Care Home: Rochester House

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What the care home does well The premises are suitable for the care of residents. Residents are helped to lead an active life. Some are getting ready for tranition to a more independent way of living outside the premises. Members of staff receive good training and support from the company to help them meet the support needs of residents. This increasingly includes the use of E-learning which members of staff said was valued by them. Care plan records reflect the needs of residents and their aspirations. These contain extensive information about how residents are progressing, aims of care identified by staff and agreed with residents, their health requirements and risks associated with their daily living and activities. The use of revised risk assessments integrated with information in individual care plan folders is reportedly benefitting residents and members of staff. The service provides a good structure for residents who are considering the next steps towards greater independence. Options are available within the company for realising this target. The company is implementing plans for enabling residents to move towards greater independence. Each resident has a range of opportunities for progressing their education and leisure, employment and social skills. What has improved since the last inspection? The AQAA referred to the use of alternative formats to assist residents with assess to some documents, for example, complaint`s procedure, accommodation agreement, household schedules and activity plans. It indicated that progress is being made to provide residents with an audio version of key documents. The AQAA suggests that the staff group intends to continue to develop more ways of encouraging residents with communication difficulties to contribute more effectively. The mamager and deputy manager outlined how staff awareness of lifestyle issues has been raised through training, staff meetings and coaching sessions. Changes have been made over the past six months to improve medication procedures, a revised medication system that has in the opinion of support workers reduced the likelihood of errors, more frequent medication audits and a tracking system for medicines taken out of the premises and for PRN. More accessible formats of the complaints procedure have been developed and residents are being re-coached in how to make a complaint or discuss their views. The service is in the process of delivering Mental Capacity Act training to all members of the staff team. According to the manager and a declaration in the AQAA, greater emphasis is being placed on the importance of formal staff supervisions and for the company to further develop a broader and more responsive training strategy. There is an on-going premises improvement programme in place. What the care home could do better: This report contains no requirements or recommendations. Key inspection report Care homes for adults (18-65 years) Name: Address: Rochester House 221 Maidstone Road Rochester Kent ME1 3BU     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: Eamonn Kelly     Date: 2 6 0 1 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 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Rochester House 221 Maidstone Road Rochester Kent ME1 3BU 01634847682 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): rochester@regard.co.uk The Regard Partnership Ltd Name of registered manager (if applicable) Mr Benjamin Wood Type of registration: Number of places registered: care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 13. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home The website www.regard.co.uk states that the company (The Regard Partnership) provides care and support services to adults and children with complex needs in more than 120 locations in England and Wales. Rochester House, registered for the support of ten people with learning disabilities, is located close to Rochester with easy access to public transport. Care Homes for Adults (18-65 years) Page 4 of 33 Over 65 0 13 Brief description of the care home Residents accommodation is on the ground and first floors: the basement contains a range of facilities for staff, residents and visitors and all floors are served by a passenger lift. Information about weekly fees and other charges may be obtained from the manager or deputy manager of the service. Care Homes for Adults (18-65 years) Page 5 of 33 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: The quality rating for this service is 3 Star. This means that people who use the service experience excellent quality outcomes. The inspection took place on 26 January 2010. It comprised discussions with the manager and deputy manager, support workers and eight residents at the premises. Care practices were discussed and all parts of the premises were visited. Some records were seen during the visit principally those addressing the personal and healthcare support of residents. We received an annual quality assurance assessment (AQAA) from the manager in January 2009. This provided good information about how residents are currently supported and how the service is being developed. Care Homes for Adults (18-65 years) Page 6 of 33 The previous inspection report and our annual service review were checked as part of this inspection. The evidence of the inspection visit and that contained in the AQAA (annual quality assurance assessment) indicated that the declared aims of the company are being met. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? The AQAA referred to the use of alternative formats to assist residents with assess to some documents, for example, complaints procedure, accommodation agreement, household schedules and activity plans. It indicated that progress is being made to provide residents with an audio version of key documents. The AQAA suggests that the staff group intends to continue to develop more ways of encouraging residents with communication difficulties to contribute more effectively. The mamager and deputy manager outlined how staff awareness of lifestyle issues has been raised through training, staff meetings and coaching sessions. Changes have been made over the past six months to improve medication procedures, a revised medication system that has in the opinion of support workers reduced the likelihood of errors, more frequent medication audits and a tracking system for medicines taken out of the premises and for PRN. More accessible formats of the complaints procedure have been developed and residents are being re-coached in how to make a complaint or discuss their views. The service is in the process of delivering Mental Capacity Act training to all members of the staff team. According to the manager and a declaration in the AQAA, greater emphasis is being Care Homes for Adults (18-65 years) Page 8 of 33 placed on the importance of formal staff supervisions and for the company to further develop a broader and more responsive training strategy. There is an on-going premises improvement programme in place. 