Care Home: Rocklee

What the care home does well People tells us that they like living at the service and are happy with the care they receive. Comments include: ` I have a better quality of life`, `I am happy living here`` `They look after me` and `Made me feel younger`. People have choices over how they live their lives and are encouraged to be as independent as possible. People take part in running the service choosing meals, keeping their bedrooms tidy and clean,going shopping and making choice over the decorations. A range of activities are available including social, educational and vocational. The majority of people attend college and are encouraged to take courses to develop their skills. People are supported to have their health and personal care needs met and the service works closely with a range of health care professionals to maintain people`s mental well being. People are supported by staff that are well trained. All have a vocational qualification and have training in a range of health related conditions. People have good communal and private accommodation which is homely and comfortable. What has improved since the last inspection? Since the last inspection the service has continued to improve the accommodation. Care planning has improved with people now having person centred plans that provide the information needed by staff to provide people with the support they need. Improvements have been made to the way all kinds of information are recorded making information useable and accessible. What the care home could do better: The service is providing good outcomes for people that live there. However there are some areas that can be improved. We made one requirement as a result of this inspection. This relates to the need for evidence to support any changes in medication.We also made some recommendations. These relate to gaining written consent of people for administering medication and for gaining medical information. We also feel that the consistency of care for people could be more improved by recruiting more permanent staff rather than using agency staff. We also recommend that the system for monitoring and reviewing the service is further developed so that they service is aware of the standard of care provided and that areas for development are identified. Key inspection report Care homes for adults (18-65 years) Name: Address: Rocklee 341 & 343 Stone Road Stafford Staffordshire ST16 1LB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jane Capron     Date: 1 4 0 4 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 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 30 Information about the care home Name of care home: Address: Rocklee 341 & 343 Stone Road Stafford Staffordshire ST16 1LB 01785603407 F/P baugha1@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Ms Jacqueline Downes care home 11 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 11. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental Disorder MD 11 Date of last inspection Brief description of the care home Rocklee is a residential care service that provides a service for adults who on admission have mental health needs. The service is located on the outskirts of Stafford town centre, having easy access to a wide range of local transport and amenities. The property consists of two semi-detached houses, the interior structure of which has been altered to allow access throughout. The exterior of the property has been maintained as two semi-detached houses in keeping with the local community. Rocklee provides accommodation for eleven people and has seven single and two shared bedrooms. En suite facilities are not provided. However, bathrooms and toilet facilities are conveniently situated throughout the home and are in close proximity to bedrooms Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 11 0 8 0 7 2 0 0 9 Brief description of the care home and communal areas. Two lounge areas that are comfortably furnished and equipped are provided for communal use. The kitchen consists of two areas with one containing the cooking and dining area and another currently awaiting refurbishment but intended to used as a second kitchen for people to cook their own meals. There is also a compact laundry area at the side of the property for communal use. The property stands in its own grounds with a lawned area and shrubs to the front, a private hardlandscaped area to the rear, together with car parking facilities. The service has a current Statement of Purpose and Service User Guide so that people know what to expect from the service. The fees charged are based on each persons needs. People considering using the service and stakeholders should contact the service directly to obtain current information regarding the scale of fees. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place over a two day period. The service did not know we were visiting. The information used as part of this inspection included: The Annual Quality Assurance Assessment (AQAA) that the service sent us. The AQAA is a self assessment document that focuses on how well outcomes are being met for the people using the service. It also gives us some numerical information about the service. Ten surveys provided by people living at the service. Two surveys from staff. Information we have had about any complaints and safeguarding we have received about the service. What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. Discussions with people living at the service. Discussions with staff and the manager. Care Homes for Adults (18-65 years) Page 6 of 30 Observation of staff supporting people. An examination of records relating to care practices, staff recruitment and training and health and safety. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The service is providing good outcomes for people that live there. However there are some areas that can be improved. We made one requirement as a result of this inspection. This relates to the need for evidence to support any changes in medication. Care Homes for Adults (18-65 years) Page 8 of 30 We also made some recommendations. These relate to gaining written consent of people for administering medication and for gaining medical information. We also feel that the consistency of care for people could be more improved by recruiting more permanent staff rather than using agency staff. We also recommend that the system for monitoring and reviewing the service is further developed so that they service is aware of the standard of care provided and that areas for development are identified. