Care Home: Nutbush Cottage

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What the care home does well Residents live in a clean, homely environment, which has been decorated and furnished to a high standard with their bedrooms furnished and decorated according to their individual needs and lifestyles. There is a excellent range of accessible information available about the home and the services and facilities it provides. This helps residents and their families make informed choices about the home. The home provides a relaxed and gentle lifestyle for residents who have complex learning disabilities, challenging behaviour and mental health needs. The home balances well the rights of residents to take reasonable risks as part of an enabling lifestyle. Services are designed to provide appropriate care and support in ways, which encourages participation and choice for residents. Resident`s benefit from personal and health care support that is individual, respects their privacy and dignity and encourages them to remain as independent as possible. Residents take part in a variety of daily activities with each resident having a flexible weekly plan. A staff member commented "the provider tries to better the lives of residents by giving them the opportunity to go out as much as possible". Resident`s benefit by being supported to maintain relationships with their families and friends. The meals are good offering both choice and variety and catering for special dietary needs. There is an experienced and established manager who ensures a clear ethos and values of the home enabling staff to provide good quality care. A sample of comments about the manager included "good manager any problems you can talk to although very young knows his job" " very nice guy open can approach him tell him and he sorts it out" and "will listen and takes on board what staff have to say". Staff clearly make a positive contribution in residents lives as residents benefit from a supervised, and enthusiastic staff team that know them and who are robustly recruited as is necessary for their safety and to be able to meet their needs. What has improved since the last inspection? This is the first inspection of the home under the new company name and registration and therefore no previous practices are taken into account prior to the new registration of the home. However it was apparent that the manager has continued to ensure that outcomes for residents remain consistently good and resident focused. What the care home could do better: Care plans are person centred and provide comprehensive guidance for staff on the personal, social and health care needs, however clearer guidance is needed on managing challenging behaviour to ensure that this is done in a consistent way in accordance with guidance provided by specialist health care professionals. The manager had developed a training and development plan which highlighted individual staffs training gaps and had taken positive steps to start to address this.The manager agreed to improve some standards of recording in care documentation in order to ensure that relevant and clear account of events are recorded and in accordance with the individuals assessed needs and goals. Key inspection report Care homes for adults (18-65 years) Name: Address: Nutbush Cottage Mitchells Care Homes Limited Nutbush Cottage Bonehurst Road Horley Surrey RH6 8PJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jane Jewell     Date: 1 3 0 5 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: Nutbush Cottage Mitchells Care Homes Limited Nutbush Cottage Bonehurst Road Horley Surrey RH6 8PJ 01293823271 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): mchnutbush@btinternet.com Mitchells Care Homes Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: 1 The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 2 The maximum number of service users to be accommodated is 4. Date of last inspection Brief description of the care home Nutbush Cottage was first registered in March 2006 and is a care home for up to four residents under the age of 65 years who have a learning disability. The home specialises in providing support to residents who have complex learning disabilities and challenging behaviour. The house is a converted detached domestic house situated on the main A203, but is Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 4 Brief description of the care home set back from this busy road via a drive and overlooks a rural setting with fields on both sides of the house. Local facilities are a short car distance away from the home. The premises consist of a main house, which has three single bedrooms and is presented across two floors. All bedrooms provide en-suite facilities or exclusive use of a bathroom. Communal space consists of a kitchen, dinning room and separate lounge. There is a separate annex, which contains a single bedroom flat, with its own kitchenette and en-suite facilities. There is a large secure garden to the side of the property. There is ample car parking for a number of cars including the homes people carrier which seats nine. The homes literature states that it is committed to providing a very high standard of care on a 24 hour basis for the people who live there. Care Homes for Adults (18-65 years) Page 5 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: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: Although the home has been in existence since 2006 the home was re-registered in 2008 under a new company name, although no changes in management or organisation structure resulted in this change this is the first inspection under the new company name and new registration of the home. The information contained in this report has been comprised from an unannounced inspection undertaken over five and half hours and information gathered about the home before and after the inspection. The manager had comprehensively completed an Annual