Care Home: REACH Bierton Road

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What the care home does well Potential service users receive a needs assessment, undertaken by staff trained to do so, ensuring that the home can meet the care needs requirements of service users. There have been no new admissions to the home since the previous inspection. Service user plans are in place, which are informative and allows for staff to provide continuity of care. One completed survey that was returned, stated under the section, "what does the home do well" was "give us choices" and one person using the service said " I`m very lucky. I have had very good keyworkers and they know what I like". The people who live in the home enjoy a range of activities. In surveys received by the Commission two comments were made from staff, "give the more independent residents a chance to go out alone" and "for the independent resident a chance to show if they can go out alone, maybe to town" and "give more support to the residents. There is a staff team who respond to service users in a respectful and appropriate manner. Daily routines in the home are flexible and people can choose when they take part in activities. The home provides a pleasant and comfortable environment in which people can live. Individuals are encouraged to personalise their own rooms with their own furniture and personal belongings. All bedrooms are single occupancy to ensure that the privacy and dignity of people using the service is promoted. The home ensures that people using the service are provided with a choice of wholesome and appealing meals in pleasing surroundings. The home makes sure that relatives and friends are able to visit at anytime within reason. There is a robust recruitment procedure in place that ensures service users are protected from harm. There is regular monitoring by the provider, ensuring that the service operates effectively. There is a good range of policies and procedures, providing staff with relevant information about all aspects of care and the home/organisation. Health and Safety procedures are thorough and records are well maintained. The evidence seen and comments received indicate that this service meets the diverse, racial, cultural, disability of individuals within the limits of its Statement of Purpose. What has improved since the last inspection? The person centred plans are more accessible to residents and show that service users are more involved in developing their own person centerd plans. All elements of risk when dispensing medication from a portable box have been risk assessd and the risk minimised to ensure safety. The home has recently been redecorated and refurbished. Staff recruitment and retention has improved, leading to a consistent staff team . More specialist training has been made avaialble available such as Ageing and Dementia in Adults with Learning Disabilites, Breast Awareness and Sexuality for Service users. What the care home could do better: Care staff must receive up to date training in safe handling of food, fire, infection control and moving and handling. Key inspection report Care homes for adults (18-65 years) Name: Address: REACH Bierton Road Aylesbury Bucks HP20 1EJ     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: Barbara Mulligan     Date: 2 6 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: REACH Bierton Road Aylesbury Bucks HP20 1EJ 01296429586 01296429586 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.Reach-disabilitycare.co.uk REACH Limited The registered provider is responsible for running the service care home 8 Name of registered manager (if applicable): Type of registration: Number of places registered: 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: 8 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 20-22 Bierton Road, Aylesbury, is a care home providing residential care to eight adults with learning disabilities. The home is a conversion of two mid-terraced houses. The Rehabilitation Education and Community Homes Limited (REACH), an organisation specialising in residential care for adults with learning disabilities, manage the service. The home is located about half a mile from Aylesbury town centre, convenient for the facilities of the town, the specialist facilities of Manor House Hospital, which is across the road and public transport. All of the homes bedrooms are single and none have en-suite facilities. The fees range from £680 to £1300 per Care Homes for Adults (18-65 years) Page 4 of 28 8 Over 65 0 Brief description of the care home week. 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: This unannounced key inspection was conducted over the course of a day and covered all the key National Minimum Standards for Younger Adults. Prior to the visit, a detailed self-assessment questionnaire was sent to the manager for completion. This was returned to the Commission by the day it was due and was fully completed, giving us the information we needed. Information received by the Commission since the last inspection was also taken into account. Eight surveys were sent to the home for people using the service to complete and two of these have been received by the Commission. Six surveys were sent for staff to complete and four of these have been received by the Care Quality Commission. The inspection consisted of discussion with the care service manager, discussion with care staff, opportunities to meet with people who use the service, examination of some of the homes required records such as care plans, risk assessments and staff files, the medication systems and accompanying records, staff rosters, observation of practice and a tour of the premises. A key theme of the visit was how effectively the service Care Homes for Adults (18-65 years) Page 6 of 28 meets needs arising from equality and diversity. As a result of the inspection the home has received one statutory requirements. Feedback on the inspection findings and areas needing improvement was given to the care services manager. The management of the home, the staff and service users are thanked for their cooperation and hospitality during this unannounced visit. Care Homes for Adults (18-65 years) Page 7 of 28 What the care home does well: Potential service users receive a needs assessment, undertaken by staff trained to do so, ensuring that the home can meet the care needs requirements of service users. There have been no new admissions to the home since the previous inspection. Service user plans are in place, which are informative and allows for staff to provide continuity of care. One completed survey that was returned, stated under the section, what does the home do well was give us choices and one person using the service said Im