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering moving to the service have an assessment of their needs which includes their views as well as the views of other significant people. Evidence: The services Annual Quality Assurance Assessment tells us that it always completes a pre admission assessment visiting people in their own home or current placement. They also say that people are always invited to visit the service so they can see and experience the service. Although there have been no new placements we saw at our last inspection that pre admission assessments take place. These involve the person themselves. Assessments are also completed by the mental health team. Talking to people tells us that they have the chance to visit the service to see if they want to live there. Our surveys also tell us that people are included in the admission process. Everyone that answered our surveys said that they feel they had enough information about the service to decide if it could meet their needs. Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: The AQAA tells us that it has some people living at the service who have a learning disability as well as a mental health condition. Talking to the manager confirms that they take into account any needs relating to their learning disability; for example written communication is backed up with visual aids and communication is made as accessible as possible. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that live at the service are involved in planning their own care and are encouraged to make choices about how they live their lives. Evidence: The AQAA tells that they feel that the care planning process has improved but feel they can improve it further. They say that everyone has an individual plan completed by a staff member with training in care planning. It tells us that plans are developed with the person concerned and includes information from all relevant people. Plans are reviewed with significant people involved. Case tracking two people confirms that care planning has improved. Plans are person centred and cover all areas of care including mental and physical health care, personal care, social care needs including any spiritual needs. Where people have needs relating to their behaviour these are in place. Care plans identify peoples needs and inform staff how these needs should be met. Plans also include peoples food preferences, activities, personal care as well as their preferred daily routine. We saw Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: that where people are on the Care Programme Approach plans are in place and these are reviewed. A risk management system is in place covering such areas as mobility, bathing, accessing the community, medication and eating. Talking to two people confirms that people are involved in their own care planning. The manager did inform us that there are plans to improve the care planning further by introducing a computerised care planning system. People are given choice over how they live their lives. People tell us and documernts confirm that people are involved in choosing the services decoration; for example people are involved in deciding the colours of the living room and their bedrooms. People also confirm that they have a choice of meals and are involved in choosing where they go on holiday. We also observed people making choices over how to spend their time; for example during the day several people chose to go out shopping and other people chose to spend time in their bedrooms or in the lounge. Everyone that answered our surveys says that they make decisions every day about their life. Records confirm that the service consults people about the service having house meetings. These show discussions about activities, holidays, meals and staffing. The services AQAA tells us that it has made changes to the meal times and the menus as a result of listening to people. One person told us that he asked to eat at a different table and the service arranged this for him. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that live at the service are supported to choose how they live their life and have opportunities to take part in social, educational and vocational activities. People have choice over what they eat and are involved in planning the meals. Evidence: The AQAA tells us that it supports people to be as independent as possible and to be involved in all aspects of daily living including shopping, preparing meals and cleaning. It also tells us that it encourages people to go to college helping them to develop their skills. The service also states that is has strong links with the community preventing social isolation. The service informs us that it plans to appoint a further staff member to establish more robust community links. It also identifies areas where it could improve the activities people have the opportunity to take part in. Talking to people confirms that people have the chance to attend college and currently Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: nearly everyone is out of the service during the day either attending college or attending a day centre. College courses are aimed at developing people educational and vocational skills including such topics are healthy eating, cookery, seeking employment and I.T. courses. Several people have work placements. One person told us that she works at a cafe at a local church. People, according to interest and ability, take part in a range of daily living activities including menu planning, cleaning, shopping and making drinks. One person we spoke to is helping to grow vegetables in the garden. We also saw one person washing up and another making drinks. Responses to our surveys confirm that people are supported to take part in daily living tasks. People are encouraged to take part in social activities. One person enjoys collecting stamps, several people enjoy going shopping, watching TV and several enjoy listening to music. We also saw that some people have been involved in Easter craft activities. The service also takes people out on day trips although some people tell us in their surveys they would like more of these trips. People also attend a local club and the manager and one of the people that live at the service are on the organising committee. The service is also undertaking some fund raising to support a school in Africa. The service arranges holidays for people and three are planned for this year. The service supports people to maintain contact and relationships with their relatives. Several people regularly visit their family. Last year the service arranged for another person to meet a close relative they had not seen for many years. Talking to people confirms that the service provides flexible routines encouraging people to decide when and how to spend their time. People tell is they choose when to go to bed and where to spend their time. The service has changed how it provides lunches for those at college in response to their views enabling some people to take packed lunches whilst others buy their meal at college. Although meals at taken within a timeframe people can choose within that period when to take them, where to eat and what to eat. People tell us they like the meals and one person commented good food in the response to our surveys. Everyone we spoke to said they there was a choice of meals available. We observed people having a range of food at lunchtime including sandwiches and hot meals. People also tell us that they are involved in choosing the menus. The service promotes healthy eating and peoples dietary needs are identified in their care plans. Records confirm that one person that had been significantly over weight now had a BMI within the healthy range. This had been commented on positively by health professionals in the persons review. Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: Care Homes for Adults (18-65 years) Page 17 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the service can be confident that they will be supported to have their health and personal care needs met. People receive their medication but there are aspects of the medication process that can be addressed to make it a more robust system. Evidence: The services AQAA tells us that it works closely with a range of specialist health care staff and supports people to access health care services. We saw that care plans contain information on peoples physical and mental health as well as their personal care needs. Where people either need support due to behaviourial or mental health needs a plan is in place. For example one plan contains good information to show staff the symptoms to be aware of that may mean that their mental health is deteriorating and describes the action to take to provide them with the support they need. Records confirm that people are supported to have their health care needs met. We saw evidence that people receive primary health care support including having eye and dental checks. Some people go to health appointments independently and the service later contacts to check the information. Although people are in agreement with this practice we advised the service to obtain the persons written consent to contact Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: medical professionals and to gain medical information about their health. Talking to users confirms that they receive support with their mental health. One person we case tracked has regular meetings with their Community Psychiatric Nurse and we saw several examples of multi-agency reviews between the person, the service, and health professionals including psychiatrists. We spoke to two staff and they are aware of peoples needs and how they should be met. One person needs support with bathing and they could describe how they did this whilst promoting their privacy and dignity. We also observed that staff treat people with respect; they call them by their preferred name, spend time taking with them and make sure they are offered choices over how they live their lives. People are supported to have their medication. Medication is stored securely and records are kept of medication received. We did some written entries on the medication sheets and advised the service to ensure these are signed by the staff member. An examination of records shows that medication is being administered as prescribed. However we did see some medication on Medication Administration Records sheets that the service tells us is temporarily discontinued. We told the service that they needed to ensure this is made clear on the MAR sheets and that records are always made to evidence when medication is altered. People we spoke said they received their medication and it was administered by staff but we did not see any consent forms on the files. The service agreed to ensure that written consent is obtained from people. Talking to staff and an examination of records shows that staff have received training in medication. The manager confirmed to us that she undertook checks on staffs competency to administer medication. People are positive about the care they receive with comments such as : They look after me, They try and keep me clean and tidy, I have a better quality of life, Made me look after myself and made me feel younger and Good health care. Care Homes for Adults (18-65 years) Page 19 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the service have access to a complaints procedure and are confident that any issues will be addressed. The staffs knowledge of the signs of abuse is improving peoples protection. Evidence: The services AQAA states that the service has a clear complaints procedure and that people are aware of the complaints process. People we spoke to could explain how they would make a complaint and tell us they are confident that if they raise an issue it will be addressed by the staff. Everyone that responded to our surveys said that they know who to speak to if they are unhappy and know how to make a complaint. We also saw that copies of the procedure are displayed in peoples bedrooms. Neither we, the commission, nor the service have received any complaints since the last key inspection. The AQAA tells us that staff are knowledgeable about safeguarding issues. Records of staff training confirm that staff have receive training in safeguarding. The two staff and the manager we spoke to are aware of signs of abuse. We did feel that the staff as they at times work alone should be more aware of the locally agreed safeguarding referral process. The manager confirms that this would be addressed and said she is in the process of updating the safeguarding procedure and putting together the referral details for all staff. There have been no safeguarding incidents since the last key inspection. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the service have good communal and private accommodation and are involved in choosing the decor of the service. Evidence: The AQAA tells us that the service provides people with a homely, safe and comfortable environment. It also states that it has a programme of annual maintenance in place. We are aware that over the last few years the service has been undergoing considerable renovation and refurbishment following subsidence being identified. This is now close to completion and the service provides people with good private and communal accommodation. The service is currently having new security and fire safety systems put in place. A number of bedrooms and communal rooms have been decorated and we saw evidence that people living at the service are involved in choosing the decor. We looked at a sample of the accommodation including two bedrooms. The service has two lounges and two adjoining kitchens giving people a choice of where to sit and eat. Bedrooms seen are of a good size and suitably decorated. Bedroom are lockable and they provide people with good private accommodation with space to sit and adequate storage facilities. Both bedrooms seen are well personalised full of the occupants belongings including pictures, ornaments, CD and DVDs. People we spoke to say they Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: like their bedrooms. The AQAA states that the service has its own dedicated domestic team who are keen to raise standards and to ensure the service is clean and hygienic. The service does identify that it could improve through introducing records of cleaning schedules. Observation showed the service to be clean and that staff are aware of infection control and hygiene standards. All staff have received training in infection control. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by staff in adequate numbers that are well trained to meet peoples needs. People are generally protected by the services recruitment process but the service must keep records that staffs identity has been checked. Evidence: The AQAA tells us that the service has a low staff turnover and that staff are well trained. It also tells us that staff are checked before they start work. The service provides a staffing level of two staff on duty at most times during the day and has one waking night staff. These hours are covered by a small number of staff and any cover needed is provided through regular carers from an agency. The manager tells us that she is looking to increase the staffing but has had difficulty finding the right calibre of staff. The current level of staffing is adequate in the light of the dependency levels of the people that live there but having permanent staffing would always ensure a consistency of service to the people that live there. We feel that the service gives a high priority to training its staff. All the staff have are NVQ trained and the deputy manager has achieved NVQ 4 and a management award. One of the other care staff has NVQ level 3. An examination of staff files confirms that staff receive regular training and recent courses include knowledge of Parkinsons Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: Disease, Dementia Care Mapping, Medication, Safeguarding, Equality and Diversity and the Mental Capacity Act. Responses to our staff survey confirms that staff receive induction and ongoing training and one commented: I have been very pleased with the changes that have been made within the home, updated systems, more information on care planning and extra training. We also received positive comments about the staff from people living there. People overwhelming feel that staff listen to them and act on what they say. Also people we spoke to say they get on with the staff. We also observed a relaxed atmosphere between the people that live there and staff. Sampling of staff files confirms that the service obtains written references and does a Criminal Record and Protection of Vulnerable Adults check before people are employed. There was however no evidence in the staff files to confirm peoples identities and we asked the manager to ensure that these are obtained. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that the service in being run in their interests. People are protected by the services health and safety practices. Evidence: The AQAA states that the manager has long experience and is qualified in care and management. She as the provider/ manager is responsible for the service meeting the necessary regulations and standards. We saw great improvement in the services record keeping since our last inspection. Care plans are person centred and useable as working documents. Daily records are now much more understandable and important records are now kept in a suitable filing system. The service provided us with an AQQA when we asked for it. The AQAA gave us information about the service telling us the changes they have made and plans for the future. The service has a quality assurance system in place and this has been implemented in part. The views of people that live there and other significant are gained through annual surveys. Staff views are gained both through surveys and staff meetings. People that live at the service also have the chance to express their views through Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: house meetings. The service does undertake some audits including an annual medication review and checks on the environment. We still feel that the system for monitoring the service could be further expanded and we discussed this with the manager. The manager stated that monitoring of practices would improve with the introduction of the computerised record keeping system. An examination of staff records confirms that staff have received training in safe working practices including first aid, infection control, fire safety and food hygiene. Checks on the fire records confirms that the service has a fire risk assessment in place and has completed individual fire risk assessments. Fire prevention equipment including the fire alarm and the emergency lighting are checked. The service is in the process of improving the fire alarm and security systems at the service. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 20 13 Appropriate information 17/08/2009 relating to medication must be kept, for example in risk assessments and care plans, to ensure that staff know how to use and monitor all medication including self adminstered medication. This will ensure that medication is administered safely, correctly and as intended by the prescriber to meet peoples health needs. Care Homes for Adults (18-65 years) Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 13 Where medication is altered by the doctor the service should ensure that records are kept to confirm the changes made. This will help to ensure that the administration of medication is made safer for people. 16/05/2010 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 19 Written consent should be obtained for the service to contact and gain medical information about people that live at the service. This will confirm that people are willing for the staff to have their medication information. Written consent should be obtained for the service to administer medication to people living at the service. This will confirm that people are in agreement with the service administer their medication. All staff should be made aware of the safeguarding referral process. This will ensure that any potential safeguarding incidents are referred appropriately and in a timely Page 28 of 30 2 20 3 23 Care Homes for Adults (18-65 years) 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 manner. 4 33 The service should ensure that sufficient permament staff are employed. This will ensure that people always have continuity of service. Copies of documents confirming staffs identities such as a copy of a passport or of a picture driving licence should be kept on staff files. This will confirm that people are who they say they are and give people living at the service added protection. To continue to develop the systems for revewing, monitoring and developing the service. This will ensure that the service is aware of the standard of service it is providing and identify any areas for improvement. 5 34 6 39 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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. Care Homes for Adults (18-65 years) Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!