Care Home: Roland Care Home (North Circular Road)

What the care home does well The home provides high quality support and care for residents, some of whom have complex mental health needs. We saw a range of detailed and up to date documentation that assists staff to sensitively meet residents needs and wishes. A resident told us, "I really do try hard here as I do not want to let Yolanda (the registered manager) down after all she has done for me". A consultant psychiatrist had recently written about the home, "I have been impressed that care is tailored to the needs of the individuals at this accommodation"; The physical environment is domestic in scale, comfortable and meets the residents needs. What has improved since the last inspection? At the last key inspection one requirement had been made to repair the rear the rear garden patio to make it safe for residents and we were pleased to see that this requirement had been complied with. What the care home could do better: No requirements or recommendations are made at this inspection. Key inspection report Care homes for adults (18-65 years) Name: Address: Roland Care Home (North Circular Road) 231 North Circular Road London N13 5JH     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: Peter Illes     Date: 1 5 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: Roland Care Home (North Circular Road) 231 North Circular Road London N13 5JH 02088860755 02082114539 ymartinroland@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Dushmanthe Srikanthe Ranetunge Name of registered manager (if applicable) Miss Yolanda Martin Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The home may continue to accommodate a specific service user who is physically disabled. The home may only accommodate service users in the 2 bedrooms located in the loft extension after they have been subject to an assessment by a competent person representing the service user and nominated by the placing authority. In the case of a service user who is self funding, the assessment must be undertaken by a competent person who is independent of the home. This assessment must clearly that the service user is able to escape from their room in the event of a fire, without the assistance to staff. A copy of this assessment must be retained in the home and be available for inspection. Any such assessments held by the home, must be subject to regular external review in accordance with the changing needs, abilities or condition of the service user. This condition will be reviewed should the care needs of the service user increase to a point where the home is unable to meet them. Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 1 5 Brief description of the care home 231 North Circular Road is a care home registered to provide accommodation and personal care for a maximum of 6 adults with mental disorders. The home was opened in 1990 and is one of five care homes belonging to Roland Homes, a company owned by Mr and Mrs Ranetunge. The home is a two-storey terrace house with a loft extension. On the ground floor there is an open plan lounge dining kitchen area, a communal toilet (which is wheelchair accessible) and two single bedrooms (one of which has a shower cubicle which is wheelchair accessible). On the first floor there are two single bedrooms, a bath - shower room, a separate toilet and a combined office -sleeping in room. In the loft there are two single bedrooms (each with an ensuite toilet facility) and a bathroom. At the front of the house there is a paved area for parking and at the rear of the house there is a garden which is partly paved and is accessible to service users. The home is situated within half a mile of shops, restaurants, transport and other community facilities located along Green Lanes in Palmers Green. The homes fees are from £750 p.w. depending on the assessed needs of the person. Information, including the contents of CQC reports is made available to stakeholders. The homes brochure states that the aim of the home is that service users will be provided with individual programmes of care, regularly reviewed to maximise stability and preserve independence. 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: 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 last key inspection of this home took place on the 26th September 2007. This key inspection took approximately six hours. The registered manager was available throughout the inspection and the senior manager from the provider organisation also attended to support the registered manager for a period during the inspection. Six people were living in the home and there were no vacancies. The inspection was undertaken by the lead inspector although terms such as we, our and us are used where appropriate within this report to indicate that the inspection activity was undertaken on behalf of the Commission. The inspection activity included: meeting and speaking with four of the people living in the home, three of them independently; detailed discussion with the registered manager and senior manager from the provider organisation; independent discussion Care Homes for Adults (18-65 years) Page 6 of 30 with two support staff on duty at the time; independent discussion by telephone with a care manager from L.B. of Camden. Further information was obtained from a very detailed Annual Quality Assurance Assessment (AQAA) that had been submitted by the home when we asked for it, a tour of the premises and documentation kept at the home. 