Care Home: Radnor House

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What the care home does well People say they like living at Radnor House. They have formed positive relationships with staff, who know them well and understand their needs and wishes. People lead full lives, they go out to day centres, clubs and lots of leisure activities that they have chosen for themselves. People are encouraged to make choices about their daily lives and things that they would like to achieve. They make their own plans to bring about their wishes. We saw that some people have already achieved their dreams. People have good healthcare support. They each have their own health plan that makes sure their health is regularly monitored and they get the right medical attention. People are supported to express their views or concerns using various different communication aids. They might use signs, pictures, photographs, or symbols. Staff know how to use the different methods and what works well for each individual. People have their own communication passports which they use to make choices and they can take out with them to help other people understand what they want. Staff look after people`s medicines and make sure they are kept safe. They make sure that people get their medicines at the right time. Staff are well trained and confident when supporting the people that live in the home. What has improved since the last inspection? They have looked at their admission process and made changes to improve things, so that they make sure people`s compatibility and communication needs are properly considered. They have developed a new transition guide to tell people about Radnor House and what it has to offer. It has lots of photographs and pictures to make it meaningful. This helps people who are thinking of moving into the home to get a real feel for what it is like to live there. People have been involved in writing their own individual plans of care called `My Plans`. They also have a separate `My Keeping Healthy Plan`. These have photographs, pictures and signs to help them understand them. Some people keep their care plan files in their own room so they can look at them at any time and show them to staff for themselves. These are good as there is lots of guidance that tells staff how to do things in the way that people want. This makes sure that all staff know how to do things in the same way so that people are supported in a consistent way. Staff have improved their communication skills by attending training courses on methods such as Makaton and BSL (British Sign Language). Staff are good at communicating with people. This means that people can make their needs and wishes known. Staff have also done training on how to deal with anger in a positive way that protects people. This has given staff more confidence to deal with situations and keep people safe. They have recruited more staff with the right qualifications and skills, who work effectively with the people living in the home. They now have a full staff team that ensures people receive consistent support. They have improved the way that the building is maintained, so that repairs get done more quickly. They have redecorated some areas of the home to keep it looking homely. They have looked at the environment and do regular checks to make sure that any risks, or maintenance things, are promptly dealt with to keep people safe. What the care home could do better: Since our last inspection they have made changes that have improved outcomes for the people living in the home. At our last visit the quality rating for this service was one star, which means that the people living in the home were experiencing adequate quality outcomes. As a result of this inspection, the quality rating has gone up to two star, which means that people who live in the home are experiencing good quality outcomes. We did not find anything that they could do better and are confident that they will continue the ongoing development of the home. Key inspection report Care homes for adults (18-65 years) Name: Address: Radnor House 139 Canterbury Road Hawkinge Folkestone Kent CT18 7AX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Christine Grafton     Date: 0 3 0 9 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 30 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 30 Information about the care home Name of care home: Address: Radnor House 139 Canterbury Road Hawkinge Folkestone Kent CT18 7AX 01303894693 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Caretech Community Services Ltd Name of registered manager (if applicable) Mrs Linda Lee Type of registration: Number of places registered: 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 Radnor House is owned and operated by Caretech Community Services Ltd and is registered to provide accommodation and personal care to a maximum of 6 persons within the age range 18 to 65 who have learning disabilities. It was first registered in October 2004 under the Care Standards Act 2000. It is a detached property situated in the centre of the village of Hawkinge, Kent. The layout of the home is suitable for people who are mobile within the home. It comprises of four single bedrooms situated Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 6 0 4 1 1 2 0 0 8 Brief description of the care home in the main house and two semi-independent flatlets that are accessed via the main front door. These have individual front doors within the main building that are fitted with a key code panel. All bedrooms have en-suite facilities and the flats have full bathing facilities plus kitchenette. There are two bathrooms with WC facilities and one separate WC. There is a large L shaped lounge / diner that opens onto the secluded rear garden, access is often restricted. A small room off the lounge is used as a quiet area but can be used as a separate dining room if required. There is a central kitchen for the preparation of all main meals. A shingle-covered car park to the front of the premises allows parking for approximately 8 vehicles. There is an administration office for the secure storage of information and a dedicated medication room. A cellar is available for storage, however is not in day-to-day use. The current weekly fees are in the range from £1560.00 to £2310.00. Copies of the statement of purpose, service user guide and previous reports can be obtained from the home. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This report takes account of information received since the last inspection of 4th November 2008 and included a visit to the home. We visited the home on 3rd September 2009 without telling anyone we were coming so that we could see what it is like for people living there on a usual day. We arrived at 09.35 hours and stayed until 15.10 hours. We talked to the manager, the deputy manager and other staff on duty. We were introduced to the people living in the home and all four people were involved in the inspection. We looked around the general living areas of the home and two people invited us to see their bedrooms. We also looked at two bedrooms that were unoccupied at the time of our visit. We observed what was going on and looked at the homes routines. At the time of our visit there were four people living at the home. At the moment they are all males and there are two vacancies. The manager says they are considering Care Homes for Adults (18-65 years) Page 6 of 30 making it an all male environment for the future. We looked at some of the homes records. We also used the homes annual quality assurance assessment known as an AQAA for short. This is a document that all homes have to send us once a year to tell us how they think they are meeting the national standards, how they have improved in the previous year, what they aim to do and lets us know when they have completed important environmental safety checks. Information from the last inspection is also referred to. Since the last inspection the manager has been registered with us, which means that we think she has the experience, qualifications and necessary skills to run the home. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? They have looked at their admission process and made changes to improve things, so that they make sure peoples compatibility and communication needs are properly considered. They have developed a new transition guide to tell people about Radnor House and what it has to offer. It has lots of photographs and pictures to make it meaningful. This helps people who are thinking of moving into the home to get a real feel for what it is like to live there. People have been involved in writing their own individual plans of care called My Plans. They also have a separate My Keeping Healthy Plan. These have photographs, pictures and signs to help them understand them. Some people keep their care plan files in their own room so they can look at them at any time and show them to staff for themselves. These are good as there is lots of guidance that tells staff how to do things in the way that people want. This makes sure that all staff know how to do things in the same way so that people are supported in a consistent way. Staff have improved their communication skills by attending training courses on methods such as Makaton and BSL (British Sign Language). Staff are good at Care Homes for Adults (18-65 years) Page 8 of 30 communicating with people. This means that people can make their needs and wishes known. Staff have also done training on how to deal with anger in a positive way that protects people. This has given staff more confidence to deal with situations and keep people safe. They have recruited more staff with the right qualifications and skills, who work effectively with the people living in the home. They now have a full staff team that ensures people receive consistent support. They have improved the way that the building is maintained, so that repairs get done more quickly. They have redecorated some areas of the home to keep it looking homely. They have looked at the environment and do regular checks to make sure that any risks, or maintenance things, are promptly dealt with to keep people safe. 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 9 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering moving into the home are given all the information they need to decide if it is right for them. They benefit from having an assessment that tells staff about them and the support they need. This helps to make sure that their needs can be met and they will be supported to achieve their aspirations. Evidence: The people living in the home have been there for some time now and there have been no new admissions during the past year. At the time of our visit there were two vacancies and the manager had been meeting with the relatives of a person who might be interested in moving in. People can learn about the home from the pictorial service users guide, which is written in a simple way to help people understand what to expect. Each person has their own copy that is written especially for them to make it meaningful. More recently, they have also introduced a new transition guide and service information book about Radnor House. It has lots of photographs and pictures that tell people all about the home, the staff, the places in the village that they can visit and the Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: activities that they can do. There is also a statement of purpose that is clear and has been updated recently. Relatives and care managers might like to look at this as it has more information about the home. We spoke to the manager about the admission process and how they decide who should move into the home. She explained that they have learnt from past experience and now have procedures in place to make sure that people are suited to the home and that staff have the right skills to meet their needs. We looked at two care plans and saw that they contain lots of details about the person, the things they want to achieve and the support that they need to live their lives in a way that encourages independence, whilst keeping them safe. Since the last inspection, they have worked hard to introduce assessments and plans of care that are more personal to each individual. We saw that these include thorough assessments that cover a wide range of topics specific to the individual. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home benefit from having their own individual care plans that make sure their needs are understood and met. They are supported and encouraged to make their own decisions and choices. Risks are managed in a way that develops their life experiences and helps to keep them safe. Evidence: We looked at two care plan files. Since the last inspection, they have completed the new person centred plans for each person. This means that each person has a written plan that is individual to them and tells staff all about them and what they want to achieve. It tells staff how to support them in the ways that they want. Each person has two folders, one called My Plan and a second one called My Keeping Healthy Plan which they have been involved in writing. These are made up with simple writing, photographs, pictures, signs and symbols that are relevant to the individual and form a real picture of the person that helps staff to understand them. There is lots of guidance that tells staff how to do things and emphasizes a consistent Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: approach. The plans show staff the best ways to communicate with people. We saw that they use a variety of different ways of communicating, including picture boards, objects of reference and signing. Since the last inspection, staff have been helping people to make their own communication picture passports, which one person showed us. This is a great help where people are unable to communicate verbally. One person showed us their care plan file, which they keep in their own room. As we looked at the various pictures, photographs and writing, the person talked to us about what it all means and described some of the activities depicted that they had enjoyed. The plan contains a section entitled Steps to My Dream which the person is well on the way to achieving. They said they are happy in the home. Next, we spent some time with the person and three staff members in the lounge and there was much laughter and positive interactions between them. The person spoke confidently with staff about their future plans. We saw staff offering choices to people throughout our visit. People were asked things like, what they would like to drink, what they would like to eat for their lunch and what activities they wanted to do. Care plans show how people make decisions about their lives and how they are encouraged to develop their independence. Things that are risky are clearly shown in the care plans and there is guidance for staff on what is to be done to keep people safe. This is called a risk assessment. This covers things like going out, or where specific behaviours might need to be managed. Since the last inspection, these have been made more individual within the person centred approach. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience 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 having lifestyle plans offering them a range of opportunities to lead fulfilling lives. They are supported to maintain contacts with families and friends, to make choices about their diet and to take part in planning and preparing their own meals. Evidence: They have told us in their AQAA that they have introduced more activities for the people living in the home. These have been chosen by individuals to suit their own personal interests. We saw an example of this, as during our visit one person was going out to play golf. They showed us their own set of golf clubs and indicated that they were looking forward to this activity. One person has been enabled to achieve their dream of having their own pet. They showed us how they had chosen to have a green budgerigar. Staff had spent time Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: with them observing their reactions to various different animal pictures. Once a pet bird had been chosen, staff had made up a pictorial visual prompter to choose the type of bird. When a budgerigar had been chosen, another picture prompter was made to pick the colour. The person indicated that they had been out to buy their pet the previous day. It was clear that they were pleased with this achievement. We also followed this process through when we read their care plan. We saw people going about their daily routines. Each person has their weekly activity schedule that they keep in their room. Care plans cover daily routines and show where one to one support is needed to develop independence skills. One person was cleaning their room with staff support. Another person was seen making a hot drink in their own kitchenette within their flat. We saw people moving about the home as they wanted and they were asked permission to enter their rooms. We spent time with two people that live in the home and with three staff members. We learnt about some of the things people like to do. People can go to the day care facility in a nearby town that the Caretech organization runs, known as the Martello Centre. This provides them with the opportunity to take part in various different activities and meet other people. They can also go to clubs, college and work opportunity placements. Leisure activities include swimming, bowling, pub trips, village walks and shopping. People are supported to maintain contact with their families and friends. The names of people who are important to them are written in the care plans in the My Plan folder that also include photographs to make it more meaningful. Staff said that visitors are made welcome in the home and people go away for family visits, which are recorded in the care plans. One person spoke about their favourite holidays and showed us some photographs. A staff member said, Our guys respond to pictures well, we take our cameras with us when we go out so that we can photograph things they like and then we use them for their communication passports. People are involved in choosing the weekly menus. A pictorial menu selector has been developed and each week staff spend time with people individually using this to record their choices. The weeks meals are then planned, making sure that healthy options are incorporated. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from having care plans that are used to make sure their health and personal care needs are met. They will know that this is done in a way that they prefer and that protects their dignity. Practices are in place for managing their medication to protect them. Evidence: We spoke to staff about how they support the people living in the home. It was clear that staff have got to know each person well. They know how to either encourage or support people with their personal support in ways that are flexible and make sure that their privacy and dignity is respected. This could be simple things like reminding to shave, or to have a bath or shower. This was also reflected in the care plans seen. Each person has their own health action plan, entitled, My Keeping Healthy Plan (see Individual Needs and Choices section above). These plans contain details about peoples health and the kind of personal support they need. They provide a clear and accurate picture of the persons health, with details of medical appointments, any follow up action taken and the rationale for decisions made. This means that peoples health care needs are closely monitored and followed up. Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: We saw that medicines are safely stored and staff keep records showing the medicines that have been given to each person. Staff have to be trained to administer the medications before they are allowed to give them out and there are clear medication policies and procedures. This includes procedures for medicines to be given when necessary and a booking out procedure for when people go home to stay with their families. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to express their concerns using signs and symbols. People living in the home are listened to and protected by the homes practices and procedures on abuse. Evidence: The home has a well written pictorial complaints procedure that is displayed in the lounge and each person has their own copy within their service users guide. We spoke to one person who indicated that they like living at the home and was confident speaking with staff. Another person indicated through signing and body language that they are happy with life at Radnor House. The AQAA states that staff spend one to one talk times with people and this together with the benefits of having an effective key working system, makes sure that staff quickly pick up if people are unhappy and act swiftly to resolve things. Staff said that they have lots of informal discussions on a daily basis about peoples needs and aspirations, which together with their shift handovers and regular staff meetings, makes sure that things are picked up and acted upon as necessary. Discussions with staff, information in the AQAA and care plans seen, show a good level of understanding about equality and diversity. They state we are beginning to develop a better picture of what the person would like and needs from the service and to work though the new person centred plans to devise simple, but clear information Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: on how the staff should do this. They acknowledge that this is an ongoing process, but we have seen examples of how well this is working so far, (see Lifestyle section above). They keep records of any complaints received and we saw that since the last inspection, there had been one minor issue raised that was dealt with to the persons satisfaction. Since the last inspection, eight staff have completed a three day course entitled Safer Care Conflict Management. We spoke to two staff about how they respond when people get angry and how they deal with verbal or physical aggression. They emphasized the use of consistent approaches and primary measures when dealing with known behaviours, which means that they do not then need to use more restraining techniques. A staff member said that the training had made them feel more confident when dealing with behaviours now. The staff training matrix indicates that five staff have completed Mental Capacity Act training at first level. The manager has also done levels 2 and 3, which covers the deprivation of liberties guidelines. The manager confirmed that they have carried out assessments for each person living in the home based on the guidance. This has included the environment and keypad locks at the front door and one persons bedroom. Four staff have also attended equality and diversity training. A staff member that we spoke to was very clear about their responsibilities for protecting people and the local procedures. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in an environment that is clean and comfortably furnished. Improvements have been made to make sure that the homes maintenance is more promptly completed to ensure that the environment is safe. Evidence: We saw that the hall and main lounge have been redecorated since the last inspection. We were told that one of the people living in the home was involved in choosing the paint and helping with the decorating work. The lounge diner and quiet room are comfortably furnished. People were seen relaxing in the lounge and moving about between the communal areas and their own rooms. Two people invited us to see their rooms. These were bright and clean, decorated in colours they had chosen, with lots of their own personal possessions. One person has recently moved from a single bedroom into one of the semi independent flatlets within the home. The AQAA states that they have seen a huge improvement in the persons happiness and mood and they state, By living in a more self supporting environment, it has boosted his confidence and given him a greater sense of self being. We saw that this is true, when we met the person in their flat. They were relaxed and interacted confidently with staff who helped him to Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: communicate with us. He indicated that he likes his new flat and is happy living at Radnor House. Another person showed us their room which was clean, comfortably furnished and highly personalized with lots of photographs of things they like. They have addressed the things that we identified at our last inspection as needing attention. They have replaced the radiator guard in the quiet room that had a hole in it. They have fixed fire extinguishers to the wall in the hall and on the landing. They say in their AQAA that Caretech now complete a monthly maintenance audit and work is being completed more quickly. We did not see any maintenance things needed at the time of our visit. People are involved in keeping their own rooms clean with staff support and guidance. They also help with the cleaning of communal rooms. All areas of the home that we saw were clean, tidy and homely. There is a laundry room on the first floor that has a washing machine and tumble drier, sink unit and separate hand wash basin. There are procedures in place to prevent the spread of infection, including liquid soap dispensers, anti bacterial gel and paper hand towels. The washing machine had broken down the previous day and had been reported to the maintenance department. The manager said they have ordered a new one. In the meantime they are taking the laundry to other homes in the area owned by Caretech. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have a good understanding of the support needs of people living in the home. People benefit from having enough staff on duty with the right skills, so that they consistently get the type of support that they need. People are protected by the homes recruitment practices. Evidence: We talked to the deputy manager about the staffing in the home and later with the manager also. We learnt that since our last inspection, two staff members have returned to work at the home, so they are known to the people living there. A third new staff member started in July, filling the staff vacancy. At the time of our visit there were four staff on duty and the manager came back to the home later in the morning and stayed for the rest of the time we were there. The staff on duty consisted of the deputy manager, a senior support worker, a flexi staff member and one agency staff, all of whom are well known to the people living in the home. We were told that they always use agency staff that know the home and the people living there. The staffing levels have been worked out according to peoples needs so that they can provide one to one support as necessary. Staff that we spoke to said they enjoy working in the home. We saw that they are Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: good listeners and good at communicating with people using different methods such as signing and reading body language. The staff team is well motivated and they get on well together. Since our last inspection staff have attended various training courses to develop their skills. These include, training in different communication methods such as Makaton and BSL (British Sign Language). The manager has drawn up a training matrix and there is a clear staff rota displayed in the office showing a months duties at a time. Currently five out of the ten staff have achieved their National Vocational Qualification (NVQ) level 2 in care or above and we were told that the remainder were either currently completing the award or would be enrolling on it. New staff have to undertake the learning disability framework training. They have to complete the Caretech induction training and mandatory courses within their first six months. Staff praised the training opportunities available to them and described a wide range of courses they had attended. One staff member spoke particularly of the benefit to people living in the home following staff training on dealing with behaviours and said that as a result there had been fewer incidents at the home. The organization has stringent recruitment procedures in place to protect the people living in the home. This includes a number of security checks being completed before a person is allowed to start work in the home. The main staff files are kept at the Caretech area office. We looked at two staff files kept at the home. These show that references and criminal records bureau checks have been received beforehand. This helps to make sure that staff are trustworthy and safe to be around the people living in the home. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a well managed home, which is run in a way that protects their best interests and promotes their health, safety and welfare. Evidence: The manager has been in post for approximately two years and has many years of previous experience working in residential care homes for people with learning disabilities. Since our last inspection, the manager has been registered with us. This means that we think she has the right qualifications, experience and necessary skills to run the home. People living in the home and staff continue to benefit from her leadership and support. Staff told us that they had been fully involved in completing the AQAA, much of which was written in their words. They say in their AQAA that they have an experienced and enthusiastic staff team working alongside a solid manager. We found that this was true. A staff member said that they had learnt a lot from the manager, saying, Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: She has really good ideas about consistent approaches with the guys. She has a good overview of the home and how it is to be run. She encourages staff to take ownership of what goes on and is open to ideas. She is good at increasing peoples knowledge and skills. We have seen throughout previous sections of this report how they have developed the service for the benefit of the people living there. They have met the requirements we made at our last inspection. The first one was for the environment to be risk assessed and any actions taken to prevent accidents. They have fixed fire extinguishers to the walls and other furniture items that could be pulled over on people. The second one was to make sure that information collected at assessment is matched to staff skills such as communication. They have done this by providing staff training in Makaton and BSL. They have also improved the staffing so that they have a full staff complement with the necessary skills to meet the needs of the people living in the home. They have regular staff meetings and there is ongoing quality monitoring that includes monthly visits from the Caretech area manager who provides additional support to the manager and staff. This also makes sure that the organization is aware of what is happening in the home. The manager showed us the homes annual quality and performance plan dated 2nd July and we saw that some of the things have already been achieved and they are working towards others. There is inclusion about the deprivation of liberties guidance and they have reviewed and risk assessed the use of the front door lock and bedroom locks, which have been discussed and agreed with the relevant persons. A fire alarm flashing light system has been fitted to the bedroom and lounge in one of the supported living flats on the first floor for the benefit of the current occupant. The AQAA indicates that the homes policies have been reviewed and updated. We saw that the home is well maintained and the dates of the most recent services were included in the AQAA. Regular health and safety audits are completed and staff have their allocated responsibilities for this, including fire checks, hot water temperatures and vehicle checks. There is a pictorial fire evacuation notice displayed in the hall. We were told that the people living in the home know what to do if they hear the fire bells. The staff training matrix indicates that staff receive the necessary training for health and safety to protect the people living in the home. Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: We have looked at all the information we have received since the last inspection and seen that the outcomes for people living in the home are good. The overall quality rating has therefore gone up from being an adequate one star service to a two star good service. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 29 of 30 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. 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