Care Home: Pymhurst

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What the care home does well The home supports people to lead busy, social lives and take part in the leisure activities that they enjoy. One resident stated in their survey response.....I like to go out and the staff help me do it. A social work professional records....Social activities appropriate to resident`s age range are provided and residents are encouraged to maintain friendships. All care plans are reviewed regularly and kept up to date to ensure that people have their needs met. Everyone that uses the service is very happy with the support they are receiving. A survey respondent, when asked what the home does well, said....It helps me cope. It gives me a feeling of safety and being in a family home. Another respondent said.....I`m happy in more ways than one. The home provides a stable staff team and the manager has an excellent understanding of each persons needs and spends time working alongside staff to ensure they are competent in carrying out their roles. One survey respondent records.....It has a good manager and staff team who provide a high standard of care and support. People that use the service have been given the information they need in order to make a complaint about the service if they need to. The manager and staff has spent time ensuring that people understand the complaints procedure. A survey respondent said.. No complaints, if there were, I`d be the first to say, I`m very happy thanks. The provider has an equality and diversity policy and it was clear from observation that people are treated fairly and no one is treated less so because of something that is different about them. The manager and staff made it clear throughout the inspection that they strive to tailor support around people`s unique needs. The manager records in her AQAA.....We have changed our duty rota so that one of our residents can attend community out reach church on every fourth Sunday, and now another resident also chooses to go on occasions. What has improved since the last inspection? Residents are provided with the aids and equipment they need. The home has invested in an electric hoist to replace an aged manual version. The primary health care team have also helped the manager access a better style bed for a person receiving services at Pymhurst, which better supports them and the staff in achieving daily living routines. There have been environmental improvements made to the home. One of the resident`s bedrooms had been redecorated. The home has a new dining room table and chairs. Since the last inspection the Provider has employed a handy man and a gardener to work across the six homes in the group, which means minor maintenance and grounds issues can be dealt with quickly. Environmental improvements ensure residents are provided with a safe, homely and attractive place to live. The service have increased their use of pictorial signs and cards to improve understanding and to help meet residents needs. What the care home could do better: People receiving the service would benefit from improvements to the home`s infection control measures and minor shortfalls in medication administration should be addressed to secure their safety and welfare. Recruitment procedures and the administration of staff files should be robust to secure the protection and safety of the people living in the home. Key inspection report Care homes for adults (18-65 years) Name: Address: Pymhurst 11 Semaphore Road Guildford Surrey GU1 3PS     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Marion Weller     Date: 2 4 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Pymhurst 11 Semaphore Road Guildford Surrey GU1 3PS 01483573318 F/P01483573718 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Pamela Mary Eales care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 6. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home Pymhurst is a large detached property situated in a residential area a short distance from Guildford town centre. The home is part of Just Homes who operate a number of similar homes in the South East. Care and accommodation is provided for up to six older people who have learning disabilities. The home provides a communal lounge and dining area situated on the ground floor, which is furnished in a homely fashion. One residents bedroom accommodation is arranged on the ground floor and the remaining first floor bedrooms are all for single occupancy. The home has a large well-established and maintained garden at the rear with an area for parking. The fees for the rooms are between £840 and £1,593 per week. Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 6 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: The last key unannounced inspection of this service was completed on the 27th June 2007. This key inspection was undertaken on the 24th June 2009 and the inspector, who was unaccompanied during this site visit, was in the home from 11:00 am until 3:00 pm. During the site visit the inspector spoke with two residents who were involved in the inspection, two members of the support staff and the registered manager. The inspector was shown around the communal areas of the home and was invited to view individual bedroom accommodation. In addition, some records and documents were inspected. The inspection report takes into account all the information obtained about the service since the previous site visit. This includes any formal notifications, phone calls and letters received and any information concerning complaints or allegations. The manager was asked to complete the homes Annual Quality Assurance Assessment (AQAA) prior to the inspection. The document was received by us within the timescale Care Homes for Adults (18-65 years) Page 5 of 28 given. