Care Home: Oak House

What the care home does well Oak House is a well run and well managed home for people with mental health issues. Sound quality assurance systems ensures that the quality of care is regularly monitored and improved. Robust and sound care plans ensure that the service is meeting peoples needs. People using the service are enabled to live as independent as possible. Restrictions to their independence are clearly monitored and are reviewed if necessary. Staff is motivated and are valued by the provider. This is done by providing a wide range of training, regular supervisions and opportunities to develop their career in the care sector. What has improved since the last inspection? This was the first inspection of the home since registering with the CQC in February 2010. What the care home could do better: We have made three requirements during this key inspection. The responsible person must ensure that Care Plan Approach meetings are arranged regularly to assess the progress of the people using the service and find new ways to improve their lives. The broken light in the small patio from the kitchen must be repaired to ensure people using the service can use the area and are safe. The loose tap in the upstairs WC must be repaired, to ensure the tap can be used safely and further damage is prevented. Key inspection report Care homes for adults (18-65 years) Name: Address: Oak House 37 Park Avenue London London N18 2UP     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: Andreas Schwarz     Date: 1 1 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Oak House 37 Park Avenue London London N18 2UP 02088048101 02083662638 tim@conniferscare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Connifers Care Limited Name of registered manager (if applicable) Ms Emmanuel Ayitey Type of registration: Number of places registered: care home 3 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: Three The Registered person may provide the following categoriy of service only: Care home only--Code PC To service users of the following gender: Either Whose primary care needs on admission are within the following categories: Mental Disorder, excluding learning disability and dementia Code--MD Date of last inspection Brief description of the care home Oak House is part of Conifers Care Ltd, which has another ten care services in and around Enfield. Oak House is located in Tottenham in a quit residential street near Fore Street. A large park is in walking distance. The home has no allocated parking , but free parking is available at Pymmes Park, which is a two minute walk from the home. Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 3 Brief description of the care home The nearest tube station is Seven Sisters Road, which can be accessed via bus. A British Rail station can be reached by foot. The home is a two storey building with accomodation on the ground floor and first floor. Information in regards to weekly fees can be found in the service users guide or can be obtained from the registered manager on request. Care Homes for Adults (18-65 years) Page 5 of 29 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: This unannounced key inspection took part in May 2010 and lasted six hours. This was the first key inspection since registering with the Care Quality Commission (CQC) in February 2010. The registered manager was available throughout this key inspection. We were able to speak to registered provider at lengths. The team leader arrived at midday and was available for questions. We spoke to two people using the service and the team leader during this inspection. A very detailed and highly comprehensive Annual Quality Assurance Assessment (AQAA), was sent to us within the given timescale. We assessed three care plans, three staffing records and other records providing us with evidence to make a sound judgement about the quality of care provided to people using the service. We would like to take this opportunity thanking everybody involved in the key inspection and making it such a pleasant and positive experience. Care Homes for Adults (18-65 years) Page 6 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All new people using the service receive a comprehensive needs assessment before admission. This is carried out by staff with skill and sensitivity. The service is highly efficient in obtaining a summary of any assessment undertaken through care management Evidence: We have viewed the homes statement of purpose and service users guide, both documents are of very good standard providing prospective people using the service with detailed information of the staffing structure, care and support provided the home, layout of the premises, complaints procedures, admission procedures, etc. The home informed us in their Annual Quality Assurance Assessment: The home provides new service user with a welcome pack to give them information about the service. This includes information on their terms and conditions, drug and alcohol policy, smoking policy, complaint procedure, equal opportunities procedure and health and safety information. We have viewed thorough assessments in all three care plan folders assessed during Care Homes for Adults (18-65 years) Page 9 of 29 Evidence: this inspection. This confirms the information provided by the home in their AQAA, We undertake a comprehensive assessment together with the service users Care Coordinators, Psychiatrist, Social Worker and his/her carer or next of kin. Prospective people using the service are assessed prior to moving in to the home, the home does not accept emergency admissions. Once the assessment is undertaken the prospective person will get feed back of the outcome of the assessment within 48 hours. It was evident in the assessments we have viewed that people using the service were involved in the assessment process. The assessment is judged as very comprehensive addressing the persons mental health, forensic history, physical health and a proposed care plan. To monitor if all information is given to people using the service, residents are given an admissions questionnaire, which ensures that all necessary information relevant to the person moving in to Oak House is provided. The detailed assessment procedure ensures that the home is able to meet the persons need and enables the home to look into ways to meet the need if facilities are inadequate. Such as training staff and any specialist support which needs to be put into place prior to moving in. During the first part of this inspection we met with the registered provider, who informed us that contracts are currently in the process to be completed for the two people who have moved in recently. We were able to view one contract, signed by the resident, which was judged as very detailed, providing the relevant information such as room allocation, fees, house rules, etc. Care Homes for Adults (18-65 years) Page 10 of 29 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. The service involves individuals in the planning of care that affects their lifestyle