Care Home: Quiet Waters

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What the care home does well Quiet Waters offers residents a very well maintained and comfortable environment where they are clearly at home. A staff survey commented on what they did well "the home has created a homely environment for service users in the day-to-day interactions with staff and it puts emphasis on the personal care of service users" and another said "ensuring consistency in the way we work with service uses and following through care plans". There are clear support plans that show the person`s needs, abilities and goals with clear guidelines for staff on how to support people and help them to achieve their goals. Keyworkers and residents check these every month to make sure that they are working well. Residents are treated as individuals and given the opportunity to make decisions. Residents are supported to lead a lifestyle of their choice and are helped to learn skills and develop confidence and independence. Family, friends and professionals are welcomed and there are good communication systems. A relative`s survey commented "(resident`s) needs are always discussed with us. We are informed regarding changes within the home that are relevant to them." Systems are in place to gather the views of the people who live at home and other stakeholders through meetings and surveys. There is a positive approach to training and development to ensure staff have the skills to support quality care outcomes for people using the service. Staff try to provide residents with consistency and continuity of care by covering extra shifts. Interaction between staff and residents was friendly and respectful. A relative`s survey commented "interactions between staff and (resident) are very good". What has improved since the last inspection? The management team have responded positively and effectively to the requirements identified in the last inspection report and the home was better managed and organised. The registered person has visited the home monthly and written a report to show that they have checked that the home is being well run and that residents are well looked after. Records were made available to show that robust recruitment procedures were in place to safeguard residents. There were also records to show that staff had been provided with induction and up-to-date training training to help them to meet service user support needs. Staff were getting more support and supervision meetings were regularly organised. There were clearer records of how the home looks after residents` money. The complaints procedure was available in a format that was more user-friendly for people using the service and so more accessible to them. Medication practice was safer and photographs were available of residents so that staff would know that the right person was getting the medication. What the care home could do better: Risk assessments for individual residents should be in place as soon as they come to live at Quiet Waters to help to keep them safe. Guidelines for medication to be taken when needed should have better information for staff to help them to make sure residents are looked after in the best way possible. The management team should make sure they regularly check the number of staff working at the home.This would make sure that there are enough people to cover the rota so that staff do not get tired and that there are enough staff to support residents in their planned activities. Comments from staff on what the home could do better included "appreciate and value staff more", "better management support", "more staff" and "create more activities that would promote community interactions and participation for service users. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Quiet Waters 8, Thorndon Avenue West Horndon Brentwood CM13 3TT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Bernadette Little     Date: 0 8 0 9 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 28 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 28 Information about the care home Name of care home: Address: Quiet Waters 8, Thorndon Avenue West Horndon Brentwood CM13 3TT 01277812466 TBC Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Voyage Ltd 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 who can be accommodated is 6 The registered person may provide the following category of service: Care Home only Code 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 not falling into any other category - Code LD Date of last inspection Brief description of the care home Quiet Waters was registered in February 2008 to provide care and accommodation to six people who have a learning disability. The home is positioned just off the A127 in West Horndon, and there is a train station, local bus route and shops nearby in the village. The service provides its own transport to support residents to access the community. The home consists of six single bedrooms spread over two floors, all of which are Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 6 2 5 0 9 2 0 0 8 Brief description of the care home ensuite. On the ground floor there is a large lounge, dining room, activities room, kitchen and separate laundry utility room. There is a downstairs cloakroom and a separate bathroom available on the first floor. The large secure garden to the rear of the premises is accessible to residents. To the front of the property there is parking for approximately ten cars. All doors to the outside are alarmed. A statement of purpose and service user guide are available. The deputy manager advised at this site visit that the current fees range between £1835 and £2385 per week. This varies dependent on the individually assessed and agreed package for each person, including for example agreed one to one staff hours. The agreed fees include the use of the homes vehicle. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of this service was undertaken on 25th September 2008. This site visit was undertaken over a seven hour period on one day as part of the key inspection. Time was spent with residents and staff and information gathered from these conversations as well as from observations of daily life and practices at the home have been taken into account in the writing of this report. The manager submitted an Annual Quality Assurance Assessment (AQAA) as required prior to the site visit. This is to detail their assessment of what they do well, what has improved and what they plan to do better. The AQAA contained a good level of information that was considered as part of the inspection process. Prior to the site visit, we sent the manager a variety of surveys to distribute to residents, relatives, staff and health/social care professionals. Subsequent to the site Care Homes for Adults (18-65 years) Page 6 of 28 visit, surveys were received from three residents, five staff and two relatives. The information provided and comments made are included in this report. A tour of the premises was undertaken and records, policies and procedures were sampled. The deputy manager was present during the site visit