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gives some numerical information about the service. The completed document gave us comprehensive information which provided a clear picture of what was happening in the service and their plans for further development. Prior to the site visit we sent surveys to four people that use the service, randomly to four members of staff, and three surveys to health and social care professionals involved with the service, to gather their views. A total of 10 completed surveys were returned to us. Comments from surveys have been used throughout the report. Care Homes for Adults (18-65 years) Page 6 of 28 What the care home does well: What has improved since the last inspection? Residents are provided with the aids and equipment they need. The home has invested in an electric hoist to replace an aged manual version. The primary health care team have also helped the manager access a better style bed for a person receiving services at Pymhurst, which better supports them and the staff in achieving daily living routines. There have been environmental improvements made to the home. One of the residents bedrooms had been redecorated. The home has a new dining room table and chairs. Since the last inspection the Provider has employed a handy man and a gardener to work across the six homes in the group, which means minor maintenance and grounds issues can be dealt with quickly. Environmental improvements ensure residents are provided with a safe, homely and attractive place to live. The service have increased their use of pictorial signs and cards to improve understanding and to help meet residents needs. Care Homes for Adults (18-65 years) Page 7 of 28 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 28 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 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with information about the home prior to them moving in so they can make an informed decision. Information formats are being further developed to ensure that they meet everyones needs. People moving to the home have an assessment of their needs and are assured these will be met before they are offered a place at the home. Evidence: The manager said that new residents are admitted to the home following a full pre admission assessment to ensure they can fully meet their needs and to identify any areas where the home may need to make adaptations prior to them moving in. The assessment process involves the prospective resident, their family or advocates and any professionals involved with their care and support. The assessment also takes into account the needs of the existing residents to ensure that the home is the most appropriate place for the person to be. People considering moving in are given the opportunity to visit the home to meet the other residents, initially with support from others, but when they feel more confident, unaccompanied so they can make an Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: informed decision about moving in. Pre admission assessments were seen for two people and they covered all the areas of support that they may need. Original assessments are regularly updated as part of the care plan review process. Feedback in surveys confirmed that assessment arrangements in place ensure that accurate information is gathered and that the right service is planned for people. One respondent said....Pymhurst offers a caring and comfortable home. Another said....The accommodation is homely and it is a happy place. The manager said they have a small brochure to show prospective residents on their initial enquiry about moving to Pymhurst. Residents are also given a service user guide, statement of purpose and a contract when they move in. The manager said they are hoping to make improvements to their information documents by incorporating more pictorial information for residents with limited understanding and were also considering the use audio and video formats. Intermediate Care is not offered at Pymhurst. Care Homes for Adults (18-65 years) Page 11 of 28 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. People have an individual plan of care that meets their assessed needs. These are being further developed in a format that will ensure they can take more control and ownership of their plans. They are supported to make some decisions in their lives and to have a say in how the home is run. People using the service are supported to take assessed and reasonable risks as part of an independent lifestyle. Evidence: Each person has an individual plan of care. Two of these plans were inspected in detail. Staff have undertaken training in person centred planning and are further developing residents care and health documentation using pictures and symbols to help residents be more involved in taking decisions about their lives. The manager said the service already uses pictorial formats to help residents with menu planning and raising complaints. Each residents care plan also includes details, in the form of guidelines and procedures, on how staff can support residents to make daily choices. Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: Risk assessments have been completed as part of the individual plans. Within the two plans inspected these showed the risk assessments in place were relevant to their needs and had been kept under review. From discussion with service users and from feedback in our surveys it was evident that people living in the home are offered choices in their everyday lives and are involved as much as possible in the running of the home. This includes planning the weekly menu, helping to shop for food and choosing the decor of the home. One person stated in their survey response......I like to go out and the staff help me do it. Care Homes for Adults (18-65 years) Page 13 of 28 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 supported to lead busy and interesting lives that meet their social care needs. They have the support they need to access the community and to participate in leisure activities. People using the service have their rights to privacy and personal space respected. A varied and nutritious menu is available and people using the service are supported to choose their meals. Evidence: Each person using the service has a programme of activities designed to meet their social needs. These are largely leisure based as residents are from an older age range. Activities are organized both at the home and within the community and include, shows, bowling, going to various clubs or visits to friends, lunch out, shopping and day trips to places of interest. An annual holiday is arranged for everyone living in the home. The manager said this event is always eagerly anticipated and enjoyed. Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: When at home people can choose to spend time in their own rooms or in the communal lounge or dining area. There are books, games and crafts available, satellite TV and a music centre. In the summer it was clear that people enjoy spending time in the garden. Records maintained in the home showed that activity plans are followed and feedback from survey respondents also confirmed this. A Care Manager undertaking a recent placement review for two residents, records.....Social activities appropriate to residents age ranges are provided and they are encouraged to maintain friendships. The manager records in the homes AQAA that in the last 12 months they have begun using a pictorial daily menu to help residents with limited communication see what is for dinner. In addition, they have introduced Choice Cards, i.e. a picture of the sports centre and a car on a card, to help residents choose activities or understand what staff are suggesting to them. Service plans for the next 12 months are to complete residents person centred planning books, which will illustrate their likes,dislikes, preferred activities, goals etc in a format that will help them have more involvement in the care planning process and therefor greater control over their lives. People are supported to maintain contact with their family and friends. The individual plans of care identify the support that will be given to ensure people living in the home have the opportunity to maintain these relationships and to build new ones. The manager records.....We encourage contact with residents families and friends and ensure they have privacy if they wish when visiting or phoning them. We always provide refreshments for visitors. The menu is planned weekly with service users involvement. Records are kept of the meals provided and the choices that people make. Feedback from service users confirmed that they enjoy the meals and feel they have sufficient choice. Snacks, drinks and fruit are available for people to access when they want it. Some people can do this independently and others require staff support. Care Homes for Adults (18-65 years) Page 15 of 28 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. People using the service have their personal care needs met in the way they prefer and are supported to be as self managing as possible. They have their health needs met through the primary health care team and have their medication managed safely. Evidence: Residents personal care needs are clearly outlined in their individual plan of care and people are encouraged to be as self managing as possible. Where necessary, residents are supported in their personal care needs with dignity and respect and they are afforded privacy when they are visited by health professionals in the home. A health professional asked if the home could do anything better said.....I find that Pymhurst has cared for all its patients in an exceptionally high manner, right across the board. I can find no negatives to report. Care plans are being reviewed every three months with the involvement of residents where possible and every six months a more formal review takes place. Residents risk assessments were observed to be detailed and comprehensive and to adequately secure the individuals welfare and safety. The service user group is now older; it was Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: recommended to the manager that care plans be reviewed at least monthly in line with the older peoples standards to ensure their changing needs are fully met. Residents health needs are documented in their individual plan along with a record of any involvement by health care professionals. The manager spoke of plans to introduce Health Action Plans for each resident as recommended in the Valuing People white paper. This will support people to identify their health needs in a holistic way and give them more control over managing their health care. Health records showed that appointments are made for service users for health checks in a timely manner. Survey respondents supported this view. One respondent said.....Particular attention is paid to detail at Pymhurst, for example, that doctor and dental appointments are made at the right time and are kept. A care manager records.....Residents health and emotional needs are being closely monitored. A health professional states.....I felt staff were really competent regarding their knowledge of client care. Residents have the aids and equipment they need. Records evidence that the home have involved a physiotherapist, district nurse and occupational therapist to help with one residents mobility problems and increasing care needs. A hoist was recommended to aid safe transfers for the individual and to assist staff. The home invested in an electric hoist to replace an aged manual version. The primary health team have also helped the home access a better style bed for the individual which better supports their care needs and aids staff in daily living routines. None of the service users are currently managing their own medication. All medication is administered by staff and is stored securely in the home. Staff records showed they have completed medication training and their competence is assessed