Care Home: Riverside Park (12)

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What the care home does well Riverside Park is a home that is safe and comfortable and is well looked after. The rooms are large which means people can get around easily and there is plenty of space for people who may need to use a wheelchair to get around. Service users have safe access to a garden that is made attractive by trees, flowering shrubs and plants. This spacious area also has garden furniture that enables service users to enjoy life outside. Staff and service users get on very well together and make visitors to the home feel very welcome. Service users are supported to take part in activities both in the home and in the local community. This means that they are given the opportunity to try new experiences and to develop relationships with people outside of the service. Staff support service users to go on holidays that they choose and to destinations that reflect their preferences and personalities. This might mean being supported 1 to 1 or going with a friend or staying at home and going out for day trips. Service users are empowered to lead their plan of care, which means that staff are guided to support them in the way that they prefer. So that everyone is able to achieve this, good records are kept detailing how individual service users communicate their needs. Good relationships have developed between staff and healthcare professionals who guide staff to work effectively when supporting service users` healthcare needs. This means that service users are supported in the right way and staff learn from professional guidance. Good nutritional food is provided and individual dietary needs and preferences are addressed appropriately. This means that service users receive food that is good for them and that they enjoy. Service users are encouraged to eat together in a relaxed and friendly atmosphere. Staff help each service user to keep in contact with family and friends and visitors are always made to feel welcome into the home. What has improved since the last inspection? All of the requirements made at the last key inspection have now been met and since the employment of the new manager there have been many improvements made. Many of the improvements made have been centred around the positive development of service users and the development of their independence. As a result service users are now more empowered and live a more positive lifestyle. Over the past 12 months the new manager, who has since registered with the Commission, has been appointed to the home and 2 full time new members of staff have been employed. The staff team is now led by a manager that is focused in her role and whose aim is to develop the service and the individual service user`s lives. Staff have received a full training programme and all are now up to date with mandatory training. More positive working relationships have developed with community nurses and the Community Learning Disability Team which enables the home to support service users` health care needs. One healthcare professional said; "It`s a joy to come in here, there have been so many improvements." Service users are now further empowered regarding accessing and administrating their medication. Locked medication boxes are kept in individual service user`s bedrooms and this promotes; safety when staff support them to administer medication, while at the same time it promotes individual`s privacy and dignity. Furthermore service users are supported to visit the pharmacy to collect their medication weekly and as a result good relationships have developed between service users and the pharmacy staff. Staff have been particularly determined to enable service users` social networking skills and this has been one example. Service users are now fully supported to develop their daily living skills by being involved in the individual household tasks and decision making and so that service users and staff can effectively communicate together, both have attended Makaton lessons. This has equipped them with the skills needed to use sign to support the spoken work. Staff feel confident that the home is being run and developed in a positive way and some comments include; "The manager is brilliant, she brings the best out in you." "I see a future in care now. I feel that I can develop further." "So many changes have been made since the new manager has come. Service users are benefitting from different approaches that we give." The new manager fully completed and returned The AQAA to the Care Quality Commission on time. This meant that the commission is informed of the manager`s own assessment of the service and any recent developments made, so that it can be determined whether the home continues to provide a good service for the people living there. It also provided detailed information about the plans the home has to further improve the service. The registered manager has achieved the necessary qualifications to establish her as fully qualified in her role and has proved that she has the skills and knowledge required of a registered manager. In addition to this there is clear evidence that she is up to date with mandatory training and that she continues with her personal development programme. What the care home could do better: A full assessment of need should be received from the referring agency for the prospective new service user as soon as possible. This will provide the home with the necessary information needed to establish whether the home can meet the person`s assessed needs before making any committments to them. Thought should be given to replacing the three piece suite in the loung with furniture that meets the needs of the people living at the home, so that they can use the seating provided comfortably and independently. The gardens surrounding the home should be given attention, so that they are kept in keeping with the gardens of the surrounding properties and that they promote a positive image of the people living and working there. The number of staff on duty should be reviewed when the two vacant places are filled so that they reflect effectively, the needs of the people living at the home. Key inspection report Care homes for adults (18-65 years) Name: Address: Riverside Park (12) Riverside Park (12) South Hylton Sunderland SR4 0RT     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Elsie Allnutt     Date: 0 5 0 5 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 31 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 31 Information about the care home Name of care home: Address: Riverside Park (12) Riverside Park (12) South Hylton Sunderland SR4 0RT 01915346695 01915346695 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.c-i-c.co.uk Community Integrated Care Name of registered manager (if applicable) Margaret Fairrie Type of registration: Number of places registered: care home 4 