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: 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 8 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 9 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. Up to date information is available to prospective residents, and other interested people, to help them to make an informed choice about living in the home. Peoples needs are properly assessed so that the home can decide whether it can meet those needs. Peoples needs and wishes continue to be reviewed after they are admitted to help staff be aware of any changes in these. Residents benefit from a written contract that tells them of their rights and responsibilities and those of the home. Evidence: During the inspection we saw a copy of the statement of purpose/ service user guide, that is available to all prospective residents and other stakeholders. The information was clear and gave prospective residents and other key stakeholders a range of required information about the home and the services it provides. Residents spoken to confirmed that they had received sufficient information about what they could expect when they were admitted to the home. The homes annual quality assurance assessment, AQAA, gave us detailed information about how the home manages new referrals. This included that when the home Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: receives a new referral it ensures it has comprehensive and up to date information from the referring agency, sends detailed information about the home to the prospective service user and their social worker, arranges an in-house assessment, invites the prospective service user to visit and the person is then offered trial visits/ stays to the home. Following this the home sets up a review with all interested parties. We looked at the files of three of the six residents living in the home, two of whom had been admitted within the past twelve months and one of whom had lived at the home for a longer period. All three files contained detailed assessment information that was available before the person was admitted, including reports from a range of health and social care professionals who had contact with the person prior to admission. We spoke independently by telephone to a care manager from L.B. of Camden. He told us that the homes assessment and admissions process worked well for his client, who had been admitted to the home within the last twelve months. He told us that in his opinion the home was doing really well in meeting his clients complex needs. It was also noted that the home had completed a Mental Capacity Act and Deprivation of Liberty Safeguard Assessment on each resident to ensure that current legislation regarding how people make decisions for themselves was being complied with. We also saw evidence that the home reviews and updates the assessment information as appropriate on a three monthly basis and more often if the persons needs changed. This enables staff to be aware of any changing needs and how to address these. The home also operates an effective key worker system and monthly key worker reports were seen on files inspected. Files inspected included a signed funding agreement with the authority that had referred the individual to the home. The files also included a separate contract with the person concerned that recorded the rights and responsibilities of both the individual and the home regarding the placement. The agreements had been signed relevant parties including both the resident concerned and the manager of the home. The registered manager told us that the home does not admit people on an emergency basis or for respite care. Care Homes for Adults (18-65 years) Page 11 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from very clear and detailed recording of their needs in their care plans to assist staff in helping them to meet these. People are supported to maximise their independence by making as many decisions as possible for themselves. People are also supported and guided to take appropriate risks in their daily lives to assist them to safely achieve their aspirations. Evidence: The homes annual quality assurance assessment, AQAA, gave us detailed information about how the home draws up each persons care plan, involving both the person themself and the health and social care professionals that are involved with the person. The files of three people were inspected and these included comprehensive and detailed care plans. The plans seen contained a wide range of individual needs and wishes, described how each of these was to be addressed and also the types of intervention to be used. It was noted that the care plans were being reviewed at least Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: every three months and were informed by up to date assessment information, including up to date risk assessments. Both residents and staff spoken to were able, in different ways, to describe the care planning system used at the home and indicated that they were involved and engaged with the process. One resident told us how the home was helping them try to locate relatives they had not seen for some while and another person told us how the home was helping them manage an identified addiction. We were impressed that both residents and staff spoken to independently were able to describe the practical actions taken and processes in place to evidence the detailed documentation seen in the peoples care plans. The home has a system whereby all staff are required to sign that they have read the latest care plans and risk assessments on all of the residents to assist in implementing these. Residents at the home come from a range of ethnic backgrounds and have differing preferences and needs including with regard to culture, religion and sexual orientation. Documentation seen clearly recorded peoples religion and the extent that they wished to follow this and also their needs and potential vulnerability around areas relating to their sexuality. Again, we were impressed that peoples individual needs and preferences were clearly recorded along with the practical steps that were being