Care Home: Rivers

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What the care home does well The home`s information booklet is adapted to meet the needs of each individual person. This means it is easy to read, in large print and in pictures. It has a range of useful information about the home, to help people and their relatives decide if this is the home for them. Policies and procedures are in place to make sure that home can meet the individual needs of anyone looking to live there. The home works closely with people and their families and those already involved in the support being provided. People living at the home told us that they had wanted to move there, and that they received enough information to help them make the right decision. Each person has a written agreement with the home which is produced in a way that each person prefers, making it easy for them to read and understand. Staff do all they can to make sure people get specialist medical support, so that needs are met. The home offers a clean, hygienic and pleasant environment for the people living there. What has improved since the last inspection? Since the last inspection care files are now well organised, so that staff can identify the care which people need, and details of contact arrangements with families are now included. A system is now in place to ensure that risk assessments are updated quickly where this is needed. People now have information in pictures, which is easy to read, to help them make individual choices in their day to day living. People are offered a healthy diet that they need. Nutritional assessments are carried out to show an individual`s needs that need to be met. Regular records are kept of people`s weight. Staff work well with people and their dietitians to ensure that healthy living is promoted and this benefits people living at the home. Records show that where individual health needs have been identified, staff make sure that they are met. Managers have made sure that staff and people living at the home understand the complaints policy. People living at the home told us that they know how to make a complaint and staff said that they would know what to do in response. There is now a system for obtaining the views of everyone who has an interest in the service, to make sure they are happy with the way it is run. This includes surveys and meetings to make sure that everyone connected with the home has a say in the direction of the service. What the care home could do better: Detailed records should be made to explain why a person`s risk assessment does not need to be updated. The management of the home should continue to work hard to improve the target for staff having achieved an NVQ (National Vocational Qualification) Level 2 qualification. Key inspection report Care homes for adults (18-65 years) Name: Address: Rivers Blythe Road Oldcotes Worksop Nottinghamshire S81 8HU     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: Frances Shillito     Date: 0 3 0 3 2 0 1 0 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 29 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Rivers Blythe Road Oldcotes Worksop Nottinghamshire S81 8HU 01909731483 01909732753 riversmilbury@tiscali.co.uk www.voyagecare.com Milbury Care Services Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Shelley Abrams Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users to be accommodated is: 5 The registered person may provide the following category of service only: Care Home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD, Physical Disability - Code PD. Date of last inspection Brief description of the care home Rivers is a care home providing personal care and accommodation for up to 5 younger adults who have a learning disability. The home is owned by Milbury Care Services and owns a number of other homes. The home is located in Oldcotes between Worksop and Retford close to shops, a pub and other amenities. The home was opened in December 2006 and consists of an adapted domestic dwelling. All of the homes bedrooms are Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 0 5 5 Brief description of the care home single, and have en-suite facilities including a bath or a shower. Bedrooms are located on 2 floors.. The home has an enclosed garden that is well maintained and easily accessible. There is ample car parking available. The manager said on 270907 that the fees for the service range from £1,266 - £1,698 per week depending on dependency needs. Further information about the home is available from the manager or the website www.milburycare.com Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections carried out by CQC (Care Quality Commission) is on the experiences and outcomes for people using a service, and their views on the service provided. This process assesses how well the service provider is able to meet regulations and minimum standards of practice. Our inspections also look at aspects of service provision which need further development or improvement. This was our first visit to Rivers since a key inspection took place on September 27 2007. This inspection visit involved one inspector, it was unannounced and took place in the daytime. Before the visit an analysis of the service was carried out from information gathered over the last year, including that from the Annual Quality Assurance Assessment Care Homes for Adults (18-65 years) Page 6 of 29 completed by the manager. We also sent out survey forms called Have Your Say About... to people who use the service. The main method of gathering information followed is known as case tracking. This involves looking at the quality of the care received by a number of people who use the service. We also use evidence from our observations during the visit, we speak with people using the service and their relatives. We look at records and talk with staff about their understanding of the needs of the people they care for. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? Since the last inspection care files are now well organised, so that staff can identify the care which people need, and details of contact arrangements with families are now included. A system is now in place to ensure that risk assessments are updated quickly where this is needed. People now have information in pictures, which is easy to read, to help them make individual choices in their day to day living. People are offered a healthy diet that they need. Nutritional assessments are carried out to show an individuals needs that need to be met. Regular records are kept of peoples weight. Staff work well with people and their dietitians to ensure that healthy living is promoted and this benefits people living at the home. Records show that where individual health needs have been identified, staff make sure that they are met. Managers have made sure that staff and people living at the home understand the complaints policy. People living at the home told us that they know how to make a complaint and staff said that they would know what to do in response. There is now a system for obtaining the views of everyone who has an interest in the service, to make sure they are happy with the way it is run. This includes surveys and meetings to make sure that everyone connected with the home has a say in the direction of the service. Care Homes for Adults (18-65 years) Page 8 of 29 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 29 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 29 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. Peoples needs are identified in an assessment before they move into the home. People and their families have the information they need in a format they understand. This helps them decide if this is the right home for them. Evidence: During the inspection visit we saw that the Statement of Purpose has been produced in large print and in pictures. This means that it is easy for everyone to read and understand. It contains a range of useful information about the home, to help people and their relatives decide if this is the right one for them. In the Annual Quality Assurance Assessment (AQAA), the paperwork completed by the manager before the key inspection takes place, the manager confirmed that procedures are in place to follow, to ensure that home can meet the individual needs of anyone looking to live there. The manager told us that the service also liaises with people and their families and those already involved in the support being provided. The manager and staff said that people are invited for a visit to help them decide if it is the right setting for them. Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: Two people living at the home told us that they had wanted to move into the home and both received enough information about the home to help them make the right decision before they moved in. In the AQAA the registered manager told us that each person has a Residency Contract, which contains personal and financial information. During our visit we looked at the contracts for two people and we found that they were clear, informative, and written in a way that the individual prefers and can understand easily. Care Homes for Adults (18-65 years) Page 12 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their assessed needs reflected in individualised care plans and risk assessments which are regularly reviewed. Evidence: During the inspection visit we saw that a requirement had been met in relation to the need for care files to be organised, so that staff can identify care practices which are needed to be carried out, and for details of contact arrangements with families to be included. During this inspection we found that these improvements had been achieved. Staff spoken with showed good knowledge of the people they support and their individual needs and preferences. They told us that they encourage people living at the home to maintain contact with family and friends and we saw clear records which confirm this. In addition we had asked the management of the home to make sure that suitable pictorial and other aids are available, to help people to exercise greater choice in the activities they are involved in, as well as in meal choices. During this inspection visit Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: we found that work had been done to ensure that people have information provided to them in the way they prefer it. Staff said that meetings are held with people living at the home who want to attend them, where menu planning is discussed and people have a choice in the meals served at the home. In the AQAA the registered manager told us that, We provide an individual support plan based on the pre admission assessment and review of needs, clearly indicating individualised procedures that may be necessary. The plan is drawn up with the involvement of the service user, family, friends, or advocate and relevant agencies as appropriate, and this is reviewed with the involvement of service users at least every six months, with changing needs agreed and actioned. During the inspection visit we looked at the support plans of two people. We saw that these plans were detailed and centred around the needs of the individual, making them unique and relevant to each person, to guide staff on how to provide the right kind of support. During the inspection visit observations of positive interactions were made between staff and people living at the home. People we spoke with told us that they can choose what they want to do and that they plan how they will spend their time. The activities and pastimes people are involved in are varied and well recorded in the weekly activity plans. During the inspection