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: 4 The registerd 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 category: Learning disability Code LD, maximum number of places: 4 Date of last inspection Brief description of the care home Riverside Park is a service run by Community Integrated Care, a registered charity, and has been opened since 1995. The home is registered to provide a residential service for four adults with learning disabilities and is situated amongst other new and varied housing near to the river in the South Hylton area of Sunderland. It was built as a domestic building and still retains that appearance. There is a large garden at the back and a drive at the front, which is spacious enough to allow four cars to park. There are local shops and other resources nearby. Each person has a single bedroom Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 4 Brief description of the care home that locks, and the use of the communal areas of the building that includes a lounge, dining room, kitchen and two bathrooms. Staff are available 24 hours per day, seven days a week to support people in their daily lives and to provide sleep in night cover. A consistent approach to all areas of service users needs is achieved by a key worker system. The aim of the service is to offer the people who live here a good quality of life by promoting independence as far as possible and a valued lifestyle through access to community based activities. The home has developed a Service User Guide that informs prospective service users about the service, the aims and how these are met. A copy of the recent inspection report is available in the home for anyone to read. The fees charged by the home are 953.35 per week. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out 5th May 2010 and was a scheduled key inspection. The inspection included a separate look at the Annual Quality Assurance Assessment (AQQA) completed by the registered manager prior to the inspection when we also looked at; Information we received since the last visit. How the service dealt with any complaints and concerns since the last visit. Any changes to how the home is run. The providers view of how well they care for people. The views of people who use the service, staff and other professionals. Care Homes for Adults (18-65 years) Page 6 of 31 During the visit we; Talked with people who use the service, staff and the manager. Looked at information about the people who use the service and how well their needs are met. Checked that staff have the knowledge, skills and training to meet the needs of the people they care for. Looked around parts of the building to make sure it was clean, safe and comfortable. Checked what improvements had been made since the last visit. We told the manager what we found. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? All of the requirements made at the last key inspection have now been met and since the employment of the new manager there have been many improvements made. Many of the improvements made have been centred around the positive development of service users and the development of their independence. As a result service users are now more empowered and live a more positive lifestyle. Over the past 12 months the new manager, who has since registered with the Commission, has been appointed to the home and 2 full time new members of staff have been employed. The staff team is now led by a manager that is focused in her Care Homes for Adults (18-65 years) Page 8 of 31 role and whose aim is to develop the service and the individual service users lives. Staff have received a full training programme and all are now up to date with mandatory training. More positive working relationships have developed with community nurses and the Community Learning Disability Team which enables the home to support service users health care needs. One healthcare professional said; Its a joy to come in here, there have been so many improvements. Service users are now further empowered regarding accessing and administrating their medication. Locked medication boxes are kept in individual service users bedrooms and this promotes; safety when staff support them to administer medication, while at the same time it promotes individuals privacy and dignity. Furthermore service users are supported to visit the pharmacy to collect their medication weekly and as a result good relationships have developed between service users and the pharmacy staff. Staff have been particularly determined to enable service users social networking skills and this has been one example. Service users are now fully supported to develop their daily living skills by being involved in the individual household tasks and decision making and so that service users and staff can effectively communicate together, both have attended Makaton lessons. This has equipped them with the skills needed to use sign to support the spoken work. Staff feel confident that the home is being run and developed in a positive way and some comments include; The manager is brilliant, she brings the best out in you. I see a future in care now. I feel that I can develop further. So many changes have been made since the new manager has come. Service users are benefitting from different approaches that we give. The new manager fully completed and returned The AQAA to the Care Quality Commission on time. This meant that the commission is informed of the managers own assessment of the service and any recent developments made, so that it can be determined whether the home continues to provide a good service for the people living there. It also provided detailed information about the plans the home has to further improve the service. The registered manager has achieved the necessary qualifications to establish her as fully qualified in her role and has proved that she has the skills and knowledge required of a registered manager. In addition to this there is clear evidence that she is up to date with mandatory training and that she continues with her personal development programme. What they could do better: Care Homes for Adults (18-65 years) Page 9 of 31 A full assessment of need should be received from the referring agency for the prospective new service user as soon as possible. This will provide the home with the necessary information needed to establish whether the home can meet the persons assessed needs before making any committments to them. Thought should be given to replacing the three piece suite in the loung with furniture that meets the needs of the people living at the home, so that they can use the seating provided comfortably and independently. The gardens surrounding the home should be given attention, so that they are kept in keeping with the gardens of the surrounding properties and that they promote a positive image of the people living and working there. The number of staff on duty should be reviewed when the two vacant places are filled so that they reflect effectively, the needs of the people living at the home. 