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 33 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 33 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. Prospective residents and their representatives are given information in a variety of ways to help an informed choice to be made. Residents have their individual aspirations and needs assessed before they enter residential care. Evidence: The AQAA (annual quality assurance assessment) prepared by the manager to assess the current service to residents and to identify areas for improvement states that efforts are being made to encourage residents to move towards a more independent way of living. This objective, seen as realistic for some residents but not for others, is in line with the aims of the service as outlined in its website and statement of purpose. Two residents provided insights into what this means for them and into how they are working towards achieving more independent lifestyles. Prospective residents and their advocates/families are able to obtain information about the service and other associated services provided by the company. A copy of the service users guide was provided to us by Email after the inspection visit. It was Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: evident from this copy that residents and others were provided with relevant information about the service. It was presented in a user-friendly way and contained information about issues that was likwely to interest them. There was information about services and facilities, about learning and development opportunities, about the general rules of conduct and about how residents could make their views known and communicate with staff and others. The evidence from three residents files seen during the inspection visit was that careful consideration is given during the time when an admission is being considered. After a long period of time where no new admissions were made, there is likely to be two new admissions in the near future. Advocates are currently visiting to make an assessment of the services and facilituies to support prospective residents. Based on descriptions of the admission procedure provided by the manager and deputy manager, there is an exhaustive procedure designed to ensure that new residents are likely to benefit from life at the premises. This includes carrying out a range of activities involving the prospective resident, advocates, medical practitioners and care managers. Following this, a series of observations are carried out to enable staff to compile a care plan and up-to-date risk assessments. From the examples of records seen and three individual profiles discussed, these are subject to constant amendment as the needs of the resident are assessed over time and the corresponding care plan and risk assessments are refined. The evidence was that the method of risk assessment and subsequent activities arising from these procedures is being further refined so that there is a workable interface with information in care plan folders for each individual resident. Each resident is provided with a contract that outlines the main aspects of the responsibilities of both parties. An example was seen of a contract that used symbols to assist service users in understanding them. The AQAA stated that residents have the option to write in their daily diaries if they chose to do so. Progress has been made and is continuing in making care plan folders more user-friendly. Residents are encouraged to take a greater part in the review process [We will need to assess and identify your needs and these will be reviewed 6 weeks after moving in and again 6 weeks later and then 6 months later unless otherwise agreed. You will be involved in these meetings and have a copy of the Care Homes for Adults (18-65 years) Page 12 of 33 Evidence: record of this if you wish. Once we have assessed your needs we will include you as to how you wish to be supported. (Extract from Service Users Guide)]. Care Homes for Adults (18-65 years) Page 13 of 33 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are helped to make decisions and to express themselves as part of developing their confidence and quality of life. Evidence: Each resident has an individual care plan formed from original (ie. at the time of the assessment before entering residential care) and subsequent assessments of their needs. Based on profiles of three residents discussed with the manager and deputy manager, the evidence was that they are encouraged to make their own decisions and choices. Care plans outline the support needs of residents and relate to all areas of their lives. The general format is used in other residential homes owned by The Regard Partnership. The evidence was that the staff team have the skills and ability to support and encourage residents to be involved in the ongoing development of their plan. As Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: referred to earlier, two residents provided insights into how they spend their time at the premises and into how they are supported in gaining skills to eventually live more independently. The examples observed during the inspection visit suggested that staff use a variety of ways to help residents communicate their aspirations and difficulties. New communication methods are being considered/implemented to assist residents and staff. An extract from the AQAA is as follows: Keyworker meetings are held on a weekly basis. We have comprehensive information on notice boards so that the service users are fully up to date with all pertinent information about the home... We have an activities board which shows what things are happening and who is involved.. Residents have an English, maths and life skills teacher. Many activity sessions are community based...Some service users are involved in the planning of some of their risk assessments. From the evidence of individual profiles discussed, it was clear that members of staff have a good knowledge of the types of support residents need and, from the evidence of the support plans seen, the staff team are succeeding in helping residents exercise choice and make plans for the future. Some residents have begun to make realistic plans for the future and all have increasingly independent lifestyles with agreed levels of staff support. Residents are supported to take reasonable risks to allow them to participate in a range of activities. Risk assessments within care plans indicate how relevant risks are assessed and kept under review. The evidence was that care plans are kept up-todate with