Care Home: PIA 132 Manor Court Road

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What the care home does well Good care plans are in place containing a lot of useful information to help staff to give the correct care and support to people to meet their needs in the way they like. People are supported to attend appointments with health professionals to help them to stay in good health. People are supported to get out and about to shops, theatres, parks and other places they enjoy so that they take part in the like of the local community. The people at the home are encouraged to make everyday choices, such as what they do and what they eat. People are involved in planning the menus so they can choose the meals they like to eat. Suitable complaints procedures are in place at the home and staff are trained to recognise and report any suspicions of abuse so that people are protected from harm. Overall the home provides a clean and comfortable place for people to live in. Grab rails, hoists and other equipment are in place to assist people with disabilities to be supported properly. Most of the staff have been at the home over two years which helps to support consistency of care for people. Staff are properly vetted and provided with a good range of training to enable them to meet people`s individual needs, such as epilepsy, diabetes and dementia. Systems are in place for checking that the home is running properly. A senior manager visits the home and writes a monthly report of her findings and any action that needs to be taken to improve things What has improved since the last inspection? Good work has taken place to arrange for the epilepsy nurse specialist to review and sign epilepsy protocols to ensure that they continue to contain the correct guidance for staff to follow in the event that a person has a seizure and needs extra medication. A new dining table and chairs has been bought for the downstairs dining room and the dining chairs have been replaced in the upstairs dining area. Surveys were sent to the people at the home and their relatives last year so they could give their views of the home. The manager reports that surveys are being sent to people again this year. What the care home could do better: There is a need for people`s relatives to be sent a copy of the contract, including their fees so that everyone is clear about what has to be paid for and to show that individual`s interests are being represented. There is room for increasing the information available in some people`s communication guidelines to help new staff to quickly get to understand people`s needs. The manager agreed to seek the advice of a speech therapist to assist with this work.Overall the home is in good condition, however there is scope for planning to replace the floor coverings in the main hallways to ensure it is nice and homely for people. Staff are trained to give out medication safely and overall the medication is well managed. However there is a need to keep better checks of the medication that is given out on an "as needed" basis, such as paracetamol, to make sure it always accounted for correctly. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: PIA 132 Manor Court Road 132 Manor Court Road Nuneaton Warwickshire CV11 5HQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kevin Ward     Date: 1 8 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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: PIA 132 Manor Court Road 132 Manor Court Road Nuneaton Warwickshire CV11 5HQ 02476383986 02476640146 jmorrissey@people-in-action.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : People in Action care home 8 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: Date of last inspection Brief description of the care home 8 132/134 Manor Court Road is a registered care home for eight people with learning disabilities and has been separated into two separately staffed homes that occupy the top and ground floors of two semi-detached houses. Effectively these are two group living homes. People in Action provide 24 hr personal care and support. 132 Manor Court Road is situated on the ground floor of the house and can accommodate four people with physical and learning disabilities. Each service user has their own bedroom with shared facilities of a kitchen, bathroom with W. C., separate WC and large lounge/dining room. There is a separate laundry area. 134 Manor Court Road can accommodate four people with learning disabilities and is situated on the first-floor level of the house. Each service user has their own bedroom with shared facilities of a kitchen/dining area, laundry, and bathroom with WC and lounge. There is a shared garden to the rear of the house. The property is situated close to Nuneaton town centre. Rail and public transport links are nearby. There is limited off-road parking. Individual placement fees range between two hundered and eighty four pounds and seven and ninty one pounds per week. The people that live at the home Care Homes for Adults (18-65 years) Page 4 of 30 Brief description of the care home are required to pay for personal items, such as hairdressing, toiletries, holidays, recreation, clothing and transport. 