Care Home: Ronak Home

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What the care home does well The home provides a good standard of care and support to a group of residents with a range of very complex and challenging needs. The staff team are very stable and demonstrate a good knowledge of the residents and are able to recognise their individual needs, particularly in relation to their autism. The staff are also kind and patient and work hard to support the residents to express their choices. The house is comfortable and offers access to a choice of communal areas as well as being very near to a park, public transport and local shops. The people who live in the home are supported to maintain positive contact with their relatives and they are able to visit the home whenever they wish to do so. One relative said, "they try very hard to meet the needs of all the clients". The home also supports the residents to develop their independent living skills and to eat a healthy and nutritious diet. What has improved since the last inspection? There have been a number of improvements since the last inspection in January 2009 where it was felt that the service was providing adequate outcomes for the people living in the home. The residents are all being supported to access a wider range of community based activities and are making better use of public transport. They have also got a holiday booked later in the year. The routines are more flexible to enable people to enjoy activities in the evening if they wish to do so. Each persons individual contract specifies the number of hours of one to one staffing they should receive each week. This has linked to a review of the staffing levels and more staff are available during the day. The home has ensured that residents monies are used appropriately and has also established an budget to pay for each persons activity programme. The manager has improved his management style and the staff all said that he is very approachable and inclusive. He has further management training planned. He is also supervising the staff regularly. Further work has taken place to develop the person centred plans with individual goals. This has included ensuring all the necessary documentation is in place. The quality assurance exercise has been completed and an action plan is in place. What the care home could do better: Two requirements were made at this inspection. The first is to improve the recording of medication to ensure residents receive their medication correctly. The second is to carry out some maintenance in the home, especially in the bathrooms and to provide garden furniture. This is to ensure residents live in a well maintained and furnished home. Some other good practice recommendations were made. These include ensuring the person centred plans are completed fully, ensuring healthcare appointments are recorded correctly, securing the medication cabinets so they are safe and monitoring the progress of work following on from the quality assurance exercise. Key inspection report Care homes for adults (18-65 years) Name: Address: Ronak Home 120 Alderman`s Hill London N13 4PT     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 Ray     Date: 0 1 0 7 2 0 0 9 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 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Ronak Home 120 Alderman`s Hill London N13 4PT 02088823586 02084479105 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): MHJ Crausaz Ltd Name of registered manager (if applicable) Mr Jarrett Edgar Type of registration: Number of places registered: care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 10 The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability (LD) Date of last inspection Brief description of the care home Ronak Home is operated by MHJ Crausaz Ltd. This company has other homes locally. This home is registered for ten adults, aged between 18 and 65 years, who have a learning disability. The majority of current residents are non-verbal and a number have a diagnosis of autism. The home is a semi-detached three storey house with a garden. There are ten single bedrooms, of which eight are en suite. The home is situated close to the facilities of Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 10 1 4 0 1 2 0 0 9 Brief description of the care home Palmers Green and is opposite a large park. There are good public transport services locally. High staffing levels and some day services are provided by the company in line with the residents individual needs. The homes stated aims are to provide care and support to ten younger adults who have learning disabilities. At the time of the inspection the range of fees at Ronak were 1612 to 3334 pounds a week. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The inspection took place on the 1 July 2009 and was unannounced. The inspection lasted for six hours and was the key annual inspection. The inspection looked at how the home was performing in terms of the key National Minimum Standards for Younger Adults and the associated regulations. The inspector was able to observe the support given to the current residents and to talk individually to one of the residents. The inspector was also able to spend time talking to the manager as well as five of the care staff who were working. The inspector did a tour of the premises and also looked at a range of records including resident records, staff files and health and safety documentation. The home had provided the inspector with a completed self-assessment questionnaire (AQAA). In addition the inspector also received completed surveys from 7 residents, 3 Care Homes for Adults (18-65 years) Page 6 of 32 relatives and 8 staff. