Care Home: Prospect House Residential Home

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What the care home does well The manager and his staff team show great awareness in meeting the needs of people with communication difficulties. People that may be interested in moving into the home are able to watch a DVD that explains what Prospect House is like. Each of the people living in the home has a detailed care package in place that identifies their needs and the steps staff must take to support them consistently. Picture care plans are in the process of being implemented and this enables people with communication difficulties to more easily understand their care plans. The picture care plans already implemented are excellent. People are given choices in their day to day lives including what activities they take part in and the food they eat. People are treated as individuals and staff support them to maintain hobbies/interests and achieve the goals they identify. People are not put at unnecessary risks but acceptable risks are taken in the course of their day to day lives enabling them to achieve goals and greater indpendence. Staff provide people with the appropriate support to enable them to lead active lifestyles. The manager and staff team communicate effectively with parents/families through arranging regular events and producing a newsletter. The home has a "themed meal evening" every month, people choose what country and staff prepare meals, dress up and play music from that area of the world. People`s health needs are taken seriously and the staff team work closely with other professionals to meet people`s needs. The home`s complaints procedure is available in a picture format but it is planned that in the future this will be available on DVD. People live in a homely, clean and comfortable environment that meets their current needs. Staff are provided in sufficient numbers to enable people to lead active lifestyles. Staff receive training to maintain people`s safety and meet their needs. As part of the home`s quality assurance procedure they ask people in the home, parents and other professionals for their opinions of the service provided. What has improved since the last inspection? Since the previous inspection a range of areas have improved and these are included in "what the service does well". What the care home could do better: There is an expectation that staff complete a monthly summary of people`s activities/significant events. The manager should ensure that these are completed regularly. Learning support plans need more detail recorded by staff to provide an accurate picture of the person`s progress towards achieving their goal. People living in the home should be invited to take part in the recruitment of new staff. The manager should produce a report identifying shortfalls highlighted by the quality assurance audit and the corrective actions taken to address them. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Prospect House Residential Home 4 Prospect Road Cinderford Gloucestershire GL14 2DY     The quality rating for this care home is:   three star excellent 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: Paul Chapman     Date: 0 6 0 8 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 31 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 31 Information about the care home Name of care home: Address: Prospect House Residential Home 4 Prospect Road Cinderford Gloucestershire GL14 2DY 01594826246 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) : prospecthouse.cinderford@hotmail.com The Silver Rooms (Stroud) Ltd care home 9 Number of places (if applicable): Under 65 Over 65 9 learning disability Additional conditions: Date of last inspection Brief description of the care home 9 Prospect House is a detached residential care home set in its own spacious grounds near the centre of the town of Cinderford. It is registered for nine adults with Learning Disabilities. All of the bedrooms are single and some have en-suite facilities. On the ground floor there is a lounge, dining room, kitchen, toilet, shower room with a toilet and three bedrooms, one of which has its own entrance. On the first floor there are six bedrooms, a bathroom, toilet, laundry room, storeroom and sleep-in room/office. The cost for living at the home is dependant on a persons assessed needs. Care Homes for Adults (18-65 years) Page 4 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: Before completing the inspection site visit to this service we (the CQC) sent the registered manager questionnaires to distribute to people living in the home, staff and other professionals involved in the service to complete. In addition to questionnaires the registered manager also completed an AQAA (Annual Quality Assurance Assessment). This document asks a service provider/registered manager to rate the services performance against the National Minimum Standards (NMS). A service provider/registered manager will be asked to provide evidence of what the service does well, what has improved in the past 12 months and their planned improvements for the next 12 months. What the registered manager tells us in this document helps to form a hypothesis and focus on different areas depending on what the AQAA tells us. In addition to providing evidence about how the home meets the NMS it also provides us Care Homes for Adults (18-65 years) Page 5 of 31 with a Dataset (information about staffing, health and safety, complaints, the environment, policies and procedures and the people living in the home). We received the completed AQAA from the manager before visiting the service along with surveys from 4 Healthcare professionals, 1 member of staff and 5 people living in the home. We visited the home on 2 occasions, July 15th and August 6th. On the first occasion the manager was not on duty and we spent 4 hours in the home observing practices, speaking to staff and people living in the home, completing a tour of the premises and examining care records. After completing this visit we spoke to the manager and agreed to return to the home and meet with them. At this meeting we discussed what we had found at the previous visit and the manager showed us the corrective actions taken as a result. What the care home does well: What has improved since the last inspection? Care Homes for Adults (18-65 years) Page 7 of 31 Since the previous inspection a range of areas have improved and these are included in what the service does well. 