and assisted with the inspection process. The outcomes of the site visit were fed back and discussed with the deputy manager and opportunity given for clarification were necessary. The assistance provided by all those involved in this inspection process is appreciated. What the care home does well: What has improved since the last inspection? The management team have responded positively and effectively to the requirements identified in the last inspection report and the home was better managed and organised. The registered person has visited the home monthly and written a report to show that they have checked that the home is being well run and that residents are well looked after. Records were made available to show that robust recruitment procedures were in place to safeguard residents. There were also records to show that staff had been provided with induction and up-to-date training training to help them to meet service user support needs. Staff were getting more support and supervision meetings were regularly organised. There were clearer records of how the home looks after residents money. The complaints procedure was available in a format that was more user-friendly for people using the service and so more accessible to them. Medication practice was safer and photographs were available of residents so that staff would know that the right person was getting the medication. Care Homes for Adults (18-65 years) Page 8 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 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 10 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 have the information they need to make an informed choice about where to live and have their needs assessed prior to admission. Evidence: The statement of purpose has been reviewed since the last inspection. It was displayed in the entrance hall of Quiet Waters along with the most recent inspection report. A copy of the service user guide was available and the format made it more accessible to users of the service. The managers AQAA confirms that it is detailed, and provided to service users prior to moving in so that it gives them plenty of information about the home. Copies of the statement of purpose and service user guide were available on the resident files sampled. The service user guide told people the things they would have to pay for and had opportunity for a copy of the contract/local authority agreement to be included. Copies of the contract with the funding authority was seen on files sampled. A residency contract was in place on the file accessed for a person admitted since the last inspection, although this was not yet signed. Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: The managers AQAA tells us that to ensure that the choice of home is the most appropriate, Voyage employs senior care planners who identify and match potential service users with potential services. There is a formal pre admission assessment format and procedure in place that involves all relevant parties so as to ensure that the management and staff team are able to meet the prospective persons needs. As part of this site visit, the care files for a person admitted to the service since the last inspection were examined. Records of assessment were comprehensive and completed prior to their admission to the service. They were supported by information from the persons previous placement. There was no evidence to demonstrate that written confirmation had been provided to the prospective resident, that based on Voyages assessment, their needs could be met by Quiet Waters. This needs to be available for each person. There was evidence to show that as part of the assessment process people are given the opportunity for visits to the service prior to admission and the transition period is thoughtfully planned on an individual basis. Care Homes for Adults (18-65 years) Page 12 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 living at Quiet Waters can expect their needs, goals and choices to be identified and met, but would benefit from more timely assessment of risks. Evidence: There is a formal care planning system in place to help staff identify the care needs of individual people and to show how these are to be supported by staff who work in the care home. Care files reviewed confirmed that information from the preadmission assessment forms the basis of the support plan. Support plans were written from a person centred approach, included a wide range of needs and abilities, short and longterm goals and specific information on how to deliver support. Daily care records were written each shift and showed good detail. The support plan sampled demonstrated that it had been signed by the key worker and the residents relative. Throughout the day residents were observed and heard to make decisions and suggestions and to be encouraged to do so by staff. This included in relation to food and drinks, where to spend their time, what to wear or whether or not join in Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: activities. Each residents file showed a record made on three occasions each day of what decisions the person had made during that time. This promoted resident choice as part of everyday practice. Where for example a decision was made based on risk assessment for a monitor to be present in a residents bedroom, agreement for this was signed by a relative. On one of the files sampled, a range of risk assessment and management plans were in place covering individual identified risks and that referred clearly to the support plan and to making choices. These had been regularly reviewed. On the file for a more recently admitted resident while risk assessments from the previous placement were available, risk assessments relating to this environment had not yet been undertaken, for example in relation to bathing, epilepsy or road safety. Subsequent discussion with the operations manager confirmed that they should have been in place and would be undertaken without delay. Care Homes for Adults (18-65 years) Page 14 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 using the service enjoy a lifestyle that suits their needs and preferences. Evidence: The managers AQAA states that support plans reflect the lifestyle choices of each individual and where the person may not be able to express their feelings, they use historical knowledge and estimations of everyday lifestyle choices to develop a lifestyle pattern that is appropriate for that individual. People living at Quiet Waters are encouraged to take part in a variety of different activities and recreation both in and outside the home. Those observed included using the garden, playing football, watching TV and listening to music and playing computerised games or dominos.On the suggestion of a staff member and in negotiation with residents, they took a walk to a local park to enjoy the afternoon sunshine. Each person has a recorded activity planner which identifies three opportunities Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: sections for each day of the week. These included bowling, going out for lunch, going