Quality Assurance Assessment form and the information contained in this document has been used to inform the inspection process. The inspection was facilitated by the Mr Mohammad T Khodabocus (Registered Manager). The inspection consisted of a tour of the premises, examination of the homes documentation and observations of residents daily routines and in their Care Homes for Adults (18-65 years) Page 6 of 30 interactions with staff. Two residents, one health care professional and three staff were consulted as part of the inspection process, residents were also observed in their interactions with staff. Feedback surveys were sent to the home for distribution in order to obtain the views on the quality of the services and facilities being provided. Four were returned in total, two from service users, one from staff and one from health care professionals. Their feedback is included in this report. There were three residents living at the home at the time of the inspection. The focus of the inspection was to look at the experiences of life at the home for people living there. Signs of residents well being/ill being (terminology used for observing behaviour for people who do no use verbal communication) were observed in order to make judgements about their experiences and wellbeing. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Care plans are person centred and provide comprehensive guidance for staff on the personal, social and health care needs, however clearer guidance is needed on managing challenging behaviour to ensure that this is done in a consistent way in accordance with guidance provided by specialist health care professionals. The manager had developed a training and development plan which highlighted individual staffs training gaps and had taken positive steps to start to address this. Care Homes for Adults (18-65 years) Page 8 of 30 The manager agreed to improve some standards of recording in care documentation in order to ensure that relevant and clear account of events are recorded and in accordance with the individuals assessed needs and goals. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 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 10 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. There is a excellent range of accessible information available about the home and the services and facilities it provides, in order to help residents and their families make informed choices about the home. The home is able to identify and meet the needs of the people whom it supports and who have complex challenging needs. . The assessment process ensures that only residents whos needs can be safely met at the home are admitted. Evidence: The homes statement of purpose, which is a book that tells people who the home is for and the service users guide, which is the book that tells people how the home works, is comprehensive and provides a wide range of information about the home and the services it provides. Both documents are in a word format and also in a widget symbols format. This is intended to make the information accessible to the residents for whom the service is intended. This is to be commended. This information Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: would be sent to prospective residents and their representatives to help make informed choice about the homes suitability. Residents have received a personal copy of the service user guide. There has been one short term placement admission to the home since the home was re-registered. Documents seen relating to this admission showed that residents are accommodated following an assessment of their needs by the provider. Information about their needs is gathered from a variety of sources including the resident, their representative and health care professionals. The needs assessment then forms the basis of their care plan. This helped ensured that staff were aware of the recorded needs of the new residents prior to them moving into the home. Residents at the home are assessed as having complex challenging needs including some additional mental health needs. Two resident are assessed as needed one to one support for the majority of their day. All residents observed demonstrated well being signs and those consulted with spoke positively about their life at the home. Through observation, looking at records and feedback from staff and other stakeholders involved in residents care, evidence was gathered that the home is meeting these needs of residents. The manager confirmed that prospective residents are provided with the opportunity to visit the home in advance to assess the quality, facilities and suitability of the home with their family and representative. The length and type of any visit would depend on the individuals needs and preferences. The first six weeks of residency is looked upon as a trial occupancy. Permanent residency is usually subject to a review of care needs with the residents their representatives and any care manager. The manager stated that residents are provided with a written contract of terms and conditions of residency with the home. This is used with residents and their families to make explicit the placement arrangements and clarify mutual expectations around rights and responsibilities Care Homes for Adults (18-65 years) Page 12 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are person centred and provide comprehensive guidance for staff on the personal, social and health care needs, however clearer guidance is needed on managing challenging behaviour to ensure that this is done in a consistent way in accordance with guidance provided by specialist health care professionals . The home balances well the rights of residents to take reasonable risks as part of an enabling lifestyle. Services are designed to provide appropriate care and support in ways, which encourages participation and choice for the residents. Evidence: Each person has a comprehensive