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 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 8 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 31 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. The home has created a Service Users Guide in a format that enables people with a communication difficulty to more easily understand what the home can offer. The manager shows a good awareness of providing information in a range of formats to meet the needs of people. Evidence: Since the previous inspection the home has completed making a Service Users Guide DVD. We watched the DVD and feel it is an accurate reflection of the service being offered in the home and would provide the viewer with a good insight. This is seen as good practice as it enables people with communication difficulties to more easily understand the service offered in the home. The AQAA completed by the manager states they are planning to create the Statement of Purpose in other formats as well. The home has an admissions policy. There have been no new admissions to the home since the previous inspection was completed. Care Homes for Adults (18-65 years) Page 10 of 31 Care Homes for Adults (18-65 years) Page 11 of 31 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 identified in detailed care plans based on thorough needs assessments. Care plans are updated at regular intervals to meet peoples changing needs and staff ensure that these plans are written with people or are explained to them. The home makes excellent use of pictures/easy read documents to empower people in the home. Risk assessments identify and minimise potential risks whilst enabling people to take acceptable risks. Evidence: The home uses a web-based computer system to manage their care records. The system provides staff with copies of peoples needs assessments, care plans, risk assessments, daily notes, medical issues and appointments and all other significant/relevant information relating to people living in the home. From the previous inspection we understand that all of the information is stored securely in line with data protection. To enable the people who live in the home to access their information the staff also produce paper copies. Speaking with people during the site Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: visit they confirmed that staff go through these documents with them. We looked at the care packages for 3 people living in the home. Each person had a completed needs assessment in place and from these documents care plans have been created. Each person has a range of care plans in place, examples of these included; shaving, oral hygiene, eating and drinking, living skills, dressing, college activities, medication, social behaviour, financial management, personal shopping and emotional needs. Each of the plans we examined provided the reader with a good level of detail that identified the persons needs and the input required by staff to meet the persons needs. As previously identified paper copies of these care plans are created for each person and where possible they are asked to sign confirming they agree with the care plan. An improvement since the previous inspection has been the creation of learning support plans in a picture format. We saw examples for 2 people that included learning how to use a keypad, mobile phone, going shopping in the local town and catching a bus to go shopping in Gloucester. Each of these documents were excellent and provided the person with a clear plan of what they needed to achieve, or had achieved. Supporting each of these plans were a number of agreed targets that needed to be achieved before the goal was reached. From reading the available documents we feel that more detail is required to accurately reflect what staff have done, and progress made by the person. But there was some good evidence of staff assessing the persons skills in achieving their goal. We spent some time with a person who keeps a copy of their care plans in a picture format in their bedroom. They were very proud of this and the fact that they could now go shopping independently. This is a real achievement. Not all people currently have picture care plans and the manager explained that this is an area they will continue developing over the coming months. The sample of written care plans we examined were seen to be regularly reviewed. We identified a shortfall with monthly summaries. Staff/key workers are expected to write summaries every month detailing what activities the person has completed, any appointments with other professionals, contact with family, behaviour and any other significant information. At our first visit this recording was very inconsistent with some monthly summaries not being completed for up to 5 months. By the time we completed our 2nd site visit this had been addressed and all summaries were up to date. The manager gave his assurance that this would not happen in the future. Whilst completing our 2 site visits we witnessed a number of examples of people being given choices of what activities they wished to do and what they wanted to eat. Records in peoples notes also provided good evidence of people being given choices. We spoke to 2 people about making choices, they commented, Staff always ask me what I would like to do and I am always given choices. people living in the home meet regularly to discuss issues and activities they would like to complete. In the past year to support people with communication difficulties the agenda for these meetings Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: has been produced in picture format. 