taken to help people achieve their needs and aspirations in these areas. This was confirmed and supported by both residents and staff spoken to independently. Residents are encouraged to make decisions for themselves and this was evidenced through discussion with individual residents and through records including minutes of the monthly residents meetings. Minutes of recent meetings showed discussion about the physical environment of the home, menus, how to make complaints and discussion about a range of the homes policies and procedures. We also noted that a copy of the homes key policies and procedures for residents was kept in the communal living space for their information. Most residents have a key to their bedroom and access to the combination code for the front door. Where someone does not have this, or where other specific limitations are imposed, it is recorded in their care plan and the reason for this. Other restrictions such as on smoking in the building and the use of illegal drugs are well recorded, including in peoples contracts. We were told that the home is not the financial appointee for any resident with the majority of residents have arrangements for managing their finances that are independent of the home. We were told that the home looks after some money for three residents, records and money for one resident were inspected and were satisfactory. Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: All residents files seen had a range of up to date and detailed risk assessments that identified potential individual risks to the person and gave clear guidance to staff on how these risks were to be minimised. Evidence was also seen that risk assessments were discussed with residents and signed by them. Residents spoken to confirmed this. 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 living at the home are encouraged and supported to participate in a range of activities, including within the wider community. They also enjoy contact with relatives and friends to the extent that they wish and which benefits their well being. People are supported to be as independent as possible, including to enjoy healthy and nutritious meals. Evidence: The homes annual quality assurance assessment, AQAA, gave us detailed information about how residents are supported to explore and take part in a range of activities that they are interested in and which can also promote their independent living skills. Four of the residents attend outside day resources including one person linking with a local Asian Centre. The home is also supporting the other two residents to identify outside day activities that may help them meet their needs and wishes. Each person Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: has a daily activity planner and copies of these were seen on residents files. The activity planners showed that residents are supported to use local community resources including shops. cinema, restaurants, pubs, library and a local leisure centre. Residents are supported to travel independently where this is appropriate and evidence seen in care plans that this is properly risk assessed to assist residents keep safe and well. We noted that one resident is supported by a member of staff to attend a night club on occasion. We were told that these outings were successful and assisted in promoting the persons self esteem. We were told that residents participate in a range of activities run by the provider organisation, which are available for all their residents. We saw evidence that residents had been involved in trips to resorts such as Blackpool and Brighton and some to places further afield including Paris and Edinburgh. Residents spoken to confirmed this and told us that they enjoyed taking part in activities with residents in the other of the providers homes. People living at the home originate from different ethnic and religious communities and evidence was seen that their needs and preferences, including in such areas as food and places of worship, were discussed with the person and recorded. People are supported to make their own decisions about their culture and religion and how they wish to pursue these. Evidence was also seen in peoples care plans and from records of key worker sessions that people are supported and counselled regarding their sexual identity and how to promote this positively and safely. Residents are able to maintain contact with family and friends to the extent that they wish. People spoken to confirmed that visitors are welcome and that they are able to see visitors in private if they so wish. However, some limitations in this area are in place for identified individuals and evidence was seen that these had been negotiated with the person, recorded in their care plan and had been discussed at wider review meetings with health and social care professionals. People are individually assessed regarding their ability to undertake their own catering arrangements and what support they need to develop their independence skills in this area. The home has in place two recurring menus, one for weeks one and three the other for weeks two and four. Evidence was seen from residents meeting records that they are consulted about what is included on the menu. In addition two of the residents are currently supported to cook for themselves three days a week. To assist with this they are given a weekly food allowance to purchase food, which they then store and cook independently with staff monitoring the process. One of the residents who cooks for themselves told us that this system worked well for them, including both the amount of money to shop with and being able to cook their own food. Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: On the day of the inspection all of the residents present went out to lunch supported by staff. Feedback on their return was that the outing was enjoyable with people having what they wanted to eat. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home receive individually tailored personal support in accordance with their needs and wishes. They are also well supported in meeting their physical, mental and emotional healthcare needs, including by accessing relevant health care professionals. The medication administration procedures within the home safeguard people living there. Evidence: The homes annual quality assurance assessment, AQAA, gave us detailed information on how residents were supported with their personal and health care support, including choosing their own clothing, bed times and bathing arrangements. The six residents have differing support needs with regard to their personal care and staff spoken to were able to describe the amount of support each person needed, which ranged from verbal prompts to more significant physical support when required. Residents spoken to independently indicated that staff were sensitive to any specific support needs they may have and how they preferred for these to be addressed. During the inspection residents spoken to were appropriately dressed and presented. Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: The home has developed good working relationships with mental health services and this assists in keeping people well. All the residents are registered with a GP and evidence seen of appointments being made and kept. A quality assurance feedback form from a GP, that the home had received through its own quality assurance process, stated, I was impressed by the way and the manner that staff at the home conduct themselves. Good quality and detailed records of appointments, and outcomes, with health care professionals were seen on the files inspected and these included the reason for the appointment and any other follow up action needed. The records showed evidence of appointments with mental health specialists, general and specialist hospital outpatient departments, dentist and optician. We were particularly pleased to see that residents were supported to attend dental services on a regular basis and that dental hygiene was given a priority by the home. It was clear from the records seen that the home pro-actively supports residents with both their physical and mental health care needs. Evidence was also seen that the home gives particular attention and support to residents who may have suffered in the past from addictive behaviour, e.g. in relation to alcohol, drugs and gambling habits. We were impressed by the way the registered manager and staff assisted people in these areas in a sensitive and proactive manner. The home had a satisfactory and recently reviewed medication policy that was seen along with written information about a range of different medications used by residents. Evidence was seen that staff had received training in the safe administration of medication and staff spoken to confirmed this. One person was being supported to be more independent with their medication at the time and the details of this were clearly recorded in their care plan along with a specific risk assessment. None of the residents are prescribed controlled medication. Medication and medication administration record (MAR) charts were inspected for two people living in the home. These were accurate, indicating medication was being given as prescribed and there were no mishandling or missed doses. Up to date records were seen of medication being received into the home and when medication was disposed of. 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 home are able to express their views and concerns and have these acted on appropriately. The homes safeguarding adults policy and procedures assist in protecting people from abuse. Evidence: The homes annual quality assurance assessment, AQAA, gave us detailed information about how the home manages new referrals to the home. This included that a copy of the homes complaints procedure is given to each resident when they are admitted to the home and that a copy of the complaints procedure is available to residents in the homes lounge. A satisfactory complaints procedure was seen in the Service User guide and a copy is kept in the residents policies and procedures folder. Residents spoken to felt confident that any complaints they made would be properly dealt with by the home. One resident said, Yolanda, (the homes registered manager) will sort out any concerns and confirmed that any issues the person was not happy or clear about could also be raised at the monthly residents meetings. Evidence was seen in the minutes of residents meetings of discussion about the homes complaints procedure and how it should be used. No complaints had been recorded by the home in the past twelve months and none received by the Commission since the last inspection. The home has a satisfactory safeguarding adults policy that had been reviewed in Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: November 2009 and which staff had signed to state they had read and understood it. A L.B. of Enfield, the local authority the home is situated in, easy to read guide on safeguarding adults was also displayed in the homes lounge. There have been no allegations or disclosures of abuse made to the home or to the Commission since the last inspection. Evidence was seen that staff had undertaken training in safeguarding adults and staff spoken to were able to describe what action needs to be taken should an allegation or disclosure of abuse be made to them. One resident told us I feel a lot safer here than at x (the last place the person had lived). The home has a satisfactory whistle blowing policy, a copy of which is kept in the policies and procedures folder that is available to