the purpose of focusing on how residents develop their skills and have their future aspirations recognised and addressed. The examples of risk assessments discussed address safety issues whilst aiming to maintain good qualities of life for residents. The AQAA suggests that the staff group intends to continue to develop other ways of encouraging residents with communication difficulties to contribute more effectively. These are consistent with the aims of the owner organisation to enable residents to live fulfilled lives and to develop the confidence and skills to move towards more independent living within other parts of the organisation or at other locations. Care Homes for Adults (18-65 years) Page 15 of 33 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. Routines and activities developed with each resident give them opportunities to exercise preferences on a day-to-day basis. They are helped to take part in activities they enjoy and to be a part of community life. Evidence: Evidence was seen in care plans, daily diary notes, activities planners and from meeting with residents significant efforts are being made by the staff team to improve the lives of residents. The AQAA described how regular resident/staff meetings take place where, for example, routine activities are discussed and plans are made for additional ones. Each resident has an agreed weekly timetable of activities and efforts are made to enable these to be carried out or varied according to factors that are relevant at any time. The AQAA referred to how members of staff work towards ensuring that suitable Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: activities are available for each resident and reviewed so that they are in step with changes agreed during residents meetings or progressive changes to routines agreed for their individual benefit. The service users guide refers to some of the activities and opportunities available. It states that the service has its own vehicle used for the purpose of visits to community locations. It also refers to the availability of a passenger lift if you find using the stairs difficult. Current activities include visits to see family members, trips to the local pub for a meal, music and activity sessions, 1-1 staff support to go to the local town and places further away. Each resident has his/her bedroom maintained in a way they prefer and they receive differing levels of staff support in keeping their rooms safe and well maintained. Records and charts maintained showed how residents are encouraged to complete daily and weekly tasks within their home, for example, cooking, cleaning and clothes washing. Residents have the very clear benefit of use of a training kitchen/dining room on the first floor to enable them to gain specific skills. Care plan records indicated how residents have different plans relating to meals, meal times and preferences. Examples were discussed where residents were involved in the preparation and review of care plans. There was evidence that daily routines are flexible to suit the different needs of residents and of how residents are helped in keeping touch with family and friends. There was evidence that residents have regular contact with heathcare specialists to help with diagnosis of conditions and advice for staff on steps for supporting the resident. The AQAA outlined how staff awareness of lifestyle issues has been raised through training, staff meetings and coaching sessions. It also indicated that there are menu discussions with residents to ensure they have contributed effectively. Examples discussed a part of case tracking showed how communication and observation methods are leading to realistic changes in how some residents see their future within supported living frameworks. There was evidence of improved lifestyles and better health of residents over the past 18 months. Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: There was evidence of a varied menu and of how residents are included in meal preparation and planning. The manager and deputy manager outlined that there is emphasis on providing balanced meals that reflect individual taste and preference as well as healthy eating. Care Homes for Adults (18-65 years) Page 18 of 33 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. Residents receive good physical, emotional and personal support. Evidence: The AQAA, for example, referred to how residents may keep their own medications as part of improving their independent living skills. Medication is stored in a locked cupboard and MAR sheets are updated when medicines are administered. Procedures have been reviewed and the manager was confident that current procedures are effective. A lockable medicine cupboard is also provided in each residents bedroom. Before any resident is enabled to maintain their own medicines, detailed risk assessments are carried out and, in the event of agreement to enable a resident to progress in this area, close attention would, the deputy manager stated, be given to the outcome of recorded reviws for continuing resident safety. The service users guide also refers to this issue for residents wishing to develop their skills and independence within a supervised surrounding. The evidence from care plan records and discussion of individual profiles of three residents indicated that they received good healthcare support. This includes access to Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: GPs and NHS healthcare facilities. The home arranges for health professionals to visit residents at home when necessary. There is good quality planning and support for residents. The care plans seen during the inspection had relevant information for carers in the event of having to deal with episodes of various conditions associated with individual residents. During the inspection visit, there was detailed discussion with the manager and deputy manager about the accuracy of the risk assessment procedure. Examples were seen and discussed of how all known risks to residents were assessed, recorded and reviewed. This report earlier referred to how the risk assessment procedure is being updated and used in conjunction with information contained in individual care plan folders. Evidence emerged during the inspection visit that support workers have a high level of awareness of residents social and emotional needs and they explained how they help them to retain individual identity. Residents individual plans record their personal and healthcare needs and outline how these are being met. Members of staff ensure that personal support is flexible and consistent and able to meet the changing needs of residents. They provided examples of how they know and respect residents preferences. There was evidence that the staff team reviewed all aspects of residents personal and healthcare needs over