1 of the people living in the home has their own car thorough mobility funding. The manager explained that they had spoken to the person about this and they had agreed that other people could also travel in it. They had signed a document confirming this. Speaking to the manager we recommended that the persons social worker is contacted about this arrangement and that they are asked to be involved in reviewing this arrangement. The manager said that they would do this. Comments from another professional involved in the home included, the service empowers individuals to take control of their lives wherever possible, and individuals are treated with respect and dignity, they are listened too and given information at a level and pace appropriate to their individual needs to enable them to make choices and decisions. All 3 of the care packages we examined contained a range of risk assessments that identified and minimised potential risks. All of the risk assessments had been reviewed at regular intervals. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People lead active and varied lifestyles and staff provide the appropriate support as required. People are supported to continue their hobbies and learn new skills. The use of pictures enables people to make choices more easily and remembers the activities they have taken part in. People have a good choice of meals and the theme nights are excellent. Evidence: People lead active lifestyles with staff support as required. On the day of our 1st site visit a number of people were off to Cardiff to the Dr Who exhibition. Staff have created activity folders with people. These are photo albums detailing all the activities people have taken part in, the examples we saw provided good evidence of people what people had been taking part in. People living in the home can have Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: access to these folders as they wish. This is another good example of people with communication difficulties being provided with information in a suitable format. From speaking to people living in the home, examining records and spekaing to staff it was clear that the following activities take place regularly (and as people want to do them); bowling, cinema, college, aqua aerobics, swimming, cooking, arts and crafts, dance and movement and music appreciation classes. Some one off trips and events include attending an X Factor concert, various beach resorts, @ Bristol, Castles and a wildlife park. The manager and his team has shown good awareness in meeting a persons needs due to increased mental and physical frailty. This has resulted in the person being supported to attend a more specialised older persons day service. A range of holidays have taken place, or will be taking place. Examples we saw included people spending time in Blackpool, North Wales and Jersey. People are able to keep pets in the home and whilst we were visiting we witnessed staff supporting people to feed them (rabbits). In addition to this the manager owns a dog that they regularly bring into the home. Speaking with them about this they explained that people get on really well with the dog. Staff support people to keep in contact with their friends and family and staff will support them to use the telephone and write letters and cards. The manager is proactive in communicating with the families and keeping them up to date with what is going on in the home. Functions are held at Easter, summer and Christmas and all families are invited, the manager said that they had fantastic turnout at Christmas when they went to a resturant for a meal. In addition to regular functions the staff and people in the home also produce a quarterly newsletter for family and friends. Speaking to the manager they explained that a person in the home is an exceptional artist. They attend the local college art sessions and recently their work was displayed in an exhibition and was featured on the front cover of the exhibitions brochure. Their creations are becoming well known locally with talk of an exibition being organised just for their work. Another person is interested in music and attends a local college to take lessons. They have formed a strong friendship with another person in the home through their joint interest in music, and playing instruments. At the time of the site visits staff were in the process of organising a skittles league locally with other services for adults with learning and physical disabilities. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: A survey completed by another professional involved in the home states, the home promotes independence, building on skills to access the local community, People are respected as individuals and the service is adapted accordingly, The home operates an 8 week rolling rota menu, and people have the choice from 2 main meals each day. There is a picture meal book enabling people to choose what they may like to eat each day. we asked staff how frequently the menu is reviewed and they answered they thought it was 8 or 9 months ago. It is recommended that the menu is reviewed at regular intervals to ensure that people are given a wider choice. Each month there is a themed meal evening. People are asked each month what theme they would like. We were told that the last theme night was an Afganistan night and staff cooked a traditional Afgan meal for the home. Previous examples we saw included American, Australian, Greek and Italian nights. As well as cooking traditional dishes staff have been known to dress up in traditional clothing and play traditional music. To support this 1 of the management team has created a folder with information about each country, recipes, and even created CDs with traditional music. this has become a really useful resource. Care Homes for Adults (18-65 years) Page 17 of 31 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 personal care needs are identified and care plans provide staff with detailed guidelines that enable them to meet peoples needs consistently. Staff work closely with other health professionals to meet peoples needs. People are empowered to take responsibility for their own health care with picture care plans supporting them to do this. Medication administration is managed effectively and minimises potential risk to people in the home. Evidence: Peoples personal care needs are identified in care plans and these provide staff with detailed guidelines enabling them to meet peoples needs consistently. Examining the health care for the 3 people showed each person had a completed health action plan in place detailing medical needs. There was good evidence of staff working with other health professionals to meet peoples needs. We saw good records of the home implementing specialist recording and monitoring systems to identify and manage behaviours. Staff make detailed notes of appointments with other professionals, the only shortfall we identified was where a person had had a blood test, Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: but there were no records of the result. This was brought to the attention of the manager. A good practice implemented by the manager is 2 people having picture care plans that support/show them how to complete body checks themselves. Records of staff training show that 2 staff have completed specialist training in Dementia to meet the needs of people living in the home. We spoke to the manager about the homes medication administration. Considering the peoples capabilities and skills we asked why no one administered their own medication. The manager explained that they felt 2 people could possibly administer their own medication and they had been asked whether they would like to and refused. There is a named staff member that oversees the homes medication and they are responsible for ordering and auditing. The member of staff was present at our 2nd site visit and we spent some time with them examining medication administration. This showed that generally medication is well managed minimising potential risks to people living in the home. All staff must complete training in the handling of medication before they are able to administer it. The only shortfalls we identified were that there should be a list of staff sample signatures/initials, and topical creams/ointments should be labelled with the date they are opened. The AQAA states that plans for improvements over the next 12 months include refresher training in medication and dementia training will be cascaded to the rest of the staff team. A GP that supports people in the home when asked what they thought the home did well commented that they felt the care is tailored to meet the individual. Care Homes for Adults (18-65 years) Page 19 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a pictorial complaints procedure to help enable people with communication difficulties to make a complaint and people we spoke to confirmed they could make a complaint if they were unhappy. Staff receive training in safeguarding vulnerable adults, their is a whistle-blowing policy and further development of the complaints procedure will help to minimise potential risks further. Evidence: The home has pictorial complaints procedure that helps to enable people with communication difficulties to make a complaint. The manager recognises that this procedure could be improved and is planning to create the procedure on DVD. Speaking to people during our site visits they were able to explain how they would make a complaint if they were unhappy, this may not involve following the procedure; both people said they would be able to speak with staff if they were unhappy and were confident they would be listened too. To support people in making a complaint the home has pictures of all staff to enable people to identify them easily if they have communication difficulties. There has been no complaints made to the CQC since the previous inspection report was completed. There has been 1 complaint made to the home which the manager dealt with appropriately. Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: Training records showed that all staff have completed safeguarding vulnerable adults and an introduction to the Mental capacity Act (2005) training. The management team in the home have attended Deprivation of Liberty Safeguards training in addition to this. Since the previous inspection the manager has introduced ID cards for each of the people in the home and they take these with them when they go out. The home has a missing persons procedure and has created a missing persons information sheet for each person detailing essential information about each person that may be needed by the Police, or other authorities. In the past staff have supported people with money recognition enabling them to gain a better understanding of what different coins are worth. Peoples money is managed by the manager and staff. Speaking to people they were able to confirm that they can access their monies as and when they wish. Each person has a money management care plan that identifies peoples skills and the support they require, these are regularly reviewed by staff. The homes quality assurance system helps to identify concerns and areas that need to be addressed. The home has a whistle-blowing policy. A comment from staff in a questionnaire when asked what staff do well they commented makes sure that people are always safe. Care Homes for Adults (18-65 years) Page 21 of 31 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 well-maintained by the service provider and as a result people live in a warm, homely and comfortable environment that meets their current needs. Evidence: We completed a tour of the premises with a member of the management team during our 1st site visit. To the front of the property is a good-sized area that is used as a car park, whilst to the side and rear of the property is a large garden. This area has been developed since the previous inspection with people in the home being involved in gardening, we witnessed people working with staff planting some flowers and picking some vegetables to be used in a meal. The home provides accommodation over 2 floors with bedrooms and showering facilities on both the ground and 1st floor. We visited a number of peoples bedrooms and saw that each 1 was decorated to individual tastes. We spoke to 2 people about their bedrooms and how they were decorated, both people said that they had chosen the colour schemes and were happy with their bedrooms. All of the bedrooms we saw contained the peoples personal belongings. 1 person is really into music and playing instruments, so their room had a guitar, drum kit and music system. Other bedrooms contained stereos, TVs, DVD players, etc. All of the people in the home can have a Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: key to lock their bedroom door if they wish. We only found 1 shortfall whilst looking around the bedrooms and this was 1 person had a badly stained pillow on their bed. When completing our 2nd visit we saw that this had been addressed with a new pillow being purchased. We saw all of the bathrooms and toilets around the home. There has been a programme of re-decoration/maintenance in these areas (re-tiling, painting and a new shower fitted downstairs) and at the time of our first visit they still needed to be finished. At our 2nd visit all of the maintenance issues had been addressed. Since our last inspection new carpets have been fitted in the lounge and hallway and new furniture has been bought for the lounge. The home has a separate lounge and dining room. All of the communal areas are decorated to a good standard and are fitted with good quality fixtures and furniture. In the AQAA the manager feels they could improve the personal appearance of the home by adding more of the artwork created by people in the home. Some pieces of artwork are displayed around the home. At the time of both site visits the home was clean, tidy and free from offensive smells. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment procedures are robust and minimise potential risks to people living in the home. Staff training is well-organised and minimises the risk of people needs not being met, or people being put at unnecessary risks. Evidence: The home benefits from a settled staff team that have worked with the people in the home and therefore have a good working knowledge of their needs. Since the previous inspection was completed 3 staff have been been employed. We examined the recruitment records for these new staff, this showed that the manager had adhered to the regulations and therefore minimised potential risks to people in the home. All new staff complete a comprehensive induction which includes attending safeguarding adults training. A recommendation for the future in respect of staff recruitment would be to involve people living in the home in the process, giving them the opportunity comment on candidates. The home has a dedicated training budget which enables all staff to complete mandatory courses and other specialist courses. Examples of mandatory training (including updates) completed by the majority of the team include; Food hygiene and safeguarding vulnerable adults. The manager has a good record of training completed Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: by staff and when updates are required. As a result of this a number of training updates have been booked for the following months. A comment from an outside professional involved in staff training was that they felt the home trained its staff well. As identified earlier in this report the management team have completed training in the Mental Capacity Act and the Deprivation of Liberty Safeguarding. 2 staff have also completed training in Dementia that will be cascaded to the rest of the staff team. All of the staff have completed Makaton training (sign language), and 1 of the people living in the home joined in with this training. 