residents. Care Homes for Adults (18-65 years) Page 21 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 live in a home that is comfortable, well decorated, well maintained and that meets their current needs. People who live in the home, staff and visitors benefit from the building being kept clean and tidy. Evidence: The homes annual quality assurance assessment, AQAA, gave us detailed information on the physical environment, including that the home has an internal health and safety inspection every three months to identify any problems or potential problems. The home is a two-storey terrace house with a loft extension. On the ground floor there is an open plan lounge/ dining kitchen area, a communal toilet (which is wheelchair accessible) and two single bedrooms (one of which has a shower cubicle which is wheelchair accessible). On the first floor there are two single bedrooms, a bath - shower room, a separate toilet and a combined office -sleeping in room. In the loft there are two single bedrooms (each with an en suite toilet facility) and a bathroom. At the front of the house there is a paved area for parking and at the rear of the house there is a garden which is partly paved and is accessible to residents. During a tour of the home it was noted that the home and its furniture and fittings were comfortable and domestic in nature. The home was well decorated and Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: maintained with good documentation to evidence regular maintenance and ongoing decoration. The toilets, bathing facilities and kitchen were all clean, in good repair and met the needs of the residents. All the communal areas were also bright, airy and clean. At the last inspection a requirement was made that the rear garden patio was repaired and made safe to maximise health and safety for all; this requirement was seen to have been complied with. We were also shown new plants including herbs and strawberries in a section of the garden that one of the more recently admitted residents was working hard to develop. One resident uses a wheelchair and has their bedroom on the ground floor. This person told us that he was able to access all the ground floor facilities in the building and had the necessary adaptations they needed. Two residents showed us their bedrooms. Both of these had been personalised to their particular taste and both spoke positively about the physical environment in the home. Residents have a key to their room and the combination code to the front door of the home unless there is a specific restriction imposed regarding this. As stated in the Individual Needs and Choices section of this report, where restrictions are placed on a resident these are well documented and evidence seen that they are discussed with the person concerned. None of the current residents had needs in relation to continence. The homes laundry facilities were suitable to meet the current residents needs and in scale for the home. Cleaning materials and other potentially hazardous material are kept locked when not in use. The home was clean and tidy during the inspection and free from unpleasant smells. Residents confirmed that they were encouraged and supported by staff in keeping their rooms clean and evidence to support this was seen in documentation inspected. Care Homes for Adults (18-65 years) Page 23 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. A staff team with a range of qualifications and competencies, in sufficient numbers, support people living in the home. The homes recruitment policy and procedure assists in protecting people living in the home. People are supported by staff who have access to a range of appropriate training. Staff also receive formal supervision and support to assist in further meeting the needs of people living in the home and in their own personal development. Evidence: The homes annual quality assurance assessment, AQAA, gave us detailed information on staffing arrangements, including that the home provides a range of training for staff and operates a robust recruitment process. The home employs a registered manager, and five support staff that are mainly based in the home. However, all the provider organisations support staff are contracted to work in all of the provider organisations homes. We were told that this maximised flexibility and ensured that when staff were on leave or absent for any other reason other staff could work at the home who knew the residents needs and who residents were familiar with. We were told that because of this flexibility the home does not use agency or temporary staff. From discussion with both residents and staff it was our judgement that this flexibility worked well for all concerned. Support staff spoken to Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: during the inspection were very conversant with the needs and wishes of residents and residents spoken to talked highly of staff, including their key worker. We were informed that the provider organisation employed thirty one staff, including managers, and that 70 of these had achieved or were working toward the national vocational qualification (NVQ) at levels 2, 3 or 4. This was subsequently confirmed in writing by the registered manager and staff records and staff spoken to also supported this. The staff rota was seen, was up to date and accurately reflected the staff on duty on the day. Two support workers cover the early shift, 8:45 am to 6 pm, one support worker covers the late shift, 6 pm to 10 pm and one support worker covers the night shift, on a sleeping-in basis. The registered manager is in addition to the above. There is also an on call manager available to the home, including at night time. We inspected the recruitment files for two support workers that had been employed at the home in the last year. These