person centred care plan in place which are designed to enable personal, health, communication, social, cultural and religious needs of each person to be addressed. Care plans are accessible and provided with Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: pictures. Three person centred plans were sampled which had been implemented in consultation with the resident and or their relatives. Staff consulted with demonstrated a clear understanding of the assessed needs of residents and how they supported each resident to ensure continuity of care. However, due to the complex challenging behaviour additional guidance is provided for staff on how to manage individuals behaviour. Examples were noted whereby this guidance was not always easily accessible to staff as it was in various formats throughout the care plan. The manager agreed to combine all of the guidance into a clearer behavioural management plan. Any episodes of challenging behaviour are recorded, this is often referred as an ABC chart. Examples were noted whereby the recorded action to support a resident through an episode did not correspond with the behavioural management plan or provide sufficient details to be able to confirm that appropriate support was provided. Guidance was also needed for staff to follow when a resident talks about historical traumatic events. This is to ensure that staff provide a consistent approach when supporting them and to ensure residents and staffs protection under safeguarding procedures when they raise past issues but refer to them using current staff names. Therefore it has been required that care plans provide sufficient guidance for staff on managing individuals challenging behaviour. Daily notes are recorded on each resident, which largely recorded the actions and events that have occurred. These were written in a respectful and none judgmental style. However one example was noted whereby the notes did not accurately reflect the events that staff described and which lead up to decisions being made by health care professionals to change medication. The manager agreed to ensure that this was rectified immediately through improved staff awareness of recording practices. Changes in residents needs and preferences were largely promptly identified through the regular review of care plans. Annual placement reviews are also held with the placement authorities and residents families. This helps to identify whether the home can continue to meet the residents needs. Much good practice was noted in the way that these reviews are planned and managed in order to ensure the maximum benefit to the resident. There are systems in place to support residents to make choices and decisions about their daily lives. This information is included in their care plan such as preferred daily routines. Residents participate in the day to day running of the home in accordance with the range of their individual preferences and strengths. The home is proactive in involving residents in as much of planning their day as possible with residents determining the afternoon events on the day of the inspection. Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: The home has a developed system in place for enabling residents to take responsible risks as part of an enabling lifestyle. For example the main risks faced and posed by residents are assessed and any measures to reduce or manage the risk is recorded in order for staff to follow. Care Homes for Adults (18-65 years) Page 15 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities are available for residents to maintain practical life skills are part of an enabling lifestyle. Residents benefit by being supported to maintain relationships with their families and friends. The meals are good offering both choice and variety and catering for special dietary needs. Evidence: Some opportunities are available for residents to continue to use practical life skills in order to maintain their lifestyle. This included involvement within individual levels of preferences and strengths in domestic and other light housekeeping tasks attending Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: college to undertake various courses. Staff spoke of residents individual weekly activity plans which have been developed based on the likes and preferences of residents and include a variety of activities and community involvement. This included buggy riding with horses, college, hydrotherapy, bike riding, holidays and shopping trips. Staff said that the weekly plans were flexible depending upon the residents preferences and needs at the time. A staff member spoke of being able to take a resident out on the bus for either a drive or to visit somewhere whenever they wanted, as this was one of their main interest. A member of staff said in response to what the home does best is the provider tries to better the lives of residents by giving them the opportunity to go out as much as possible. One residents spoke of recently celebrating their birthday at the home. It was evident that residents are supported and encouraged to maintain family links through visits to their family, having family visit them at home and through telephone contact. One resident is supported to maintain contact with the residents from the organisations sister home where they used to live. On the day of the inspection, it was observed that the routines of the home were reflective of residents individual needs and their preferences. Residents were able to move around the communal space freely, choosing which rooms to be in and what level of company they wanted to enjoy. Staff spoke of the flexibility in daily routines regarding meal times, going to bed, rising and bathing. The manager reported that residents are involved in menu planning, shopping for food and in some cases help prepare meals and snacks. Menus showed that a varied and balanced diet is provided which includes fresh produce which have been