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: The quality rating for this service is 2 star. This means that people who use the service experience good outcomes. This was a key unannounced inspection, which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for residents. The inspection focused on assessing the main key Standards. As part of the inspection process the inspector reviewed information about the home that is held on file by us, such as notifications of accidents, allegations and incidents. Care Homes for Adults (18-65 years) Page 6 of 30 The inspection included seeing everyone living at the home. Due to the communication needs of most people living at the home it was not possible to get a clear impression of their views of the service. The inspection also included case tracking the needs of three people that live at the home. This involves looking at their care plans and records and checking how their needs are met in practice. Discussions took place with four staff on duty, as well as the manager. A number of records, such as care plans, complaints records and fire safety records were also sampled for information as part of this inspection. An annual quality assurance assessment was completed and returned by the provider giving the managers views of the homes performance during the last year. What the care home does well: What has improved since the last inspection? What they could do better: There is a need for peoples relatives to be sent a copy of the contract, including their fees so that everyone is clear about what has to be paid for and to show that individuals interests are being represented. There is room for increasing the information available in some peoples communication guidelines to help new staff to quickly get to understand peoples needs. The manager agreed to seek the advice of a speech therapist to assist with this work. Care Homes for Adults (18-65 years) Page 8 of 30 Overall the home is in good condition, however there is scope for planning to replace the floor coverings in the main hallways to ensure it is nice and homely for people. Staff are trained to give out medication safely and overall the medication is well managed. However there is a need to keep better checks of the medication that is given out on an as needed basis, such as paracetamol, to make sure it always accounted for correctly. 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 set out 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is scope for increasing the information available to people and their relatives so that everyone is clear about their rights and what they have to pay for. Evidence: One new person has moved to the home since the last inspection. The manager explained that the move was hastened by the closure of another service run by the organisation and included the involvement of Warwickshire Social Services. This was verified in information the persons file. The person concerned said that they did not have many other options to move elsewhere as their last home was closing but said they were provided with the opportunity visit and meet people before moving in. The persons file included pre admission information from the social worker and an assessment and care plan that had been promptly completed by the manager shortly following the persons admission. A service user guide was seen on peoples files containing information about the service they expect from the home. Contracts were also looked at on two peoples Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: files. The contract did not contain the current fees and extra charges that are levied by the home and which are referred to in the service user guide. The contracts had not been signed by relatives or advocates, which is good practice to show that peoples interests have been represented effectively. The manager said that she would ensure that relatives were provided with this information. The manager also agreed to place a service user guide on display downstairs to remind people of their rights and said that people would also be periodically reminded of the information at their house meetings. 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. Peoples needs are for are planned for and reviewed so that they can be supported in a safe and appropriate manner. Evidence: Three peoples care plans were checked. Each person has a care plan in place containing good levels of information about their personal routines and likes and dislikes so that staff are able to support people in the way they like. This is particularly helpful for people who cannot easily say what they want so that their known choices can be respected. The records in the care plan are dated to show when they were last reviewed or amended. The dates on the records seen indicate that most documents, including information about personal care and risk assessments are being reviewed periodically or as needs change to keep the information up to date. A person at the home confirmed that they had been involved in meetings about their future care. Entries in Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: social work review documents also demonstrate that people are encouraged to take part in reviews. Comments by staff demonstrated a satisfactory understanding of peoples needs and of the support they are expected to provide. For example staff were aware of the frequency they need to carry out blood sugar tests for a person with diabetes and when to seek medical advice and assistance. Risk assessments are in place addressing hazards associated with everyday living and peoples specific needs e.g. going out in wheelchairs, bathing, epilepsy and diabetes care. The communication guidelines in two peoples folders were seen to contain only brief details about peoples needs. The manager agreed to refer the two people concerned for a service from the speech and language therapist to consider any other ideas for aiding communication, such as audio communication passports. The manager also said that she would increase the information in peoples communication guidelines, where necessary so that new staff joining the home have all the information they need to help them to communicate with people more easily. Positive work has been carried out to make some documents easier for people to read, such as the service user guide and complaints procedure. The people at the home are being encouraged to make everyday choices. Pictures are available to help people to plan the menus and a folder containing brochures about day trips are available to help people to choose where they want to go. Two people confirmed that they go shopping to choose their own clothes and personal items and a person at the home went shopping on the day of the site visit to choose curtains for their bedroom. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with access to the community and go places they enjoy to meet their social needs. People are involved in menu planning so that that they receive the meals they enjoy. Evidence: Six people attend day services on a part time basis during the week and two others stay at home with staff support. One of the people that does not receive a day service confirmed that they are happy with the level of support provided them to get out and about. They said that they have frequent visits from their brother and go to see him regularly at his home. They also said that they often go to town several times a week to shop for personal items and have coffee, as well as trips to the pub and going to cafes for lunch. They also said that they do some shopping for grocery items for the home and visiting places. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: The records of another person show that they are regularly supported to attend music classes at Bedworth college, go shopping, local walks, and going for meals. They have recently been to a safari park on a day trip and are regularly supported to see their father. They have recently been supported to go shopping to choose the paint to decorate their bedroom. On the day of the site visit they were supported to choose curtains to match their newly decorated room. Other examples given of activities and trips that take place include bowling, cinema, theatre and country parks. Comments by people at the home and staff confirmed that people are supported to celebrate their Birthdays, which may include a trip to the cinema or theatre or going out for a meal, dependent on individuals choice. Similarly staff said that relatives are invited to attend some parties and celebrations e.g. Easter, Christmas and bonfire night parties. This was also verified by a person living at the home. A member of staff confirmed that plans are being made for people to go places on holiday. One person has already been to a Butlins holiday camp this year and two people have plans to go to Cyprus in August 09. Most people at the home require staff to prepare their drinks and meals. One person at the home confirmed that they make their own hot drinks and snacks on occasions. The homes menus indicate that efforts are being made to provide people with a suitably balanced diet. A staff member explained that efforts are made to buy healthier foods for people, such as low fat milk, yoghurts and biscuits to help people to have a better diet and not increase their weight. Fruit was available in the home for people to eat. Peoples likes and dislikes are recorded in their files so that staff know what people enjoy. Information contained in health records indicates that the home makes appropriate use of the community dietician to provide advice and monitor the weight of people where necessary. As previously noted pictures of meals are available for staff to help people to choose from when planning the menus. A person with good verbal communication skills confirmed that the food is to their liking and well cooked. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are for are planned for and reviewed so that staff have suitable information to support people in a safe and appropriate manner. Evidence: As previously noted, peoples care plans include good details of their personal care routines and patterns of daily living. This enables staff to be more sensitive to peoples needs and support them in the way they prefer. Staff were seen to be friendly and responsive to people. A person at the home confirmed that she never has to wait long to receive support from staff when she wants it and said I like some best but they are all nice The people at the home were observed to be dressed in an age appropriate manner indicating they are supported to maintain a good self image. A listening device is in place in one persons bedroom to enable staff to monitor any seizure activity. The manager said that she had just learnt of new seizure monitoring equipment on the market that activates an alarm when people have a seizure and Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: intrudes less on their privacy. The manager said that she would be investigating the suitability of this equipment for the person concerned. Three peoples health care plans and records were looked at. The plans contain satisfactory level of information about peoples health-care needs and the records are well maintained to show that health care monitoring is taking place. Information in peoples plans show that specialist nurses, such as diabetes and epilepsy nurses have been involved to draw up protocols to support staff to monitor and respond to the needs of people with these conditions. The records show that people are being supported to attend appointments with consultants and other health professionals e.g. speech therapists, dietician, psychiatrist and psychologist. Similarly people are being supported to see local health-care professionals such as dentist opticians and chiropodist for check ups and treatment. One person has recently been supported to attend a retinal screening appointment, in keeping with their needs and bone density scan. The health records show that a person with dementia is being monitored by health professionals to determine any changes in their condition. Two peoples recent medication records were sampled. The records indicate that staff are keeping a record of the number of tablets received at the home and any tablets carried over