we saw that people were listening to music, making drinks and cooking with staff support. At the last inspection we asked the management of the home to make sure that there is a system in place for promptly updating risk assessments if the need arises. In the AQAA, the registered manager told us that, Staff support service users to take responsible assessed risks. The risk assessments of two people were seen, which staff explained are reviewed regularly. We saw that they set out the identified risks and the measures in place to minimise those risks, and that they are regularly updated to take account of any changes. We also found that in some cases a record had been made which did not provide sufficient detail to explain why a persons risk assessment did not need to be updated. Staff were observed during the inspection visit, storing confidential information in locked filing cabinets or locked offices, in line with the Data Protection Act (1998). Staff were also seen ensuring that the door to the office was closed when they were making phone calls to ensure that confidentiality is maintained and respected. Care Homes for Adults (18-65 years) Page 14 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home enjoy positive relationships with family and friends and they have access to transport to enable them to engage in meaningful activities both at home and in the community. Evidence: It was noted from the records kept and what relatives and staff said, that people living at the home enjoy personal and family relationships. Staff told us that they do all they can to encourage people to maintain contact with family and friends. People living at the home told us that staff support them to live the life they choose. The manager had also told us in the AQAA that the team supports people to access chosen day services, colleges and the community on a regular basis. On the day of the inspection visit we saw that one person was out at college. We also found that others were spending time at home listening to music, or going out into the community with Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: staff support. Staff spoken with and the management of the home said that they provide support with developing daily living skills, they help with welfare benefits and budgeting, and offer any support that will help people to live as independently as possible. One staff member told us, We go through budgeting and cooking once a week. This encourages them to do something they are interested in. We encourage healthy eating. The deputy manager and staff told us that there are enough staff on duty to make sure that people can be accompanied when they go out into the community. They said that people like to go for a pub lunch, bowling, visits to the cinema, the local park and various places of interests. Staff told us that there are drivers on the staff team which enables people in getting out and about in the community with support. Positive interactions were noted at various times between staff and people living at the home. Staff were observed knocking on peoples doors, to respect for their privacy. People were seen helping themselves to a drink and watching television or listening to music, on their return home from the day service. During the visit there was an opportunity to observe people having lunch with support from staff. The food looked wholesome and appealing. We also saw later that staff were preparing a nutritious evening meal of chilli con carne with salad and jacket potatoes. People living at the home told us that they enjoy the food. At the last inspection we asked the management of the home to make sure that people are offered a healthy diet in accordance with their assessed needs. During this inspection visit we found that records showed that nutritional assessments are carried out to determine individual needs that are to be met, and regular records are maintained of peoples weight. Staff told us that they work closely with people and their dietitians to ensure that peoples individual needs are met and that healthy living is promoted. We found that improvements in this area have been made and that the healthy living initiatives at the home are of benefit to people living there. Care Homes for Adults (18-65 years) Page 16 of 29 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. Staff ensure that they obtain specialist medical input in peoples best interests, to ensure that their health needs are met. Medication is managed safely by competent staff. Evidence: Observations during the inspection of the home have shown us that staff offer personal care to people in a way that is line with their wishes and preferences. Before this inspection the manager told us in the AQAA that staff support people with respect and dignity and they ensure that their health needs are met. At the last key inspection we asked the registered manager to make sure that where it has been identified that resources are needed, these must be provided. We had seen that there was a management action plan in each file and this listed tasks that needed to be done, including providing a picture board of scheduled activities and a communication passport, but this had not been done. During this inspection visit we found that work had been done to make sure that information was produced in a way that people could understand. During discussion with the registered manager after the inspection visit, she explained that work was continuing to make sure that people can Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: read and understand any written material produced by the organisation. During the inspection visit the case files of three people were seen, which confirmed this. For one person detailed recording was seen, showing us that reviews take place regularly, so that all the professionals involved