very lucky. I have had very good keyworkers and they know what I like. The people who live in the home enjoy a range of activities. In surveys received by the Commission two comments were made from staff, give the more independent residents a chance to go out alone and for the independent resident a chance to show if they can go out alone, maybe to town and give more support to the residents. There is a staff team who respond to service users in a respectful and appropriate manner. Daily routines in the home are flexible and people can choose when they take part in activities. The home provides a pleasant and comfortable environment in which people can live. Individuals are encouraged to personalise their own rooms with their own furniture and personal belongings. All bedrooms are single occupancy to ensure that the privacy and dignity of people using the service is promoted. The home ensures that people using the service are provided with a choice of wholesome and appealing meals in pleasing surroundings. The home makes sure that relatives and friends are able to visit at anytime within reason. There is a robust recruitment procedure in place that ensures service users are protected from harm. There is regular monitoring by the provider, ensuring that the service operates effectively. There is a good range of policies and procedures, providing staff with relevant information about all aspects of care and the home/organisation. Health and Safety procedures are thorough and records are well maintained. The evidence seen and comments received indicate that this service meets the diverse, racial, cultural, disability of individuals within the limits of its Statement of Purpose. Care Homes for Adults (18-65 years) Page 8 of 28 What has improved since the last inspection? 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 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 who use the service have their needs thoroughly assessed prior to admission, ensuring that staff are prepared for admission, and given an opportunity to visit the home beforehand to ensure it meets their needs Evidence: At the time of the visit eight people were using this service. There have not been any new admissions to the service in the past twelve months, according to information supplied prior to the inspection. At the last inspection it was identified that the organisation has good systems for assessing the needs of potential residents. Referrals are assessed and considered by an experienced manager. Admission of a new resident is carefully considered alongside the needs of the people who live at the home. Following assessment and after considering whether the service is able to meet assessed needs, the prospective resident is invited to visit the home. When admission is agreed a three-month introductory placement is arranged. A review is held at the end of the period to ensure the individual and the other members of the house feel Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: happy and comfortable with the admission. 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. Detailed care plans are in place, which adequately documents the care needs of people who use the service, and how these are to be met, within a risk assessment framework. People who use the service are enabled to make decisions and be as independent as possible. Evidence: A service user care plan/Person Centred Plan (PCP) is in place for each person using this service. At the previous inspection it was identified that the Person Centered Plans were complex and did not facilitate the engagement of all residents in the process. Three service user care plans were examined during this visit. These contain sufficient detail for staff to learn about residents they support. Specific needs have been identified within the care plans and there is an action plan in place to provide staff with the details of how these needs are to be managed and fully met. Individual preferences, likes and dislikes are recorded in care plans and describes how these will be met. One person who uses this service said, Im very lucky. I have had very good keyworkers and they know what I like. Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: On the day of the visit one person was completing their own Person Centred Plan which they wished to show us. This clearly relates to the wishes and goals of the individual and shows their future wishes and aspirations. Care plans are signed and dated by the person completing them. Visual observations of people using this service showed that people were appropriately dressed and people were seen to be wearing the aids needed, for example clean glasses. All individuals have a review every six months to which families and interested parties are invited. All residents are encouraged to lead their own review as much as possible. Monthly residents meetings are held as an open forum. Minutes of these are maintained and were examined during this visit to the home. These show that individuals are encouraged to air their views and be involved in decision making, whether it be about themselves, or choosing a new item for the menu, a new activity or a haircut. Annual holidays are discussed and are chosen by the residents. All residents are actively encouraged to participate in potential support staff interviews. The interviews of potential support staff are held in the house and residents can ask any questions they wish, which are recorded on interview records. Residents continue to be encouraged and supported by staff in making decisions. A local independent advocacy service, Aylesbury Vale Advocates, maintains involvement with some residents. Risk assessments have been completed for the use of the dish washer, ironing, meal preparation, the risk of choking and personal care and the management of epilepsy. These show that they are reviewed and updated regularly. 