developed with guidance from dieticians. Mealtimes and arrangements for eating are tailored to meet the individual residents needs and what events and activities were occurring that day Care Homes for Adults (18-65 years) Page 17 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from personal and health care support that is individual, respects their privacy and dignity and encourages them to remain as independent as possible. The medication systems are well managed promoting good health Evidence: During the inspection staff were observed to support and care for residents in a sensitive manner whilst offering choice and encouraging independence. Personal care practice were discreet and respected the privacy and dignity of residents. Good attention was given to the personal appearance of residents, which was age appropriate and afforded choice. Staff were observed using a variety of communication methods when supporting residents including humour. However, as previously stated care plans need to provide clear guidance on how to support residents with complex challenging behaviour to ensure that consistent support is provided and is in accordance with professional guidance. Staff support residents to ensure their health needs are met, with care plans containing a record of any visits or contact with professionals external to the home. Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: There was evidence of current involvement from General Practitioners, behavioural management teams, specialist nurses and psychologists. There was evidence to indicate that where concerns have been raised about the health care needs of residents then this has been sought promptly. A health care professional spoke of staff following their guidance and how professional staff were. The system for the administration of medication were good with clear and comprehensive arrangements being in place to ensure residents medication needs are met. Good practices were noted in the administration of PRN medication which provided staff with clear instructions when these types of medication should be prescribed and clear records of when they were prescribed to ensure that there use can be effectively monitored. 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. An effective complaints procedure and appropriate adult protection policies helps to protect the rights and interests of residents, with some further guidance needed on one care plan to enable staff to provide a consistent approach when supporting a residents when they raise previous safeguarding concerns. Evidence: There is an accessible complaints procedure in place for residents, their representative and staff to follow should they be unhappy with any aspects of the service. Although it is recognised by staff that residents would require support to make a complaint and were knowledgeable on how they would support a resident to do this. No complaints have been received or recorded by the home. The manager reported that they have implemented a new safeguarding adults procedure and had identified that some staff needed to update their training and had arranged for this to be completed. Staff consulted with demonstrated a good understanding of their roles and responsibilities under safeguarding adults guidance. As previously noted care plans need to provide clear guidance for staff on how to support a resident when they recall past traumatic events and use current staff names when talking about these past events. This is to ensure that staff provide a consistent approach and helps to protect the resident and staff from safeguarding allegations. At the time of inspection a safeguarding referral had been made to social services for Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: investigation, relating to the management of an episode of challenging behaviour and at the time of this reports publication the outcome had not yet been concluded. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a clean, homely environment, which has been decorated and furnished to a high standard with their bedrooms furnished and decorated according to their individual needs and lifestyles. Evidence: The home is set back from a main road in its own secure grounds, although the home is not close to other domestic properties and local community resources are a short drive away this seems to suit the needs of residents as they appear to benefit from the peaceful location and being able to access the garden and countryside. The manager spoke of the organisation having its own maintenance staff which enabled repairs to be undertaken promptly. There was a high standard of decoration and repair throughout the home. Residents bedrooms were highly individualised reflecting individual lifestyles and preferences. Communal space in the main house consists of a lounge, dining room and kitchen with much thought having been given to creating a domestic environment. The home is surrounded by secure gardens, which overlook farmers fields where animals graze and which provides a focal point. The garden is well maintained and has seating areas, Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: a resident enjoys being able to play football in the garden. The annex which consists of a bedsit style arrangement is also decorated, furnished and maintained to a high standard, creating a very pleasant and individualised place in which to live. There are sufficient number of toilets and bathrooms located around the home including all bedrooms providing en suite facilities or having exclusive use of bathing facilities. The home is not designed to offer a service to people with physical disabilities and the stairs and other access arrangements would make it unsuitable for residents with significantly restricted mobility. Generally residents do not currently need any specialist equipment to help with mobility or independence around the home. Consistent feedback was received that standards of hygiene and cleanliness are high which was also confirmed during the inspection with all areas observed to be cleaned to a high standard. 