and quality of life. The care plans are person centred and are agreed with the individual. The care plan includes a comprehensive risk assessment, which is regularly reviewed. The service has a can do attitude and risks are managed positively to help people using the service lead the life they want. People using the service make their own informed decisions and have the right to take risks in their daily lives. Evidence: We assessed care plans of all three people using the service. The home has admitted one person at the end of February 2010, the second person in mid March 2010 and the last person at the end of April 2010. All care plans viewed were very detailed and people using the service were involved in the implementation of the care plans. The registered manager informed us that key workers meet monthly with people using the service to discuss care plan objectives, outcomes of these meetings are recorded in detail and are included in the six monthly review process. The home has arranged a Care Plan Approach (CPA) meeting for the person who moved into the home in March Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: 2010. We spoke to the service user who informed us that he is happy at Oak House and staff support him in areas he is unable to do independently. During the discussion with the person we were told that he is not happy with the 10:00pm curfew and the policy of not being able to self administer his medication. We discussed this with the manager and the person and suggested to discuss this during the upcoming CPA meeting at the end of May 2010. We noted in one of the care plans that the last CPA meeting was undertaken in November 2008, since then the person has moved from another home managed by Conifers Care to Oak House and became more stable, it is therefore required to arrange a CPA meeting within the next two months to address the progress of the person. We observed people using the service leaving the home independently and using a key to let themselves in and out of the premises. Breakfast and lunch is prepared by people using the service independently and the kitchen is accessible 24 hours. We observed people using the service preparing lunch and dinner and helping themselves to fruit and drinks. People using the service are encouraged and supported in making decisions about their care and support during progress reviews and on a day to day basis. Advocacy information is available and the local MIND office is in close proximity to Oak House. One person told us that he is going regularly to MIND, which enables him to make friends and get help and support if required. People using the service manage their own finances and we observed one person contacting the Department for Work and Pension (DWP) to find out about his benefit. Any limitations such as no visitors after 10:00pm and returning to the home by 10:00pm is clearly stipulated in the admissions handbook. We observed however that people using the service are able to have overnight stays if this is discussed in advance,enabling the home together with the person to design a risk management plan for this activity. Risk assessments are detailed and a thorough risk management plan is in place. Risk assessments address warning signs, how to manage the risk and who to contact if the person becomes or is at risk. In addition to a general risk assessments all people using the service have a very detailed clinical risk assessments, which looks at triggers or signs of relapse in the persons state of mental health. The manager informed us that risk assessments are reviewed during monthly progress meetings or if risks to the person have changed. Care Homes for Adults (18-65 years) Page 12 of 29 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. The service has a strong commitment to enable people who use services to develop their skills, including social, emotional, communication, and independent living skills. Individuals are supported to identify their goals, and work to achieve them. People who use the service have the opportunity to develop and maintain important personal and family relationships. People who use services are involved in meaningful daytime activities of their own choice and according to their individual interests and capability. Meals are well balanced and highly nutritional and cater for cultural and dietary needs of the people who use services. Evidence: We received the following comments in regards to the lifestyle of people in the AQAA: We encourage our service user to participate in planning their daily activity. Service users keep a copy of their weekly activity plan. We provide weekly activity group for all the residents within the company and we also provide refreshments during the Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: sessions. We encourage all our residents to participate in weekly menu planning and ensure that all service users have a menu of their choice frequently. One of the people told us that he is accessing Barnet College for literacy and numeracy classes twice a week. He told us that he is also planning once he has completed the courses to look into further education, which would enable him to gain employment. Another person told us that he is planning to do similar courses in September 2010. Care plans viewed demonstrated that further education is discussed with all people using the service. The manager told us that access to further education is depending on the willingness and ability of the individual. Another person informed us that he is visiting a drop in centre run by MIND on a daily basis, which was observed during this visit. The home provides during the admissions process information of amenities and opportunities for further education, but leaves it to the individual to decide if they want to make use of these. People using the service are able to access the community independently, shops , pubs and restaurants are in close proximity to the home. Libraries and sports facilities are available in Edmonton Green, which can be accessed easily by public transport. Staffing ratio is consistent during weekdays and weekends and senior staff is available seven days a week. Staff have taken part in equality and diversity training and the staff team reflects the cultural diversity of people using the service and the community. People using the service are enabled to maintain and make relationships. One person is regularly visiting his partner, who is also able to come to the home. Family involvement is encouraged, but is depending on the wishes of people using the service. The home has an open house policy, which states that up to 10:00pm people using the service can welcome visitors in their home and room. During the initial assessment process people using the service design together with the key worker an activity plan. This activity plan is reviewed regularly and new activities are suggested. People using the service have an allocated laundry day and are responsible for the up keep of their personal space. All people using the service have a key to