may discuss and agree a way forward for their care and support. We found that a review meeting was taking place on the day of the inspection visit. The consultant psychiatrist told us about the good work that staff at the home have done to help a person settle into his new home, They have a good understanding, they are striking a balance and he is doing very well. He is relaxed and happy. We found that a detailed record had been made promptly by the deputy manager at the home, to make sure that the persons support plan was updated, to guide staff on how best to care for this person. We also found that for another person living at the home, staff have ensured that they work closely with and obtain specialist support from a psychologist, psychiatrist, and the social worker involved, in this persons best interests. We saw that a letter from a Clinical Psychologist recognised the good work done by staff, ... your team are working successfully with him. You have very good strategies in place for minimising his anxiety and you have found the recommendations from Speech and Language very helpful. The relative of one person living at the home said, My sister has been at the Rivers for over four months now and is receiving care of a fantastic standard. The difference in her is obvious, she is happier, less anxious and becoming less reliant on her aging parents. I cannot praise the staff enough - they are professional, caring and fun. I am very impressed with how staff have enabled her to develop as an individual and gain self confidence and self esteem. At the last inspection we asked the registered manager to make sure that where health needs have been identified, arrangements are put in place to make sure they are met. During this inspection visit, we found that from what staff, people and involved professionals told us, and from the evidence we saw in detailed records, improvements in this area have been achieved, and the health needs of people are now being met. For example we saw the records made for one individual,in which routine and specialist medical appointments had been recorded. Before the inspection the manager had told us in the AQAA that people living at the home, with capabilities are given the opportunity to administer and control their own medication. If support is required, direction from service users on their preferred method of administration is followed. The company have robust policies and Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: procedures; these are adhered to and audited weekly. During the inspection visit a person living at the home told us that staff support her with her medication. We found that medication records were completed well. The stocks of medication were also examined and found to be appropriately stored and in good order. Staff said that that there are two medication cabinets so that they can keep a medication supply for one week in one cabinet and all the other stock in the other cabinet. They said that this cuts down the chances of errors and that when medication is received into the home every four weeks, it is organised in this way in the best interests of the health and wellbeing of people living at the home. Following the inspection visit the registered manager told us that the pharmacist who supports the home had carried out a medication audit in November 2009 with a very positive outcome. This means that the health and wellbeing of people at the home is safeguarded by good medication management at Rivers. Care Homes for Adults (18-65 years) Page 19 of 29 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. Complaints procedures are in place which are understood by people living at the home and the staff who support them. Safeguarding training is provided to staff and is regularly updated. Evidence: At the last inspection we asked the management of the home to make sure that staff and people living at the home understand the complaints policy. We found during this inspection visit that improvements had been achieved in this area. In the AQAA the manager told us that All service users and their families are provided with an accessible version of the Letting us know what you think policy and service users are each provided with I am worried cards. This complaints procedure was seen at the home during our inspection visit. We found that it had been written in large print and in pictures, making it easy for people to read and understand. The complaints record was also seen. Managers and staff both told us that no concerns had been raised since the last inspection. Two people living at the home told us that they know who to speak to if they are unhappy, and that they always know how to make a complaint. All staff who filled out our Have Your Say... survey forms told us that they know what to do if concerns are raised with them by a person living at the home, or by a Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: relative, advocate or friend. All the people living at Rivers who completed our survey forms told us that they would speak to staff if they were unhappy about something. Before the inspection visit took place the registered manager told us in the AQAA that the safeguarding policy has been produced in a way that is easy for everyone to read. This will help people to understand what to do if they did not feel safe, and it will also help to make sure they are protected. We saw during the inspection visit that a safeguarding policy and procedure is in place for staff to follow. During discussion the deputy manager confirmed that no safeguarding alerts had been made since the last inspection, and that no safeguarding incidents have arisen. Everyone we spoke with showed us that they understand their responsibilities in keeping people safe and who they should contact if they had any concerns. The manager stated that staff have