regularly through supervision sessions with the manager. Residents medication administration records were largely well maintained. A minor shortfall in good practice was discussed with the manager in relation to the home evidencing that hand written transcriptions on medication administration charts are accurate. This requires the signature of a second trained member of staff who has personally checked both the first administrators hand written transcription, and the original dispensing label for accuracy. This will ensure residents are not given the wrong medication. The manager stated her firm intention to address this issue immediately. Care Homes for Adults (18-65 years) Page 17 of 28 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. People using this service know how to make a complaint if they need to and can be assured their concerns will be taken seriously and acted upon. They are safeguarded in the home from harm and abuse. Evidence: The home has a written and pictorial complaints procedure which includes appropriate timescales for dealing with peoples complaints. The manager confirmed that any complaints or concerns they received would be dealt with promptly. The complaints procedure is regularly discussed at keyworker meetings with residents. Every six weeks there is a residents house meeting and they are again reminded about how they can make a complaint. The homes AQAA records that all residents have the ability to complain except for one who may have difficulty raising their concerns in detail. Records show the home has additional guidelines in place to assist this person. Survey respondents confirmed that they knew how to complain and who to. One survey respondent said....No complaints, if there were, Id be the first to say, Im very happy. A complaints log is kept and records of any complaint made by residents are also recorded in their individual file. Previous records clearly evidence how concerns are resolved. There have been no complaints received by the home in the last twelve months. Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: There is a safeguarding adults policy in place and all staff undertake training in adult protection issues during their initial induction and again in their further training. The manager stated that during staff interviews, specific questions are asked to try and ensure that staff will have the potential to understand responsibilities placed upon them to report on any suspicion or allegation of abuse. The homes AQAA records that the manager is confident that her current staff team would report on promptly and professionally, following recognized procedures. The home was observed to have a copy of Surreys Multi Agency Policies and Procedures document dated 2008 and the manager has received adult safeguarding training from the Local Authority. There have been no safeguarding alerts or investigations in which the home has been involved over the last year. One survey respondent when asked what the home does well said.....It gives me a feeling of safety and being in a family home. Care Homes for Adults (18-65 years) Page 19 of 28 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 clean and comfortable and meets the needs and preferences of the people that live there. Evidence: The home is kept clean, odour free and is being maintained to a good standard of decor and repair, with one exception. The removal of the homes aged manual hoist has resulted in some damage to the floor covering in the residents communal bathroom on the ground floor. This is now difficult to clean properly and has the potential to compromise infection control measures and may place residents at risk. The manager has reported this situation to the landlord and requested an urgent repair to secure the welfare of people living in the home. All residents bedrooms are for single occupation and have been personalised to reflect the tastes and the interests of the occupants. The inspector was invited into a service users bedroom. The resident said they had everything they needed and were very happy with the home. Survey respondents also supported this level of satisfaction with the home. One respondent said.....Pymhurst offers a caring and comfortable home. Another said.....The accommodation is homely and well maintained. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: There is a communal lounge and dining room for residents to use and the kitchen is accessible to the people living there. There is a large garden to the rear of the property, which is well maintained and used frequently by the residents. There are sufficient bathrooms to meet peoples needs with a mixture of baths and showers. A cotton hand towel was damp from use in the ground floor toilet, despite liquid soap and paper hand towels being provided. It was recommended that the use of disposable paper hand towels at all times would ensure the homes infection control policy was not compromised. The manager stated her firm intention to address this issue. The manager spoke of numerous environmental improvements. One of the residents bedrooms had been redecorated and another resident had chosen colours for their room to be decorated as well. The home has a new dining room table and chairs. Since the last inspection the Provider has employed a handy man and a gardener to work across the six homes in the group. The manager stated that environmental plans for the next 12 months include moving forward with the planned extension, designed to create a new dining area and another ground floor bedroom. In addition, the outside of the house needs to be painted and the manager continues to liaise with the landlords to move this forward. Care Homes for Adults (18-65 years) Page 21 of 28 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. Residents benefit from a competent, motivated and qualified staff team who are properly supervised in their work. Some minor improvements to the content of staff