diverse needs in a culturally sensitive manner; staff also work in partnership with multi-professional and disciplinary teams and access support to help them meet the needs of the individuals in their care. All staff are conversant with the aims, values, ethos and the policies and procedures of Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: the service and it was evident from observing and talking to staff that they adhere and work effectively and efficiently within these boundaries; staff also work within the standards of conduct of the General Social care Council and wher it applies to the Nursing and Midwifery Council. The service operates a 24 hour high support service and ensures that there are adequate staff on duty at al times to meet the personal, health and social care needs of the people who use the service and be able to manage emergengencies with accessible support; evidence was found via staff records and the daily rota of this being the case staff and management of the service, that stringent policies and procedures are followed relating to the selection and recruitment, application forms completed with employment history, CRB and POVA checks completed, two references obtained and prof of identity and experience and training; all permanent staff are trained to NVQ 3 standards and the management of the home have NVQ 4 and the Registered Manager Award. It was evident from speaking to staff that they had completed a comprehensive induction programme incorporating mandatory training in moving and handling, food safety, first aid and health and safety. Completing the induction and mandatory training ensures that staff develop the skills to perform their roles competently and effectively anabling them to maintain best practice. Staff are also enabled to offer the suport and encouragement that the people who use the service require to achieve their goals enabling them to look towards to eventually living independently in the local community. Regular recorded supervisions, probation interviews and performance monitoring are carried out by the organisations managers and appropriate actions taken as necessay; during these sessions support and guidance is given and training needs are identified. The organisation has a designated person who accesses appropriate training and ensure staff register and attend courses; all relevant training and development is organised by the organisations central HR department who have a budget and annual training plan to deliver the training needs of the staff team. The home manager holds regular staff meetings and the minutes are recorded; staff also have day to day contact with the home manager ensuring that they receive the guidance, support and encouragement they need to be effective and efficient members of the staff team. Care Homes for Adults (18-65 years) Page 25 of 30 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. People who use the service benefit from a well run home; with an effective and efficient management and staff team; ensuring they receive good quality care in a safe environment. The policies and procedures in the home are clear and useful providing staff with all relevant information and guidance ensuring that the people who use the service benefit from being offered support from staff who are confident and understand what is expected of them. The home has a good quality assurance process in place getting views from the people who use the service, their relatives, the staff and other healthcare professionals who visit the service and acting upon these comments to improve the service provision and the quality of care. The policies and procedure in place offer staff up to date information and guidance. Record keeping is in a clear, effective and accurate throughout the home; all information is stored in compliance with the Data Protection Act ensuring confidentiality at all times. The people who use the service are protected from harm by staff following the organisation health and safety policies and procedures that comply with legislation. Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: The organisations policies and procedures are clear and offer staff up to date advice and guidance and provide them with all the relevant information appertaining to their role within the home enabling them to give the people in their care the support and encouragement they need. The home has a new manager, who was employed in one of the organisations other homes; he has now been transferred to Nsoromma this took place on the 8/07/2009; from looking at the application form it can be seen that this person is very well qualified and experienced to run this service; the organisations approach to managing the home is inclusive, positive, open and transparent in that the people who use the service, their relatives, visitors, staff, advocates and stakeholders can approach the manager at any time about any issues or concerns. Staff are given the opportunity to take responsibility for many aspects of the service, under supervision as part of their development and staff are involved in consultation and decision making in the running of the home; also staff meetings are held regularly where ideas and information are shared and discussed. The home undertakes 6 monthly surveys, uses a suggestion box and holds regular meeting with the people who use the service to ascertain their views about all aspects of their care and how the home is organised and run. There is continuous quality monitoring and audits of all aspects of customer care , maintenance, health and safety and personnel documentation and records i the home the whole of the management and staff team are involved in this process. Staff undergo rigorous training in health and safety and in maintaining safe practices to protect the people who use the service and themselves. The organisation ensures that the people who use the service have their best interests safeguarded by the record keeping polices and procedures of the organisation; making sure that all information is stored in compliance with the Data Protection Act. The people who use the service have access to their records and information held about them and in line with this, they sign their one to one record following each session. Care Homes for Adults (18-65 years) Page 27 of 30 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 28 of 30 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 29 of 30 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. Care Homes for Adults (18-65 years) Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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