2 of the management team have completed their NVQ level 4 in Health and Social Care (National Vocational Qualification), whilst the 3rd has just started the same qualification. All other members of the team have a minimum of NVQ level 2 in Health and Social Care, 2 staff have just completed the level 3, and another 2 are just starting it. The fact that all staff have a minimum of an NVQ level 2 in Health and Social Care shows the commitment of the service provider to develop his staff team and provide a quality service. When speaking to 2 of the management team it was clear that they were really enthusiastic about what they were doing in the home. They were really committed to ensuring that they provide the best service possible for people in the home and ensuring peoples needs were met. During both of our site visits we were able to observe the relationships between the staff team and people in the home. Relationships were clearly respectful, friendly and supportive. Since the previous inspection the manager has reviewed the staff recruitment and retention policy and made amendments to the staff induction policy. Care Homes for Adults (18-65 years) Page 25 of 31 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. The manager continues his professional develop with training and this helps him to identify further developments/good practice in the service. The quality of the service in this home continues to improve therefore the outcomes for people living in the home are better. Health and safety around the home is taken seriously and risks are minimised through staff training and regular checks around the home. Evidence: The registered manager has completed the Registered Managers Award and an NVQ level 4 in Care, they also have considerable experience working in this field. The manager continues to develop his personal skills and since we met previously he has; completed training in recruitment, The Mental Capacity Act (2005), Deprivation of Liberty safeguarding (DOLS), Autism and have recently enrolled on a course named Action Learning for Social Care Leaders, in addition to this they also attend the Gloucester Care Providers Association meetings allowing them to network with other providers and keep abreast to any changes to legislation. Before completing the inspection site visit the manager sent us the AQAA for the home which he had Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: thoroughly completed. Since we last completed an inspection of this service the owner of has purchased a quality assurance package. We dicussed this with the manager, they explained that as part of the process they send questionnaires to people living in the home, parents/family and other professionals involved with people in the home. The completed questionnaires returned to the manager are then scored and these scores enable the manager to judge where improvements are needed, and what they do well. The results of the last questionnaires were published in the homes quarterly newsletter to parents. The manager stated that the next time they complete this exercise they intend to address it formally by identifying the lowest scores and develping a formal plan to address the shortfalls. There was evidence that without writing a report on this occassion shortfalls had been identified and actions taken to address them. It is recommended that next time this process is completed a formal plan is developed. In addition to the quality assurance package there are a number of other areas identified in this report that provide good evidence of the quality, and the service being led by peoples needs. Examples include care plans, activities and documents/processes developed to enable people to make choices. Health and safety systems are in place. Sound food hygiene practice is promoted and the home has adopted the safer food, better business model supplied by the local environmental health department. Looking in the fridge in the kitchen it was found to be dirty and a couple of dishes of food were uncovered. This was brought to the attention of the staff on duty and by the time of our 2nd visit this had been addressed. A cleaning rota had been introduced to ensure the kitchen was cleaned regularly. Fridge and freezer temperatures are on the whole being recorded twice daily. All hot water outlets are thermostatically controlled. Water temperatures are recorded for all outlets around the home. Fire records are well maintained with evidence of regular monitoring of equipment and systems. A fire risk assessment has been completed for the home. Regular fire drills take place for all people and staff. Evidence of regular fire training is in place. Portable appliance testing has been completed. The home has a COSHH cupboard that is locked at all times. Each of the cleaning chemicals used in the home are supported with a data sheet. In the AQAA the manager states that a planned improvement for the future is the development of a fire safety guide on DVD for people in the home. Care Homes for Adults (18-65 years) Page 27 of 31 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 31 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 6 Learning support plans require greater detail to evidence the steps taken by the person on the way to achieving their goal. This detail should provide evidence that the person is safe/capable of achieving the goal. The manager should ensure that the monthly summaries are completed regularly. Failure to do this makes reviewing peoples progress difficult to assess easily. The manager should contact the social worker of the person whose car is used by the home and ask them to review this arrangement. The 8-week rolling rota should be reviewed at regular intervals. Topical creams and ointment should be labelled with the date they are opened. A list of the staffs sample signatures/initials should be kept with the medication records. People living in the home should be involved in the recruitment of new staff and given the opportunity to comment on them as part of the process. The manager should compile the findings of the quality Page 29 of 31 2 6 3 7 4 5 6 7 17 20 20 34 8 39 Care Homes for Adults (18-65 years) assurance process into a report. Care Homes for Adults (18-65 years) Page 30 of 31 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. 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