showed evidence that the home had obtained all the required documentation to evidence a robust recruitment procedure including: proof of identity with a photograph, two written references that had been verified; evidence that the person was entitled to work in the UK where applicable, evidence that the person had an enhanced criminal records bureau (CRB) clearance and an independent safeguarding authority (ISA) check that had been applied for by the home and had been received before the staff members started working there. Evidence was seen that staff receive a good quality induction, which reflects current Skills for Care good practice, when first employed and that the home provides ongoing training and refresher training. Evidence was also seen that the home had provided a range of training/ refresher for staff over the past twelve months including on the Mental Capacity Act/ Deprivation of Liberty Safeguards, mental health awareness, drug and alcohol dependence, personality disorder, fire safety and health and safety. Two support workers spoken to independently confirmed that they found the training provided helpful. Evidence was seen that the home provides regular supervision to all staff at least every two months and this was confirmed by documentation seen and support staff spoken to. Staff also told us that in addition they could approach managers at any time for support and advice. Care Homes for Adults (18-65 years) Page 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from the effective and high quality management systems used in the home and their views and those of other stakeholders are sought and acted on regarding the quality of life they experience. Health and safety procedures assist in protecting people living at the home, staff and visitors. Evidence: The homes annual quality assurance assessment, AQAA, gave us detailed information on the conduct and management of the home including that residents and staff views are taken into account and that management develop and review the organisations policies and procedures according to current legal requirements. The registered manager presents as being competent, is experienced and impressed us with her knowledge of the management issues involved in running the home, her knowledge of the needs and preferences of the residents and her commitment to promoting the best interests residents. She has completed her Registered Managers Award and is a national vocational qualification (NVQ) assessor. Both staff and residents spoken to independently told us that she was very supportive and it was Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: clear to us that they held her in high esteem. One resident spoken to independently was telling us of some of the difficulties they had experienced in their life and how they felt that they had made considerable progress since living at the home. This included the person telling us, I really do try hard here as I do not want to let Yolanda down after all she has done for me. Another resident told us they were appreciative of the efforts the registered manager had made to try to help them locate relatives that they had lost contact with for many years. We also spoke to the provider organisations Senior Manager, Mrs Ranetunge, who visited the home during the inspection. She also has a clear vision for developing best practice for the home and the other homes in the provider organisation. Evidence was seen of good management practises at the home promoted by the provider organisation. This included regularly reviewing all the policies and procedures and having a system whereby all staff sign to confirm they have read and understood the updated policies, key policies and procedures being available to residents in the homes lounge, regular and meaningful consultation with residents, both individually and through regular residents meetings and in fostering positive working relationships with health and social care professionals that have contact with the home. It is also noted in other sections of this report that the overall standard of record keeping in the home is of a very high standard. The home has a number of ways of monitoring the ongoing quality of the service offered to residents. An effective key worker system is in operation, detailed records of monthly key worker sessions were sampled and residents spoken to knew who their key worker was. As stated above home also holds regular residents meetings and records of those sampled showed that residents were consulted and discussions took place on a range of areas that affected their every day life. The home also seeks more formal feedback through quality assurance surveys, which were sampled. Feedback seen included: from a consultant psychiatrist, I have been impressed that care is tailored to the needs of the individuals at this accommodation; and from a community psychiatric nurse, Staff are helpful and friendly. Response to quality assurance surveys are collated and acted upon by the provider organisation. A range of satisfactory health and safety documentation was seen. This included: a gas safety certificate, electrical installation certificate, portable appliance test certificate and evidence that the homes water supply had been tested to minimise the risk of legionella. The homes fire log was inspected and showed a current fire risk assessment and emergency plan, that the fire fighting equipment had been serviced and that fire drills were being undertaken every three months. Care Homes for Adults (18-65 years) Page 27 of 30 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 28 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 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 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. 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