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. Staff clearly make a positive contribution in residents lives as residents benefit from a supervised, and enthusiastic staff team that know them and who are robustly recruited as is necessary for their safety and to be able to meet their needs. Any training gaps had been identified by the manager with action being taken to address. Night time staffing levels are currently under review to ensure they remain appropriate. Evidence: Staff confirmed that the normal staffing structure is for two support workers during the waking day, plus a person in charge which is usually the manager who also part of the day. This they felt was sufficient for them to be able to provide the one to one support two residents are assessed as needing and provide the necessary supervision and support to the third resident. However due to recent changes in a residents night time needs the manager, in response to staff feedback, is currently monitoring the night time staffing arrangements to establish whether the sleep in night arrangements are sufficient. A letter of compliment was seen from a relative which praised the professionalism of staff and thanked them for the support offered to their relative. Staff were observed Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: supporting residents sensitively and were very knowledgeable on the individual needs and preferences of the resident they were supporting. The home has been proactive in ensuring that the majority of staff receive a National Vocational Qualification (NVQ ) in Care or are in the process of working towards it. The home also employs several part time registered mental nurses and who have known the residents for a significant number of years. Staff consulted with said that they had completed all of the mandatory areas of training needed for them to work safely with residents. This included manual handling, first aid and medication and spoke of the areas of specialist training that they have also undertaken in learning disabilities. The manager had identified that some staff needed to update areas of their training including safeguarding adults and the need to provide further areas of specialist training for example in challenging behaviour and had developed a training needs analysis in order to address this. The manager reported that there is little staff turnover and uses a pool of the organisations bank staff to cover leave. The personal files of three staff were inspected and these showed that a good recruitment process is followed which includes the use of an application form, interviews, Criminal Records Bureau (CRB) checks and written references prior to employment commencing. This helps to ensure that only staff who are suitable to work with vulnerable people are employed. Staff said that they receive regular supervision with the manager regarding their performance, conduct and training needs. All staff consulted said that they felt well supported by the manager and provider to undertake their roles and felt able to approach them for advice and guidance. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents continue to benefit from an experienced and established manager who ensures a clear ethos and values of the home enabling staff to provide good quality care to residents with the home managed in the best interest of residents. The home regularly reviews aspects of its performance through a program of selfreview and feedback. A range of regular health and safety checks helps to promote the health and safety of residents and staff. Evidence: The manager has worked at the home since it open in 2006 and became the registered manager in March 2007. They hold the recommended management qualifications and demonstrated much commitment and enthusiasm to improve outcomes for residents and for the services provided to remain resident focused. Consistent feedback was received regarding their approachability and a sample of Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: comments about the manager included good manager any problems you can talk to although very young knows his job very nice guy open can approach him tell him and he sorts it out and will listen and takes on board what staff have to say. There are several mechanisms in place for the manager to obtain feedback on the quality of the services and whether it is achieving its aims and objectives. This includes feedback surveys, annual placement reviews, monthly health and safety audits. The organisation has been awarded the Quality management system ISO 9001. This sets universal good practice standards of administration to which the home has consistently met since 2005. Written guidance is available on issues related to health and safety. Records submitted by the home stated that all of the necessary servicing and testing of health and safety equipment has been undertaken including regular internal health safety checks. Systems are in place to support fire safety, which include regular fire alarms and emergency lighting checks, staff training and maintenance of fire equipment and fire drills were reported to have been undertaken. The manager reported that a fire risk assessment has been completed which records significant findings and the actions taken to ensure adequate fire safety precautions in the home. The required monthly visits to monitor the services and facilities by the responsible individual is undertaken by a representative. 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 1 6 15 That care plans provide clear 17/07/2009 guidance for staff on managing individuals challenging behaviour. To ensure that staff support residents in a consistent way 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. 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