to the cinema or library, trip to Southend with dinner out, going to the bank to withdraw their money or going to an evening club. Activities in-house included cooking, laundry, karaoke or sensory sessions. A record of whether the activity actually occurred was also maintained. Staff spoken with and records indicated that opportunity to attend college courses is being supported for residents. Records were also maintained of family contacts or residents spending time staying with their family which indicates that outside relationships were encouraged. One relative survey included the comment (residents) activities are tailored to their individual needs, mainly on a one-to-one basis. Some residents spoken with indicated that they liked the food at Quiet Waters. Care files include a list of peoples individual likes and dislikes including in relation to interests/hobbies and food and drinks. Ample food stocks were available. Residents were seen to be offered and make choices regarding snacks/lunch and drinks during the site visit. A member of staff spoken with explained that a four week menu is in place and that residents would have input to this through the regular resident meetings. A survey received from a relative commented the food is good quality and healthy. Care Homes for Adults (18-65 years) Page 16 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 can expect their personal and health care needs to be identified and met as they would wish. Evidence: Rotas indicate that there is always at least one female member of staff on duty to support personal care. The managers AQAA tells us that staff are encouraged from the outset to provide personal care and support in a way that promotes dignity, privacy respect and autonomy. Staff spoken with confirmed that this forms part of their induction training, were aware of residents individual needs, abilities and preferences and observed to respect privacy and dignity in practice. The managers AQAA states that specific health issues for individual service users are identified in the initial assessment process and then developed in the support plan to give instructions as to how these can be met. This was evidenced on the files reviewed where each person had an individual health care plan as well as a plan for their medication, written from a person centred approach. Each person has an allocated key worker who reviews the persons needs with them on a monthly basis. Staff on duty were aware of healthcare appointments and planned visits by professionals such as Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: the behaviour therapist and occupational therapist and these were identified within the persons records. A sample signatory record was maintained with the Medication Administration Recording (MAR) indicating the people the manager had assessed as competent to provide medication to service users. Written evidence was provided of medication competency assessments for a sample of staff. Photographs were available on MAR sheets and protocols for as required medications to support identification which is an improvement from the last inspection. A protocol for rectal diazepam, while noted positively to now be in place, was not dated, did not include information on the types of seizures, timescales involved and any additional actions to be taken and need to be developed further. MAR sheets sampled recorded medication received and tallied with the medications remaining indicating that people received their prescribed medication as they should. This is further supported by a practice of two staff signing for all medication administration. Care Homes for Adults (18-65 years) Page 18 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect their complaints to be listened to and that they will be safeguarded by staff knowledge and the supporting information and systems. Evidence: The complaints procedure was displayed in the hall along with information on advocacy services, the homes policy and procedure on safeguarding vulnerable people and procedures for letting us know what you think. This is also referred to in the service user guide and the AQAA states that service users are given a copy of this policy and a welcome pack available in a variety of formats. Information supporting people on how to make a complaint or what to do if you dont like something is included in the service user guide. Of the two surveys received from relatives, one person stated that they did know how to make a complaint and the other that they did not. One person commented the care staff will always listen to any concerns that we have raised with them. It was stated that complaints would be recorded in the bound complaint book. This would not support confidentiality and an effective format for recording complaints should be developed. There were no entries in the book and the deputy manager advised to the best of their knowledge no complaints had been received by the home. The format of the report of the monthly visit undertaken under Regulation 26 demonstrates monitoring of any complaints or safeguarding issues. Care Homes for Adults (18-65 years) Page 19 of 28 Evidence: The managers AQAA indicates that one complaint had been received that was resolved within 28 days. The Commission had made the service aware of anonymous information it received alleging that there was ineffective management of the staff rota and that the senior team were not trained to dispense medication. Voyage responded appropriately and provided the Commission with requested records to demonstrate appropriate staffing levels and staff training. As recommended that the last inspection, the Southend, Essex and Thurrock guidance on safeguarding had been obtained and the deputy manager was clearly aware of it. Voyage have their own safeguarding adults policy and procedure which was readily available and has been signed by the registered manager and the majority of staff, which is good practice. One safeguarding referral has been made and investigated since the last inspection where a member of staff identified inappropriate practice and reported this promptly. Voyage responded in a timely way and took appropriate action to support the investigation and safeguard residents. A clear procedure in relation to whistleblowing was available. Staff spoken with confirmed that they had attended training on safeguarding and demonstrated an awareness of types of abuse as well as confidence in challenging and reporting this. Information from staff surveys also confirmed that they would know what to do if someone has concerns about the home. Records of a residents money were reviewed and the system found to be satisfactory. Safe storage was available and records of money paid out was signed for, supported by individual receipts and audited regularly by the registered manager and also by the operations manager. Care Homes for Adults (18-65 years) Page 20 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. Residents of Quiet Waters live in a well maintained, safe and modern environment that meets their needs. Evidence: The statement of purpose identifies that the property has been designed to provide an environment that is homely while maximising each service users dignity and privacy. Residents have opportunity to use a range of communal spaces including a large lounge, separate dining room, and activity room and sensory room. There is also a large and well maintained garden which was seen to be used by residents. There are two bedrooms on the ground floor and four on the first floor all of which have ensuite toilet and shower/wetroom. There is also a separate downstairs toilet facility and a communal bathroom facility upstairs. All ground floor areas of the premises are wheelchair accessible. Two residents showed us their bedrooms and both had keys to their own room. Bedrooms were personalised and reflective of the individuals interests. A separate and well equipped laundry was available. All areas of the home were clean and pleasant. No health and safety issues were noted. 