files will ensure that residents are fully protected by the homes robust recruitment practices. Evidence: Three staff files were seen and these contained the necessary documentation to evidence that appropriate checks had been made before employing people to work in the home. This included two written references, a health check list and a criminal records check. All staff complete an application form, stating their full job history, and undergo an interview. Staff files are kept securely in the managers office, but made available for inspection and audit purposes. Staff records could be improved by ensuring that each staff file evidences a good quality recent photograph of the employee, as proof of identity. Some files evidenced poor quality photocopies taken from the individuals passport. In addition, the application for employment form should provide a statement by the applicant as to their mental and physical health as required in Schedule 2. The home could evidence that over 50 of staff employed are NVQ qualified, at either levels 2 or 3. Staff training records evidenced that staff have completed the Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: mandatory training courses they need to carry out their roles safely. The manager spoke of accessing specialist training in dementia for staff to meet the specific needs of people living in the home. The homes AQAA records that the manager has acquired an infection control training CD which all staff will be expected to view and she continues to use a more comprehensive induction process for new staff. Training for staff in Equality and Diversity had taken place on the 2nd June 2009. The trainer had completed one of the homes quality assurance sheets and records......Residents are treated with respect and enabled to live the life they individually choose. Staff have regular supervision with the registered manager and records showed this covers many areas of their work and practice. The supervision sessions are also used as a means of keeping staff updated with any changes in legislation and good practice guidance. A resident spoken with on the day of the site visit and survey respondents evidenced a high level of satisfaction with the staff at Pymhurst. One respondent said....The service recruits and retains good care workers who dont just work at the home because its a job. Another said....It is a happy home with friendly competent staff. I am very satisfied. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home benefit from a competent and experienced manager who runs the home in their best interests and they or their representatives are regularly consulted about the care they receive. The health and welfare of service users is protected and they can be confident that where minor shortfalls exist, these will be addressed quickly by the manager. Evidence: The registered manager is a qualified general and learning disability nurse and holds The Registered Managers Award (RMA). She is keen to keep her skills and knowledge updated. The manager has worked at Pymhurst for a number of years and demonstrated an excellent understanding and insight into the individual needs of the people living in the home. Survey responses from residents and others involved with the home were very supportive of the manager. One respondent said.....It has a good manager and staff team who provides a high standard of care and support. In relation to The Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: assessments of capacity and decision making for residents are being undertaken in a way that complies with the published codes of practice. There is no one living in the home who is the subject of a deprivation of liberty authorisation. The home is being run in the best interests of the people who live there. Regular quality audits take place and the home has monthly visits from the responsible individual. Visits are well documented and results available for inspection. Visitor observation records are available in the hall to enable any visitor to the home to make comments on what they observe during their visit. Completed records were seen and evidenced a high level of satisfaction with the service offered at Pymhurst. Our own surveys undertaken before the site visit supported this view. Monthly resident meetings take place and these are documented and survey forms are sent to relatives or their representatives annually. Staffing levels are currently meeting the needs of the resident group with no agency staff being called on for the last two years to ensure continuity of care to the residents. Due to the increasing age and changing needs of people living in the home, the manager spoke of keeping staffing rosters under review. Either the manager or her deputy are present for a shift in the home on most days. Monthly staff meetings are held where agendas are set and concerns and ideas for improvement discussed openly. Formal supervision sessions for staff are held every six weeks or more often if needed. Annual appraisals are carried out and residents house meetings are held every six weeks. The manager records that the home supports some residents to handle their personal finances. Records and receipts of all expenditure and income are kept locked away with only the manager and her deputy having access. Relevant risk assessments have been completed for the home and a fire risk assessment is in place. There were no significant issues regarding health and safety, although residents would benefit from improvements to the homes infection control measures and minor shortfalls in medication administration being addressed. Recruitment procedures and the administration of staff files should be robust to secure the protection and safety of people living in the home. The manager stated her firm intention to address the issues mentioned in the report. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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