the past six months and at closer intervals. This was evidenced through discussion of residents profiles and how they are moving towards better realisation of their preferences and expectations. The AQAA refers to how risk assessments have been updated and to how they integrate with individual care plans. Information was discussed on how staff training in health matters and individual health action plans are now seen to be giving residents more control over their own health with the support they need. The AQAA stated that service users have been supported to access the local multidisciplinary team for health needs which are beyond the remit of the home. Care Homes for Adults (18-65 years) Page 20 of 33 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at the home know that they can complain or comment about the support they receive and that their complaints and comments will be taken seriously. They are protected from abuse by procedures practiced by staff and policies within the company. Evidence: The service has a complaints procedure and residents are encouraged to express themselves in ways that members of staff understand. The service users guide states that we will provide you with a key worker who with other care workers will be responsible for providing you with care and support for as long this is agreed and needed...to arrange meetings with you to review and revise your support plans...and to keep records of your meetings and provide you with a copy if you wish. This involvement, evidenced during the inspection visit as central to the way support is provided, is accompanied by an outline of residents rights. 1. You have the right to be treated fairly and not discriminated against. 2. You have the right to advocacy. If you find it difficult to speak up, you may need someone to help you. This is called Advocacy. Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: 3. You have the right to be included about the service we provide and about any changes we propose. 4. You have the right to make a complaint. 5. You have the right to be treated with respect and dignity at all times by the staff. 6. Confidentiality: you have rights that records about you remain confidential and you can see these at any time. 7. You also have the right to say who this information can be shared with. The service users guide goes on to explain in a user-friendly way how he/she may make a complaint or comment about any aspect of how the service is conducted. No complaints have been received since the previous inspection visit. The manager said that staff welcome comments from residents and their supporters about how care and support is provided. This feedback is used as part of quality assurance procedures operated by the company. Policies and procedures for safeguarding adults are available to all members of staff. These give specific guidance to those using them. The manager and deputy manager said that all support workers are aware of local authority procedures for Safeguarding Adults. We are notified of relevant incidents that occurred at the home. Reflection on these is reportedly used as part of quality assurance measures for the protection of residents. An example of this was the reporting of medication errors identified. The important thing is that such errors are identified and steps taken as a result to minimise the chances of such errors harming residents. The recruitment procedure contains the checks (including CRB checks) necessary to help contribute to the protection of residents. All members of staff receive training for their responsibilities under current arrangements relating to ISA (independent safeguarding authority) matters. The manager and deputy manager were aware of how current ISA arrangements affect staff in the care sector and of the responsibilities in this regard for people registered with us. The AQAA stated that all members of staff are aware of the rights of residents and of how their interests must be identified and promoted. It outlines how the companys Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: quality assurance system focuses on issues consistent with current care standards with emphasis on making residents quality of life progressively better. It also highlighted the fact that current stable management conditions have had a positive effect on residents and on the staff team. Reference was also made by the manager and deputy manager to staff guidance on relevant aspects of the Mental Capacity Act and how procedures might be affected in the future by aspects of this legislation. The AQAA contained the following declaration: We have all the relevant company policies in place and staff have read and understand them. Service users have all had their rights explained to them so that they know what to do if they have a problem. Staff have had relevant training regarding whistleblowing and the complaints procedure. All complaints and allegations are actioned as soon as is possible. We have a robust system to protect service users finances. A system is in place to protect monies belonging to those who do not or cannot manage it themselves. The complaints procedure is avaliable in a user friendly format and now also in audio format. Care Homes for Adults (18-65 years) Page 23 of 33 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 premises are suitable for the support of residents. Evidence: The AQAA stated that essential refurbishment is carried out routinely. Bedrooms are suitable for the needs of residents. Each person has his/her own bedroom that is well decorated and personalised with their own belongings. Bedroom doors are lockable; people can have their own keys and are able to invite others to visit their room when they wish. Issues relating to the retention of keys and general rules relating to use of premises are contained in the service users guide. The garden is suitable for use by residents. The premises were clean throughout. Residents use the laundry facilities as part of agreed household tasks and to give them the skills they need where they might be able to aim towards moving to more independent living. The premses have facilities for helping residents gain skills in, for example, cooking. There is a training room for this purpose on the first floor. A declaration was made in Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: the AQAA that all necessary checks are carried out and that the necessary safety certificates are in place. This included checks on all portable and fixed electrical appliances. The manager is arranging for premises improvements to be carried out including redecoration of the exterior of the premises. Care Homes for Adults (18-65 years) Page 25 of 33 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. Residents are in the care of members of staff that are supported by the company through