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. People living at Quiet Waters can expect to be cared for by a safely recruited and familiar staff team who provide continuity of care. Evidence: The deputy manager advised that the home are currently recruiting and have vacancies for three full-time equivalent support staff. Rotas indicate a limited number of permanent staff available who are supported by bank staff and those from other local homes within the Voyage group. Staff spoken with advised of rare agency usage so that continuity of care is provided to service users. Staffing levels vary in line with the individual residents contracted additional staff support hours and how they are used at any particular time, the times that residents may have gone home to stay with their family and if respite care is being offered. Of the five staff surveys received two people said there usually was enough staff to meet residents individual needs and three people said their only sometimes was. Staff spoken with said they were a good staff group, do try to cover.. rare agency.. there is usually enough staff and another person said about staffing levels staffing levels are okay, but staff are tired, but they do cover. Activity sheets .. dont always happen due to limited, but not short, staffing levels, even in-house. A survey from relative on what the home could do better commented extra staff at certain times of the day Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: while another said care homes should be staffed as two staff per service user at all times . Staffing levels and hours worked should be kept under review. The managers AQAA indicates that of eight permanent staff three have achieved NVQ level II or above in care/health and social care. The last inspection contained a requirement in relation to evidencing safe recruitment of staff. The files for two staff recruited since the last inspection were reviewed. Voyage have an agreement with the Commission to store many of the required staff recruitment records centrally. Review of the documents available in the well-organised files at Quiet Waters and the additional information provided by fax confirmed appropriate recruitment procedures to safeguard residents. The managers AQAA states that there are plans to include service users in the recruitment process in future, which would be considered good practice. All five completed staff surveys received indicated that staff were being given training relevant to their role. Four of five people felt their induction mostly covered, or covered very well, everything they needed to know to do the job when they started. More recently employed staff spoken with confirmed they were currently working through their induction record books, reading care plans, policies and procedures and undertaking basic training on the electronic system provided. Training records reviewed for long serving members of staff demonstrated that staff receive training and updates including in relation to nonviolent crisis interventions, safeguarding, moving and handling, fire, infection-control and more service user focused issues such as autism and epilepsy. Files sampled for three staff contained a supervision agreement and records of supervision. A displayed supervision plan showed that each staff had had two supervision sessions since April and four more were planned to occur. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect an increasingly well-run service that seeks their views and promotes their health and safety. Evidence: The manager has recently returned to Quiet Waters following long term leave. The deputy manager was in charge of the home at the time of this site visit. The managers AQAA states that they have four years relevant experience as a manager, hold NVQ level 4 and are actively pursuing further management training. Systems are in place to gather the views of people who use the service and other stakeholders. The deputy manager advised that surveys had recently been sent out and responses would be sent to head office for analysis. In their AQAA, the manager indicates a plan for improvement as completion of the Voyage annual service review process and the creation of a development plan based on the views gained from service users, their families and other key stakeholders. There are regular and detailed reports of the required monthly visit by the registered Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: person to review how the service is running. These were confirmed as being announced visits rather than the required unannounced visits. The person responsible for undertaking these visits confirmed that they will in future be unannounced. Minutes of staff meetings were available and was signed by staff to confirm they had been read. Minutes of monthly resident meetings were available that are supported by pictures and symbols to make them more accessible to people living at Quiet Waters. Aspects of health and safety reviewed were found to be well managed. A random selection of service and maintenance records were made available on request and were assessed to be in good order. Fire drills undertaken record staff names to evidence they have attended and records included evidence of staff attending fire training. Records also demonstrate that the fire fighting equipment, emergency lighting and fire alarms are checked regularly to ensure they are in good working order. There are routine health and safety checks that include both hot and cold water outlets and risk assessment relating to safe working practice. 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 1 2 3 4 5 9 20 22 32 33 Undertake timely individual risk assessments to promote resident well-being and safety. Ensure that protocols for as required medications contain all relevant information. The system should be implemented for recording complaints that ensures confidentiality. Staff should achieve relevant NVQ training. Staffing levels and the hours worked by staff should continue to be reviewed and monitored. Care Homes for Adults (18-65 years) Page 27 of 28 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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