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Two requirements were made at this inspection. The first is to improve the recording of medication to ensure residents receive their medication correctly. The second is to carry out some maintenance in the home, especially in the bathrooms and to provide garden furniture. This is to ensure residents live in a well maintained and furnished home. Some other good practice recommendations were made. These include ensuring the person centred plans are completed fully, ensuring healthcare appointments are recorded correctly, securing the medication cabinets so they are safe and monitoring Care Homes for Adults (18-65 years) Page 8 of 32 the progress of work following on from the quality assurance exercise. 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 32 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 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can be assured that they will be thoroughly assessed and have opportunities to visit the home as part of deciding if the service is right for them. Staff have a wide range of skills and experience to enable them to meet the residents complex needs. Contracts are easy to understand and state what service the residents will receive. Evidence: We arrange short stays for prospective service users. During this time we will be constantly assessing and evaluating whether we can meet their needs. If in agreement we will arrange their admission. (Extract from the AQAA prepared by the home) The service provides a happy and friendly environment. (Quote from a survey completed by a relative) Since the last key inspection there have been no new admissions to the home. We looked at four case notes and they all included a comprehensive assessment prepared by the staff in the home. These assessments provide a good summary of the needs of Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: each person. They also include a contract in a clear format. These state specific arrangements for each person in terms of the number of one to one hours of staff support they must receive. The AQAA explains the assessment and admission process offered to prospective new residents. This is clearly comprehensive and offers an appropriate process for future residents. We discussed the current needs of the people who live in the home with the manager and care staff. They have very specific individual needs linked to their learning disability, complex behaviours, autism and epilepsy. The staff spoken to had a very good understanding of the individual needs of the residents. In addition it was observed that the staff were supporting the residents with great skill and sensitivity. The staff spoken to said they had received training on meeting the needs of the people living in the home, which has included epilepsy and makaton sign language training. It was seen that some of the epilepsy training needs to be updated and the manager explained that a date for this had not yet been confirmed. The manager from discussions indicated that he recognised the importance of the Mental Capacity Act and deprivation of liberty safeguards, for the residents. He said that whilst some senior staff including himself, had received training in this area most of the care staff had not been trained. We looked at the statement of purpose and service user guide. These were both written clearly and were up to date. Care Homes for Adults (18-65 years) Page 12 of 32 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. The people living in the home can be confident that they will be supported to have a person centred plan and risk assessments. This will facilitate the residents receive the support they want and to make choices in their daily lives. Evidence: We encourage residents to make and form decisions, explain consequences and understand their right to take risks. (Extract from the AQAA prepared by the home) I know about my care plan. My key worker talks about it with me when we meet each month. She talks about everything she is writing in my file. (Quote from a resident) We inspected the person centred plans for four people currently living in the home. We also spoke to the manager and care staff about the person centred plans. All of the people whose records were inspected had person centred plans in place but these were at different stages of development. These are replacing the previous care plans and are written in an accessible format. They clearly state what people like and dislike Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: and give clear guidance to the care staff on what they need to know to support the individual successfully. The person centred care plans have been prepared by the key workers who have consulted with relatives and other care professionals. The person centred plans include individual goals, which are called learning logs. Progress with meeting these goals, were being monitored on an ongoing basis. The four residents whose case notes were inspected had all had a review in the previous year or had a review meeting planned with their care manager. The manager explained that they are working with the placing authorities to arrange these reviews using a person centred approach. Each resident had a named key worker and co key worker. The staff were asked about their role as a key worker and this showed that the support they provided was very comprehensive including helping with personal shopping, attending healthcare appointments, ensuring all the residents personal care needs were met and organising leisure activities. The staff spoken to were familiar with the person centred plans. The four residents whose case notes were inspected all included individual risk assessments covering all areas of potential risk and these identified what action the home would take in response to the identified risks. Due to the complex needs of the residents certain restrictions were in place including locking some doors or having a buzzer to alert staff to when a door opens. This is all recorded in the persons case notes and agreed at review meetings. The manager also said he could contract