from prior to the new delivery. A running balance is being kept of peoples PRN (as required) medications. Three PRN medications were checked against the record. One persons record was incorrect and indicated that there should be 102 paracetamol tablets in stock when in fact there were only 86 in the packet. A member of staff explained that there had been no space left in the correct area on the countdown record so she had recorded it elsewhere. It was unclear as to where some of the other unaccounted for paracetamol had been recorded. The manager said that she would set up a new sheet with more space to record individual PRN medication, as the current sheets are used to record three different medication types, which can be confusing. Since the site visit the manager has confirmed that this change has been made. The manager also agreed to carry out frequent management audits of the PRN medication records to make sure that all the medication can be properly accounted for and said that checks of PRN medication would be included in the shift handover check. Protocols are in place for people prescribed PRN medications so that staff know when and how to give these medications properly so that they are not given inappropriately. Staff confirmed that they had received medication training and been assessed three times by the manager before being allowed to give out medication. Staff also said they complete medication workbooks to assess their understanding of good medication procedures. Verification of this was seen on staff records. Care Homes for Adults (18-65 years) Page 18 of 30 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. Suitable arrangements are in place to respond to peoples concerns and complaints and staff are trained to recognise and report any suspicions of abuse so that people are protected from harm Evidence: The manager said that there have been no complaints made to the home since the last inspection, 2 years ago. This was verified in the complaints log, which is being routinely monitored and signed by a senior manager. An accessible complaints procedure is available in the home and in the homes service user guide that is shown to people moving in. A person at the home with good verbal communication skills said that they would see their favourite staff at the home or the manager if they were unhappy. They also said that they would talk to their relative if they wanted help. The records of meetings show that people are asked if they okay and the manager agreed to use the meeting to remind people about the complaints procedure from time to time. There has been one safeguarding issue at the home since the last inspection, last year. The incident was referred to Social Services for investigation under the safeguarding procedures and appropriately dealt with. When asked, two staff on duty confirmed that they had received Safeguarding training. Both staff demonstrated a satisfactory Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: understanding of the different types of abuse that they may encounter and to whom they should report any concerns. Staff also confirmed that they knew about the whistelblowing policy and to how to report any concerns about the running of the home. Peoples money is held in safekeeping by the home. Two peoples records were checked. Each transaction is being signed by staff as verification of money passed to people or spent on their behalf. Receipts are being kept as further evidence of money spent. Peoples money is checked and signed for by staff arriving on shift, as part of the shift handover process, so that money is accounted for on a day-to-day basis. The recording sheets show that the manager checks the money and signs the record at the end of each month to verify that it is correct. Periodic audits are also carried out by staff of the organisations finance section. 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 home is being satisfactorily maintained and upgraded so that people benefit from clean and comfortable accommodation. Evidence: Good work has recently taken place to redecorate the downstairs lounge and dining area so that it looks nicer for people. Two people have recently had their bedrooms redecorated and one was in the process of completion. Peoples bedrooms have been made comfortable with and contain equipment, pictures and other personal belongings that confirm they have been supported to personalise these areas in keeping with their preferences. The downstairs bathroom is fitted with hoisting equipment to help people to bath safely. Grab rails and shower chairs are also available for people to use where necessary. The home has a spacious spa pool for people to relax in. This is also fitted with hoisting equipment to enable people to get in and out safely. The home has a goodsized garden which was tidy and well maintained, providing a pleasant space for people to sit out and relax. Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: Overall the home looked clean and tidy though the light coloured carpets on the first floor are beginning to show some signs of wear in the doorways, most notably the entrance to kitchen. The washable flooring on the ground floor is functional but undermines the homely feel in other parts of the home. A cleaning schedule is in place which staff follow and sign to verify the cleaning tasks carried out. The home has a modern washing machine with a sluice facility capable of coping with the small amount of continence laundry at the home. A staff member confirmed that red bags which open up in the washing machine are used to carry soiled laundry through the home and minimise the need to handle it, in keeping with good hygiene practices. Staff were seen to make use of protective clothing and gloves that are situated about the home. 