the front door and their room and can access all areas in the home. Smoking is prohibited on the premises, but people using the service are able to smoke in the patio area from the kitchen and dining/living room. We noted however that there was no ashtray, we discussed this with the manager and recommended having an ashtray fitted to the wall in both smoking areas. As mentioned earlier people using the service can make their breakfast and lunch Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: independently. Evening meals are discussed on a weekly basis and a menu plan is put into place. We assessed the menu plan for the current week, the menu is judged as healthy, culturally appropriate and nutritious. People using the service have two allocated days to do the cooking with care staff. One of the people using the service does all his meal preparation independently and purchases ingredients locally. Care Homes for Adults (18-65 years) Page 15 of 29 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. Personal health care needs including specialist health, nursing and dietary requirements are clearly recorded in each persons plan. Personal support is responsive to the varied and individual needs and preferences of the people who use services. People who use services have access to health care and remedial services. The home has an efficient medication policy supported by excellent procedures and practice guidance, which staff understand and follow. People who use services are given the support they need to manage their medication. Evidence: The home made the following comments in their AQAA: Residents are able to provide for their own personal care. We ensure they have all the facilities and necessary items in order to do this. Staffs are always sensitive to residents needs and respect residents privacy at all times. We keep accurate records of healthcare appointments and all residents have access to all services that they required. When a resident refuses to attend healthcare appointments this is well documented and reported to the appropriate professionals. CPA meetings are always attended and documentations are in place. All residents have monthly health checks which are recorded in the files. All visits from professionals and to professional are recorded. Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: People using the service manage their personal care needs independently and do not require support around eating their meals. We noted that all people using the service were well groomed and dressed during this inspection. People using the service can choose when to get up or go to bed, provided they have taken their medication within the prescribed times. The home supports people using the service during their admission to register with with a local GP and are allocated for a key worker responsible with day to day help, support and advice to enable people improving their lives. The home and organisation has excellent links with local mental health teams and Registered Mental Health Nurses are available internally to deal with emergencies. We viewed detailed health care records in service users care folders, outcomes and actions of these visits are clearly recorded and follow up appointments are documented in the homes dairy ensuring that people using the service are reminded to attend these appointments. Clinical Psychiatrists review peoples health six monthly or annually and further appointments can be arranged by the home if required. One person told us that he visited his Community Psychiatric Nurse for a depot injection in the morning of this key inspection. The home has a detailed medication procedure in place. Medication is stored safely in a lockable cabinet. The manager informed us that none of the people using the service self medicate currently as per policy. This however should be reviewed for one of the people using the service as discussed earlier in this report. Each person has an individual medication folder, which contains a medication administration sheet (MARS), information about the medication, any risk assessments relating to the medication administration. Staff take part in medication awareness training during their induction, but are not allowed to administer medication until they have taken part in a detailed medication training provided by Enfield council. Once people are assessed as competent in the administration of medication they are required signing a competency sheet, which is held in the individual medication folders. MARS had no omission and a separate form is in place for staff to record and people using the service to sign when medication leaves the premises for social leave. Each service users has an individual PRN profile. The responsible person told us that a controlled drugs cupboard has been ordered, this is however not imminently pressing as none of the people using the service are on any controlled drugs. Homely remedies are stored in a separate lockable medication cupboard and each person has a individual profile in place. We viewed information in peoples care folders in regards to their wishes in the event of death or serious illness. People using the service are able to voice their wishes in Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: regards of burial and funeral arrangements. The form is filled out together with the service users during the initial admission to the home. Care Homes for Adults (18-65 years) Page 18 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an open culture that allows people using the service to express their views, and concerns in a safe and understanding environment. The policies and procedures for Safeguarding Adults are available and give clear specific guidance to those using them. Evidence: The home told us in their AQAA that no complaints have been made since registering with the CQC. The complaints procedure is provided to people using the service in their welcome pack and is also displayed on the notice board in the hall way. All people using the service are verbal and able to raise dissatisfaction and satisfaction about the care and support provided. The home has a compliments book, one family member made the following comments, I was impressed with staff and the place. We spoke to two people using the service who had no issues or complaints which they would want to raise with us. The home made no safeguarding referral since registering with the CQC. Clear safeguarding procedures are in place and all staff have taken part in safeguarding adults training. Robust recruitment procedures ensure that all staff are vetted thoroughly prior to being offered employment. Care Homes for Adults (18-65 years) Page 19 of 29 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. People using the service live in a comfortable, clean and homely environment. Evidence: The home has been previously registered under a different provider, since been taken over by Conifers Care Ltd, the home has undertaken a full refurbishment. The registered provider told us that a £50.000 investment was made to bring