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. Service users have an active lifestyle which reflects their interests, provides them with nourishing meals and have contact with family, friends and the community. Evidence: Service user files examined outline the individuals interests and activities that they enjoy. There is good regard for the diverse needs of the people living at the home and their requirements related to their disabilities, lifestyle choices and personal preferences. People who use the service attend activities that are tailored to meet their individual needs. Some of these include trips to the local swimming pool, walks, shopping in the town, bingo, vocal therapy, three people attend the local college and a further two people attend sheltered work placements. On the day of the inspection one person chose to attend a game of bingo in the afternoon. Some service users continue to Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: regularly attend a social club in Aylesbury. When individuals are at home they enjoy a range of interests which include knitting, painting, sewing, board games, TV, video and music. Some comments made in the returned staff surveys are give the more independent residents a chance to go out alone and for the independent resident a chance to show if they can go out alone, maybe to town and give more support to the residents. The service user care plans provides details of what individuals do during the week, social likes and dislikes and information about how they access the community. Family and social contacts were seen recorded in all files. There are no restrictions about family and friends visiting and people who use the service are supported to maintain family relationships and have regular visits from and to their family. From observations on the day of the inspection visit, staff members were seen to treat the People living in the home with respect and patience. One comment made during this visit was Im very lucky to live here, I can go to town and Im going on holiday soon. Records are maintained of service users diets and these demonstrate that individual needs, such as healthy eating are being met. Monthly weights are recorded and nutritional screening is evident in files. The inspector had the opportunity to observe a lunchtime meal. This was relaxed, unrushed and well organised. People were well supported by staff and the food was attractively presented. One comment made about the food was the food is lovely. I like the food. The home will offer drinks and snacks throughout the day in accordance with needs of each individual. 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 who use the service have their needs outlined within their individual plans, ensuring that the manner in which they are supported and cared for by staff is appropriate and promotes their preferences. Evidence: Service user care plans provide detailed information about the type of support and assistance people using the service need. We were told that people who use the service are supported to choose when they like to go to bed, have a bath, have their meals and take part in other activities. Choices around clothes and hairstyles remain with the individual and personal preferences are recorded within individual care plans. This was confirmed in a discussion with one person who was in the home on the day of the visit and in surveys returned to the Commission. There is evidence of health care screening in service user care plans. Each file contains health and hygiene guidelines for staff to follow. Each file contains an appointment record sheet and staff record all health care appointments attended by service users. For one individual who has epilepsy there is a detailed support plan in place regarding the management of the individuals epilepsy. There is good information about the Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: support people need with oral hygiene, continence care, personal care and maintaining a healthy weight and nutrition. All service users are registered with a GP practice and specialist services such as physiotherapy, occupational therapy, psychology and speech therapy are accessed via the Community Learning Disabilities team. Dental services are accessed at a local health centre. Service users attend a local optical service in the nearby town and there was evidence of optical prescriptions in files. Medication practices were examined during this visit to the home. Four people using the service were able to self administer their own medicines with some support from the care staff and up to risk assessments are in place for these individuals. Medicines are stored in a locked portable box. Additional stock is stored in a locked metal cabinet within a lockable cupboard. Staff currently take the portable box out of the cupboard to dispense medication in the dining room. There is a risk assessment in place for this which is reviewed on a regular basis. Medication Administration Records (MAR) are in good order with staff signatures alongside prescribed dose times. There are detailed guidelines in place for the administration of as required medicines, which are available in the medication administration records and individual service user care plans. Training records for staff expected to administer medicines were examined and it was noted that staff have completed safe handling of medicines in social care training. 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. There are procedures in place for Complaints and Safeguarding Vulnerable Adults which ensures the views of people who live at the home are listened to and people are kept safe from harm, but the recording of complaints needs to be improved. Evidence: The service has a complaints procedure in place and this includes the timescales for responding to a complaint. The Annual Quality Assurance Assessment (AQAA) tells us that the home has received one complaint since the previous inspection. However, the homes complaints log which was examined during this visit does not record any complaints received by the home. The home should ensure they keep a record of all complaints received and record the action taken and the outcome of the complaint and must address this shortfall. Procedures are in place for the protection of vulnerable adults and staff have access to a whistle blowing policy. The home has a copy of the local authority Safeguarding policy. Training records demonstrate that staff have undertaken training in adult protection. The Annual Quality Assurance Assessment tells us that there has not been any safe guarding referrals in the previous twelve months. The home has continued to keep the Commission informed of any safeguarding incidents. 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. A clean, comfortable and homely environment has been created for people who use the service, ensuring that they have appropriate surroundings in which to live. Evidence: The home is located close to the town of Aylesbury. It is opposite Manor House Hospital, a Learning Disability services and not far from the Tindal Centre, a Mental Health services. centre. The home consists of two terraced houses converted to one house. All areas were tidy, in good order and clean on the day of the visit. The entrance hall leads to stairs to the first floor, a ground floor bedroom, the lounge, dining room, and kitchen. Then further on to the staff office, a small laundry room, and a sitting area to the back of the building. There are stairs to the first floor in each half of the building. The lounge and seating areas are comfortably furnished and spacious and on the whole these are in good decorative order. Efforts have been made to make these areas look homely, with many personal touches such as pictures, side lamps, books, plants and ornaments. One person spoken to on the day of the visit said I like my room, I like to keep it tidy and I like the garden. The kitchen was clean and tidy and the dining area is bright and spacious. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: There are sufficient bathrooms and toilets to meet the needs of the people using this service. The garden to rear of the house is well maintained with garden furniture for use for all house members. All areas of the home appeared clean and there were no unpleasant odours. It is part of the philosophy of the home that residents are supported to undertake domestic chores and on the day of the visit people were observed to be taking part in households tasks. Laundry facilities are sited so that soiled articles, clothing and infected linen are not carried through areas where food is stored, prepared, cooked or eaten and do not intrude on service users. The laundry floor finishes are impermeable and these and the wall finishes are readily cleanable. The home has an infection control policy and the inspector observed this. Instructions are in place for the washing of soiled linen. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing numbers and skill mix is adequate but improvements need to be made in staff training to ensure that people who use the service benefit from staff who are competent to do their job. Recruitment procedures are undertaken to ensure staff have the right skills and competencies to support the people who live there. Evidence: Staff were observed to be accessible to and comfortable with service users and showed a good awareness of service users needs. The homes staff rota demonstrates that there are two staff on duty in the mornings and two staff working in the afternoon. Comments made from returned staff surveys express concerns about the levels of staff working in the home. The staffing is just not enough to be fair to everyones needs and I feel there is not enough staff at present to deal with the hours of work. The home presently has three full time vacancies which are covered by relief staff who were familiar with the home and its residents. The care services manager said that recruitment is currently taking place to fill these vacancies. Service users spoken to on the day of the visit said that staff are very good, they know me very well. Im very lucky. The AQAA tells us that there are currently eight staff employed at the home and three Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: of these have completed NVQ training. This does not meet the 50 target as set out in the national minimum standards. The recruitment files for a selection of staff were examined, including those people new to the service. All files looked at contain the necessary documentation. There is evidence that all staff CRB checks had been obtained and references had been undertaken before the staff member started work. All staff complete an induction programme that covers the common induction standards for social care and this was seen in the four files examined. During the initial induction to the home staff are extra to the numbers on the staff rota and work alongside more experienced staff. Training records show that several staff need to up to date their mandatory training. The AQAA tells us that only 50 of care staff have completed training in safe food handling and only four staff have completed Infection Control training. Records examined in the home show that moving and handling and fire training are out of date for most staff. The home must address this. There is specialist training available for staff, and an example of this is equal opportunity and diversity training, aging and dementia in adults with Learning Disabilities, Breast Awareness , Sexuality for Service users and non-violent crisis intervention. 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. There is no registered manager in the home at present but temporary arrangements for the home ensure continuity of care and there are good systems are in place to safeguard the residents and staff working in the home. Evidence: At the time of the visit there was no manager for the home. The care service manager was visiting on the day to undertake the providers monthly Regulation 26 visit. We asked about the present management arrangements for the home and were told that another manager from a sister home attends two days a week and the operational manager and the care services manager visit the home twice a week. The care services manager said that interviews have already taken place and it is hoped that a new manager will be in place shortly. The organisation & home has a clear and accountable management structure and the manager is supported by the organisation. The inspector noted good teamwork in progress and all the staff spoken to had a good working knowledge of the individual residents and their care needs. Each home is given an annual quality audit to complete. Following the completion of this audit an action plan is drawn up to ensure improvements are completed. Quarterly monitoring Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: visits are undertaken to ensure the action plan is being attended to. Regulation 26 reports are completed and these follow a detailed format that shows speaking with staff and people who use the service is a regular feature of the visits, plus good practices such as examining a sample of individuals money and staff training records. Staff spoken to confirmed that regular staff meetings are held and they are given the opportunity to raise concerns and make suggestions. The annual quality assurance assessment (AQAA) was returned to us by the date it was was completed fully and in detail. A range of health and safety checks are in place at the service and carried out on a daily, weekly or monthly basis. Weekly fire checks are carried out and recorded. Fire drills involving people who use the service are undertaken and recorded. The fire risk assessment is dated May 2008 and is now due to be reviewed. There are individual risk assessments in place There is written evidence of water and fridge and freezer temperatures. PAT testing was last carried out in June 2009, Gas appliances were serviced in March 2009 and electrical installatin was last serviced in November 2004. The latest visit from the environmental health department was on 26/06/2008 and no recommendations were made during this visit. 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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