received training in safeguarding and staff spoken with confirmed this. Training records seen showed us evidence that this training had taken place. Care Homes for Adults (18-65 years) Page 21 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offers a clean, hygienic and appealing environment for the people living there. Evidence: In the AQAA the manager told us that, We provide an accessible, homely, clean, hygienic, safe, well maintained and comfortable environment to meet individual service users needs. The home is well located to access local facilities and transport networks and is fit for purpose.... During the inspection visit a person living at the home provided a tour of the house. We found that the home was well maintained and decorated in attractive and appealing colours. People told us that they like the home and they can choose where to spend their time and how to decorate their bedrooms. They told us that they particularly like the garden where they can enjoy BBQs in the warm weather and the sensory room where they can relax and unwind. During the inspection visit, most of the bedrooms in the house were seen. They were clean, tidy and personalised with photgraphs, and other personal belongings. People living at the home told us that the home is always kept clean and fresh. Care Homes for Adults (18-65 years) Page 22 of 29 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. Staffing levels are adequate and staff receive training that is relevant to their work. This will help ensure that people receive the best possible care and that their needs are met. Evidence: During the inspection visit the training matrix was seen. We found that most staff have achieved an NVQ (National Vocational Qualification) Level 2. The manager explained that work is being done within the organisation to make sure that more staff complete this qualification. Staff told us that they are encouraged to undertake their NVQ studies as soon as possible. We found from the training records seen and from what the manager and staff told us that staff receive the mandatory and specialist training that is relevant to their work.In addition the manager reflected in the AQAA that shift planning arrangements take account of meeting the needs of people living at the home, for example for staff to accompany people to medical appointments. Staff spoken with told us that there are enough staff to meet the individual support needs of people and to complete the necessary records. The rotas were seen during the inspection visit and the deputy manager and staff on duty were spoken with Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: regarding staffing arrangements. Staff told us during this inspection visit and in the survey forms they filled in for us, that they have regular supervision and opportunitites to discuss any issues which arise outside of these meetings. People said they feel supported and that there is always someone they can approach for guidance. The recruitment files of two staff were seen and discussion took place with staff who work in the service. Evidence was seen that all the necessary checks had been made before the staff started work and for each person there was a clearly defined job description setting out their roles and responsibilities. Care Homes for Adults (18-65 years) Page 24 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, safety and welfare of people living at the home is protected by action taken by management and staff at the home. Quality assurance activities at the home have been put into practice so that everyone with an interest in the home has a say in the way it is run. Evidence: The registered manager told us in the AQAA that she has achieved NVQ (National Vocational Qualification) Levels 2, 3 and 4, the Registered Managers Award and a range of other qualifications. We found that there was evidence that team meetings are planned and take place. Staff said that they receive regular supervision and that there is an inclusive and approachable atmosphere amongst management and the team. At the last inspection we asked the management of the home to make sure that there is an effective quality monitoring system, that finds out about the views of people living at the home. We found during this inspection visit that there is now a system for Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: obtaining the views of everyone who has an interest in the service, to make sure they are happy with the way it operates. This includes surveys and meetings to make sure that everyone connected with the home has a say in the direction of the service. Various organisational policies were seen. They were found to be up to date and accessible to staff. We saw that a senior manager carries out the monthly visits to the home and writes a report, as required by regulation. We found that there were no recommendations following last months visit. The registered manager confirmed during discussion what was reflected in the AQAA, that health and safety checks are undertaken by staff at the home. A number of records were seen during the inspection visit which demonstrated that these checks are being made and recorded, so that people live in a safe and comfortable environment. Care Homes for Adults (18-65 years) Page 26 of 29 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 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 When risk assessments are reviewed, a clear record should be made to explain why the risk assessment does not need to be updated. The management of the home should continue to work hard to improve the target for staff having achieved an NVQ (National Vocational Qualification) Level 2 qualification. 2 32 Care Homes for Adults (18-65 years) Page 28 of 29 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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