the home up to meet National Minimum Standards. On the ground floor of the property is one service users room, the kitchen, which has access to a small patio area. The lounge and dining room is located in a newly build conservatory, which has access to a small but suitable paved garden. A separate toilet and bathroom is located on the ground floor. Two further bedrooms, a WC and the office is located on the first floor. We used the upstairs toilet and noted that the tap in the sink is loose, which must be addressed. The home is nicely decorated and furnishing is comfortable and of good standard. We noted that the light in the small patio leading from the kitchen is broken, which must be repaired. A washing machine and electric clothes dryer is in the kitchen. People using the service have allocated laundry days. We were not able to see service users rooms during this inspection. Separate facilities to store cleansing materials are in place. Regular Health and Safety checks ensure that people live in a safe and well Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: maintained home. The home was clean , light and airy during this inspection. Care Homes for Adults (18-65 years) Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be confident that they are supported by a well qualified and supported staff team, which has good understanding of their needs and health. Evidence: We viewed the current staff rota, the home has six staff members employed, some of the staff work full time and some part time. The rota showed us that staff is on duty 24 hours. The management structure in the home is one registered manager, one team leader, one senior support worker and four support workers. People using the service told us that staff is always available and a senior member of staff is on duty during the weekend. Emergency contact numbers are displayed on the noticeboard in the office. The registered manager is a RMN, four support workers hold their National Vocational Qualifications in Care and the two staff which have joined most recently have applied for funding to gain this qualification. The organisation has very good links with Skills for Care, which enables them to access training and funding for care related qualifications. We viewed three staffing folders during this inspection all necessary records such as Criminal Records Bureau Check (CRB), two references, right to work in the UK, proof Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: of address, application form, interview records and contracts are in place. New applicants are interviewed by four directors to ascertain their suitability of working with this client group. The home is providing a wide range of training, to name just a few, Challenging Behaviour, Health and Safety, medication awareness, Adult protection, Mental Health, Equality and Diversity, etc. Adult protection training has been arranged for June and some staff take part in risk assessment training and infection control training during May 2010, this was indicated on the staffing rota. All staff have individual training records, which are updated regularly. A list of training and when they will expire was on the noticeboard, which helps the manager to forward plan and book support staff on refresher training. All new staff have to undertake a six week induction programme, records of this has been viewed in staff folders assessed during this inspection. A separate supervision folder is in place, we sampled supervision records for three members of staff and it was clearly evident that all staff receive one to one supervisions every two months. Staff working for the organisation over one year are invited by the manager for a performance appraisal. Care Homes for Adults (18-65 years) Page 23 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be confident in the management of the home. Sound quality assurance measures ensure that people using the service are protected and quality outcomes are continuously measured to improve the service to people. Evidence: The registered manager has a number of years experience in managing mental health service. He is a registered mental health nurse and has been working in mental health settings for the NHS. He informed us that he has started his Registered Managers Award. We spoke to the team leader, who informed us the the manager is supportive and approachable. The organisation has a sound management structure in place, which ensures the manager is supported and quality outcomes are monitored regularly. The responsible person is regularly available and has sound knowledge of community care and mental health, previous to managing the organisation he was employed as a Commissioner for Barnet Primary Care Trust. Since opening the home has had one residents meeting, the agenda for the second meeting was displayed on the noticeboard in the kitchen. The organisation arranges Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: quality assurance meetings every two months, the meetings are attended by a representative of the senior management board. A full quality assurance check is undertaken every six months, which is based on the outcomes of the National Minimum Standards. The last assessment was undertaken in March 2010 and areas raised during this assessment have been addressed. Staff have the opportunity to meet monthly to discuss issues relating to the home and the support provided to people using the service. Health and Safety certificates have been assessed as compliant during the registration. We sampled the fire risk assessment, which is of good standard. A wide range of Health and Safety policies are in place in a folder in the office and staff indicate with their signature that they have been read. In addition to this new people using the service are issued with some basic Health and Safety policies in their welcome pack. Care Homes for Adults (18-65 years) Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 29 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 The responsible person must 01/07/2010 ensure that all people using the service have regular CPA meetings This ensures that the persons progress is discussed and future plans relating to the person are discussed and actioned. 2 24 23 The responsible person must 01/07/2010 repair the tap in the upstairs toilet This ensures that the tap can be safely used and the risk of flooding is minimised. 3 24 23 The responsible person must 01/07/2010 ensure that the outside light in the small patio area is repaired. This ensures people using the service are able to access the area safely. Care Homes for Adults (18-65 years) Page 27 of 29 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 The responsible person should ensure that issues of self medication and 10:00pm curfew is discussed during the CPA meeting arranged at the end of May 2010. We recommend to provide ashtrays for both smoking areas, this prevents the fire risk and makes the areas tidier. 2 16 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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