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 are properly vetted and well trained so that the people at the home are supported by suitable staff team. Evidence: Comments by staff on duty confirmed that there are typically four staff on duty to support the eight people at the home, in addition to the manager / team leader. This was verified by the manager and in a sample of recent rotas. Two staff sleep-in at the home at night in case they are needed to provide care and support. Comments by staff and the manager indicate that there is not currently anyone at the home that is routinely in need of care and support during the night that would necessitate the need for waking night staff. The manager explained that there has been a low staff turnover during the last year aiding stability and consistency of care. Two staff files were looked at to check the homes recruitment procedures. Both files contained evidence to show that staff are interviewed and issued with contracts of employment. Both files contained evidence of proper vetting procedures including two references and Criminal Record Bureau checks. This is necessary to ensure that suitable staff are employed at the home. Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: Comments by three staff and information is staff training records indicates that they being provided with training updates to support safe care practices, such as first aid, food hygiene, fire safety, moving and handling, medication and safeguarding training. The training matrix also indicates that staff have been provided with other care courses related to the needs of the people at the home, such as diabetes dementia, epilepsy and the administration of midazolam (medication for epilepsy). The records show that the majority of staff have also received training in equality and diversity. This training emphasises that people are individuals with their own needs and preferences to be respected and supported. The manager reports that of 23 staff, 15 have completed relevant National Vocational Qualifications and 3 are currently completing these courses. These courses are designed to equip staff to support people effectively. Two staff confirmed that they are provided with regular planned supervision. This was verified in staff supervision records. 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. Overall the home is well managed and monitored to ensure that it provides a good service to the people that live there. Evidence: The manager holds the Registered Managers Award and the National Vocational Award level 4 in Care. These qualifications are designed to assist Registered Managers to carry out their role effectively. The manager has delegated a number of areas of responsibility to staff to address, such as checking the spa pool and ordering protective clothing. There has been no consistent formal procedures for management monitoring of these areas of practice. Since the site visit the manager has revised a checklist (received by fax) to support management monitoring of these and areas of responsibility and said that this would commence straight away. The manager already carries out a quality assurance check each month, which involves Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: sampling a number of records and checking various practices, such as finances, medication, building checks and staffing. The manager agreed to carry out more in depth audits of the medication system, in particular checks of PRN (as required) medication records to make sure that all medication is correctly accounted for. A senior manager also carries out regular monthly monitoring checks to satisfy herself that the home is running smoothly and to set objectives for the manager to achieve to support the ongoing improvement of the service. The manager explained that surveys have recently been sent relatives to give their views on the home. The manager explained that the surveys are initially returned to senior managers at the head office so that they can identify any concerns or trends that need to be addressed. Last years surveys show that two relatives did not know how to complain. The manager confirmed that this was highlighted by senior managers and relatives have since been sent a copy of the complaints procedure. Staff confirmed that they have regular meetings to discuss policy and practice and to keep up to date with changes in peoples needs. This was verified in staff meeting records. The fire safety was sampled. The records indicate that fire alarms and lights are being tested regularly and that the fire safety equipment is being appropriately maintained. The records show that fire drills are being routinely carried out at the home. Maintenance certificates are in place to show that gas and electrical equipment is being periodically tested to make sure it remains safe to use. Hot water temperatures are being monitored and recorded so that any risks of scalding can be identified and addressed. Maintenance records were seen, demonstrating that lifting equipment and wheelchairs are being routinely maintained so that this equipment remains safe for people to use. 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 1 5 Proceed with plans to send contracts, including fees and additional charges, to individuals relatives or advocates so that their interests are properly represented. Refer people to the speech therapist, where necessary to provide advice and assistance in the development of communication guidelines and to assist with any equipment that may help people to communicate with others. Action should be taken to closely monitor the running total of PRN medications in the home to ensure that medication is properly accounted for. 2 6 3 20 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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. 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