personal development and recruitment procedures. Evidence: Staff files for all staff in the group are kept at the companys office and the range of checks carried out during recruitment was discussed with the manager. On the basis that the manager has declared that the company has a central HR department and that managers of individual residential services are fully involved in all aspects of recruitment, we are satisfied that residents are protected in a number of ways including via the required recruitment procedures. The evidence offered by the manager was that the manager of each service is involved in recruitment procedures. Managers, for example, ensure that CRB checks are taken up in every case. The manager was aware of how current ISA (independent safeguarding authority) arrangements affect staff in the care sector and of the responsibilities in this regard for people registered with us. Based on discussion with the manager and deputy manager and records seen (including those viewed on the homes IT system), the evidence was that all new Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: members of staff have induction and foundation training based on standards recommended by Skills for Care. All support workers are trained to NVQ Level 2 or 3 and all new staff are expected to achieve NVQ training. The registered manager is qualified and experienced in the care and support of people with learning and physical disabilities. The deputy manager is similarly experienced and is progressing towards NVQ Level 4 in Care and Management. There was evidence on this occasion that a stable management system is in place and that the staff team is addressing the needs of residents. It was evident that the manager and team leader undertakes formal supervision in a planned way with all members of staff. The stated purpose is to identify practice standards relevant to the needs of residents and staff and to progress the objectives of the staff team and aims of the group. The AQAA included an analysis of the effectiveness of recruitment and staff development procedures. From discussion with the manager and deputy manager, it was possible to conclude that all relevant checks are carried out, there is a process for involving some residents in the recruitment process and support workers receive guidance and on-going support. The AQAA, for example, stated that in addition to the statutory training provided for every member of staff specific training to meet the needs of each resident is given. Examples of the knowledge and skill levels needed by staff were discussed during the inspection and it was clear that all staff receive specialist training as needed according to the changing needs of residents. The AQAA referred to the initiative of the company in developing a broader and more responsive training strategy to meet the needs of clients. Examples were seen of the evolving training programme now available via E-training to all members of staff. The AQAA contains the following statement: New staff in the home are shadowed until they find their feet to promote continuity with the service users. This also helps them to become familiar with the support needs of service users and for service users to get to know the new staff members. There is Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: a robust recruitment procedure which is adhered to by the home. CRBs and POVA checks are sought before the member of staffs start date. CRBs are renewed every three years. All applicants have to sign a declaration on their application form of any criminal convictions or cautions. Once in employment staff are aware that they have to inform their line manager of any new convictions. A large percentage of staff either have, or are working towards, an NVQ qualification. All training is easily accessible with the elearning system. Care Homes for Adults (18-65 years) Page 28 of 33 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. Residents live in an environment that is well managed. Evidence: The AQAA stated that policies are gradually have been updated with more accessible formats being introduced. Quality assurance questionnaires have been developed and are completed by residents, their families and health/social care professionals with an annual report compiled from the results. The manager said that managers in individual residential homes and the registered responsible person for the overall service make assessments of this feedback and use it to progress the quality of the service. Other procedures include reviews of care plans, staff meetings and regular 1-1 supervision. The service has a development plan and environmental risk assessments are regularly conducted to ensure the safety of service users. Care Homes for Adults (18-65 years) Page 29 of 33 Evidence: Risk assessments for individuals form a key part of support in place for residents. The medication system has been reviewed by the manager and improvements made for the safety of residents and benefit of staff. This includes how residents are enabled to keep their medication, the rules they must follow, how procedures are followed to ensure that essential medication is taken and how medication is handled when residents are off the premises. The manager and deputy manager explained how consideration is given to carrying out health and safety procedures affecting the safety of premises and individuals. The evidence during the inspection visit was that all members of staff are working to improve services and to provide an ever-improving quality of life for residents and are aware of current developments both nationally and by CQC. Care plan and healthcare records seen indicated that there are procedures in place for meeting the needs of respective residents. Declarations are included in the AQAA about the required checks to premises and associated procedures and safety certificates. The manager has the experience and qualifications to run the care home in line with current legislation and standards. The AQAA outlined how this experience is being deployed for the benefit of residents. From evidence seen during the inspection and from references in the AQAA, the use of a person centred approach is improving the lives of residents and giving support workers an effective framework to carry out their work effectively. The provision of the service by the manager and staff team is complemented, according to the manager and deputy manager, by the support received from other parts of the company and from the registered responsible person for the wider service. Care Homes for Adults (18-65 years) Page 30 of 33 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 31 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 32 of 33 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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