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 10 of 31 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 11 of 31 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. Service users receive good information about the home and a comprehensive assessment process is in place that confirms the home can meet service users needs. Evidence: Although information about the home is available, the Service User Guide is currently under review. This is to ensure that the information available is accurate and up to date, so that people who may be interested in using the services delivered at the home can see a true picture of what the home hopes to achieve and how that is accomplished. A good assessment process is in place that is used to assess prospective service users and to be used as an ongoing tool that identifies changing need. Recently this tool was used to re-assess a person who had lived at the home for many years and whose independence and individual living skills had further developed over the years. The assessment process was jointly carried out with the home and the care manager and fully involved the service user. This process concluded that the person had the capacity and necessary skills to move on to supported living accommodation. The Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: service user made the final decision and was happy to move out of Riverside Park to live a more independent lifestyle. The preadmission assessment process is currently being carried out for a prospective new service user who has recently visited the home to meet the other people and staff who live work there. The home is currently waiting for the contracting agency to provide them with a full assessment of need, so that they can gain more information about the person and so that they can confirm whether Riverside Park can meet their needs. The needs of the other two service users living at the home have also recently been reassessed. This has resulted in new care plans being developed and medication being reviewed and modified. The manager confirmed that the re-assessment process has had very positive outcomes for all service users. Care Homes for Adults (18-65 years) Page 13 of 31 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. Care plans, that are the outcome of ongoing assessment, guide staff to appropriately support service users care needs, promote their independence by safely addressing risks and enable staff to support service users to make choices about their lives. Evidence: An effective care planning system that is based on service users assessed needs and that is service user led, is in place. The care plans are written is such a way that empowers service users to guide staff to support them in their preferred way when meeting their assessed personal, healthcare and social care needs. Although only two service users are currently living at the home, both have diverse needs and can demonstrate challenging behaviour. However as a result of their needs recently being reassessed both now have very clear up to date care plans. The care plans are written in such a way that empowers service users to guide staff to support Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: them in their preferred way when meeting their assessed personal, healthcare and social care needs. So that service users can have access, as far as possible, to their care plans, pictures are used to illustrate the written word. Service users are projected in a very positive way and this is clearly illustrated in the way the file All about me is recorded. This is where individuals likes, dislikes, interests, daily routines and aspirations are recorded. Service users are treated as individuals and encouraged to take responsibility for themselves and the running of the home. This includes being part of discussions about the home and making decisions about changes to be made. One service user was involved with the manager to review and modify the Service User Guide. Service users independence is promoted safely and so staff have guidance to follow, risk assessments and risk managment plans are in place. Both the care plans and risk strategy plans are reviewed and updated as part of a comprehensive monitoring system. A key worker system is in place and such monitoring, reviewing and recording is a part of the key worker responsibilities. Care Homes for Adults (18-65 years) Page 15 of 31 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. Service users are supported to live appropriate and fulfilling lifestyles both in their own home and the local community, while at the same time they are supported to maintain relationships with family and friends. Furthermore meals are healthy, nutritious and attractive, and are prepared to meet service users individual dietary needs. Evidence: As part of the person centred planning process service users are supported to develop individual lifestyle plans and as a result individual daily activity planners give service users a structure to their day. However these are used flexibly and so that service users have the support needed regarding individual activities, the staff rota is also flexible and organised to suit individual activities. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: It has been found that by trying different experiences and finding new opportunities to explore has resulted in service users developing new and positive relationships. This has proved to make a marked affect in relation to the social and cultural lives of the people living at Riverside Park. Service users now take part in a variety of activities including attending shows at community theatres and other venues, going to local places of interests, such as Beamish and going to healthy living groups in the community. As a result this has had a positive effect on the development of both service users. Both service users have bus and metro passes, cinema cards which enables them to take a carer to support them free and Beamish visitors cards, which for an annual subcription, enables them to visit at any time. Service users were joined for a light midday meal which was nutritious and attractively served. During the meal one service user, with the assistance of staff, discussed plans for a holiday in London, while the other indicated that they preferred to stay at home and go out for special days. Service users were given the choice of food and both chose something different. One was sensitively encouraged to eat and drink and the other was sensitively encouraged to choose something appropriate to their healthy living plan, while at the same time they were both made to feel a valued member of the group around the table. Care Homes for Adults (18-65 years) Page 17 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users personal and healthcare needs are met in a flexible but consistent manner, reflecting a healthy lifestyle. The medication arrangements in place are appropriate to the needs of service users and promote their independence. Evidence: There are good arrangements in place to support service users to register and attend community based healthcare appointments and good relationships between the home, service users and healthcare practioners, have developed. Clear records are in place to record appointment dates, the need of the visit and the outcome of appointments and visits. Currently service users continue to enjoy good healthy lifestyles that reflect their good health and individuality. All service users healthcare needs are recorded and monitored in Healthcare Action Plans that are written with a person centred approach. This not only empowers the service user but also promotes their dignity and self worth. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: The manager and staff have worked hard to establish and record how individual service users prefer to be supported and assisted and this has been successful by confirming and recording the diverse ways service users communicate. A section of the care plan records individual communication methods and clear descriptions of how facial expressions, body language and behaviour relates to a persons emotional feelings and preferences, are recorded. A small file entitled My Health Action Plan, that is easily transportable, has been developed by the manager and is now used throughout the organisations homes within the area. This records information related to individual service users healthcare needs, ways of communicating, moving and handling and preferences so that if the person is to be admitted to hospital or is attending a hospital appointment, the healthcare professionals, who may not know the person well, have direct access to important information about the person to work from. The manager is commended for this effective piece of work. When supporting service users to attend medical appointments, staff are encouraged to support the rights of service users and to act as their advocate, ensuring that the best possible care and treatment is received. There has been some very positive feedback from a consultant psychiatrist regarding the improvement in one persons behaviour. This was mainly achieved without increasing medication, but by staff being consistent in their approach to the behaviours and treating the person with respect and at the same time promoting their dignity. This has resulted in the person now experiencing an improved lifestyle with reduced challenging behaviour. The home is commended for this action and result. Staff work directly with healthcare professionals and take advice when needed to improve the care of the people they support. When professional advice is given, for example related to dealing with challenging behaviour, it is used as guidelines in individual care plans and as a tool to guide staff to approach and deal with behaviours demonstrated by individual service users. Risk assessments and risk strategy plans are in place and are used as part of the care plan to support service users safely, while at the same time promoting their independence. The medication system has been reviewed and changed to ensure that service users are; in control of leading their individual care plan regarding this, have their independence safely promoted and to establish clear procedures, monitor the Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: administration of medication and to ensure service users safety. Care Homes for Adults (18-65 years) Page 20 of 31 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. Arrangements are in place that helps to protect service users from abuse and to seriously address complaints and concerns about the service. Evidence: The home has a comprehensive complaints procedure that has been developed into picture format in an attempt to make it more accessible to the service users. The manager with the assistance of a service user developed the new complaints procedure. So that service users verbal communication is supported and signs of concern or distress are recognised, detailed records are place that inform staff of the signs given by service users that might indicate when they are not happy or concerned. Such occasions are recorded in individual care files and acted upon. Staff receive ongoing training regarding the principles of safeguarding and all have attended training regarding the local authoritys safeguarding procedures. The procedures, a copy of which is kept in the home, are also regularly discussed in staff meetings and supervision sessions. During their induction period staff are made aware of the GSCC Codes of Practice, so that they know the principles that they are expected to work to. If staff do not follow these principles their performance is monitored and the homes disciplinary procedures are followed if needed. The manager has attended training regarding the Mental Capacity Act and the Deprivation of Liberty has carried out assessments, using the Kingsley deprivation of liberty assessment tool, for all service users. Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: The home keeps clear records of service users financial affairs. These are appropriately kept, up to date and show clearly how service users monies are spent. Each service user has a bank account for the deposit and withdrawal of personal money. All staff receive training regarding challenging behaviour and guidelines are in place regarding how individual service users challenging behaviours are to be addressed. Care Homes for Adults (18-65 years) Page 22 of 31 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 standard of the environment is generally good, providing service users with a spacious, attractive, hygienic and homely place to live. Evidence: The decor and furnishings throughout the home are of a good standard, ensuring that service users live in an attractive and comfortable environment. Since the last inspection new flooring has been laid in one service users bedroom and the office and a new double glazed front door has been fitted. The three piece suite in the lounge however, due to its height and design and the changing needs of service users, does not currently accommodate the needs of the service users. The manager is hoping to replace this. One person has purchased their own remote controlled recliner chair which they have in their bedroom and which they are now able to get in and out of independently, such furniture should be available in the lounge. Plans are in place to replace the dining room furniture with consideration to the service users needs. It has been decided that two separate tables might accommodate people more effectively and enhance the eating experience, considering the different personalities and the changing needs of the current service users living Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: there. This has been discussed with both service users and staff. The gardens are extensive and well furnished with a greenhouse where plants are grown. There are plans in place to extend the use of the greenhouse and to encourage service users to grow more plants and vegetables. However the garden is currently in need of attention to improve the appearance of the home from the outside. Weeds are growing along the front paths, lawns and borders and need to be addressed. So that the image of the people living and working in the house is promoted positively, all areas of the environment should be positively maintained. The kitchen is large and well designed, equipped with appropriate appliances and is a safe and hyhienic area. Staff are aware of the measures to take to reduce the risk of cross infection due to having a washing machine sited in the kitchen area. Risk assessments in relation to this are in place as well as individual risk assessments related to service users carrying out individual laundry tasks. Staff have attended training in relation to the control of infection and domestic tasks carried out reflect this. Care Homes for Adults (18-65 years) Page 24 of 31 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. Robust recruitment and selection procedures, regular training opportunities and supervision ensure that service users are appropriately supported and protected by a competent and qualified staff team. Evidence: The number of staff designated to each shift is sufficent to meet the current needs of the service users. This however will need to be reviewed when the current two vacancies are filled and new service users move into the home. The staffing number will then have to reflect their needs. The staff work with enthusiasm, are focussed on their role and work with sensitivity when supporting service users. A relevantly new member of staff was able to discuss issues surrounding their work with competence and interest. Staff are guided in good care practice by following the values and principles set out in the GSCCs Codes of Practice and their work reflects this. The staff are aware of the homes disciplinary procedures and these are followed when needed. A good training programme has recently been followed and all staff are currently up to date with their mandatory training. Other training attended includes Equality and Diversity, Level 3 in Dementia Care, Food Nutrition and Hydration, Person Centred Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: Planning and Care Legislation. All staff are also aware of the new regulations. All staff have at least NVQ level 2. The home follows the companys robust recruitment procedures and staff files include completed application forms, 2 references and satisfactory CRB checks. Care Homes for Adults (18-65 years) Page 26 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager, who has worked hard to develop an informed and supportive staff team, provides excellent leadership and runs a service that has effective monitoring systems that are focused on the best interests of the service users. Evidence: The manager was recruited to manage this home in August 2009 and has successfully registered with the Care Quality Commission. She has a wealth of experience working and managing care services and is focussed in developing this service in the best interests of the service users. The manager was instrumental in assisting one service user to move on to living more independently and in reviewing and updating care plans for the other service users following re-assessment processes. The manager has the appropriate qualifications needed to effectively manage a care home and she continues to focus on her personal development. She has a suitable management qualification and has NVQ 4 in Care. Recent training attended includes the Mental Capacity Act and the Deprivation of Liberty, palliative care, Management of Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: Medication level 4/5 and Equality and Diversity. The manager has an open door approach and much work has been focused on developing a competent staff team. The home is managed well and good relationships have developed between the staff team and the service users. The manager is up to date with current issues surrounding learning disabilities and develops the service to reflect the priniples of Valueing People. The supervision system has been reviewed and developed further by the manager to include a set agenda. This includes set issues to be discussed including medication, training, role responsibility, health and safety and annual leave. Staff receive regular support, direction and 1:1 supervision from the manager. The service has a quality assurance system in place that includes the provision to ask service users their views on the service provided. The system is monitored internally monthly by the manager and annually by an external person. This ensures that the homes policies and procedures are followed and that the service is led in the best interests of the service users. Robust health and safety procedures are in place and staff practices reflect knowledge of these. The fire log and accident records are appropriately kept up to date. An up to date insurance certificate and registration certificate are on display. The manager has a good understanding of her responsibilities as a registered manager and keeps CQC informed of required issues. A detailed AQAA (Annual Quality Assurance Assessment) was returned to the Commission as requested. This clearly records how the service has improved since the last key inspection and also includes the managers plans for future developments to the service and the home. Care Homes for Adults (18-65 years) Page 28 of 31 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 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 It is recommended that a full assessment of need is received from the referring agency for the prospective service user as soon as possible. This will provide the home with the appropriate information needed to make an informed decision regarding whether they can meet the persons needs effectively. Thought should be given to replacing the three piece suite in the lounge with furniture that meet the needs of the people living at the home, so that they can use the seating comfortably and independently. The gardens surrounding the home should be given attention, so that they are kept in keeping with the gardens of the surrounding properties and promote a positive image of the people living and working there. The number of staff on duty should be reviewed when the home has the maximum number of service users living there. This is to ensure that all service users needs continue to be met effectively. 2 24 3 24 4 33 Care Homes for Adults (18-65 years) Page 30 of 31 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). 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