the social service lead on the deprivation of liberty safeguards to seek advice in these cases. Each person living in the home had individual behavioural guidelines as part of their assessment and risk assessments and these were clearly written and gave appropriate guidance to the staff. We observed the people living in the home and their interaction with the staff. It was positive to note that they were being facilitated to make choices including when they wished to get up or move around the home, when they were ready to eat and in some cases what they wanted to eat or drink. The staff were observed to be very aware of both verbal and non-verbal communication. They were also able to describe how they facilitate choices by for example offering a choice and observing the residents response. The AQAA prepared by the home identifies that in the next year it wants to develop further the use of a wider range of communication methods. Since the last inspection residents meetings have taken place. Whilst one resident is Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: able to verbally express his wishes the other residents have non verbal communication. The purpose of the meeting is to enable residents to make choices about activities, food etc. It is suggested that this meeting is reviewed to see if an alternative means of facilitating choice that is more effective can be introduced. Care Homes for Adults (18-65 years) Page 15 of 32 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 in the home are supported to develop their independent living skills. Residents are enjoying a full and active lifestyle that includes accessing a range of community facilities. Relationships with family and friends is valued by the home. Evidence: I went cycling the other week, that was a lot of fun. (Quote from a resident) They use public transport as much as possible. (Quote by a relative in a survey) There are lots of new activities taking place including cycling, horse riding and tramp lining. (Quote from a member of staff) We treat our service users as normal individuals who have the right to experience every day the ups and downs of life. (Extract from the AQAA prepared by the home) Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: The staff spoken to explained that the people living in the home were being supported by staff to develop their independent living skills in line with their individual needs. For example some residents are being supported to be more independent in terms of their personal care, others are learning to make use of public transport and others are being supported to assist with the shopping. The development of independent living skills was also reflected in the residents person centred plans and learning logs. We spoke to the staff, resident and looked at the residents activity records to get an understanding about the activities that are taking place. One resident talked about how he attends a range of college courses including art, cookery, gardening and IT. The manager explained that one of the residents goes to a specialist day centre five days a week. The other six residents are supported by staff to participate in a range of activities. Four staff commented that since the last inspection the residents were taking part in lots more activities based on their individual interests. One resident who is less mobile enjoys going to the pub, playing snooker and watching his favourite football team West Ham. Others are enjoying a lot of physical activities including cycling, trampolining, exercise classes, horse riding and outings. Many of these activities take place outside and the manager acknowledged that they need to start planning some more indoor activities for the winter months. The home has also has an external fitness instructor to come once a week to the home to do an exercise session with the residents and an aromatherapy masseur on a monthly basis. The residents have also been supported to have some individual sensory or musical equipment. These all help to stimulate and provide entertainment for the residents. In addition one resident has a treadmill that is kept in the lounge and this provides regular exercise. A number of the surveys completed before the inspection raised concerns about the fact that the home no longer has access to a minibus with a driver. It was however very positive to see that the people living in the home were making extensive use of public transport. The staff team also has drivers who can use the minibus where needed. All the residents have booked a holiday in Hampshire later in the year. The AQAA identified that the residents have different ethnic and cultural backgrounds. One person is Muslim and in line with her relatives wishes, does not eat pork, wears Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: some traditional clothing and joins her relatives to celebrate some festivals. Other residents go to church and one of the residents explained how a volunteer comes to the home each Sunday to take him to church. The manager explained that the people living in the home have close contact with their relatives, who either come to visit them or go home. The staff explained how for a number of residents they support family visits by either escorting them on the journey home or by staying with the resident during the family visit. In terms of the routine in the home two staff said that this has become more flexible. The manager said that evening activities are supported and staff can stay on later if needed. We saw the record of food eaten in the home and this was a healthy and nutritious diet. The person centred plans provide the details of each persons dietary preferences. One resident said he was trying hard to eat a healthy diet. The staff said they do the shopping at a local supermarket and then buy additional fresh food during the week. Care Homes for Adults (18-65 years) Page 18 of 32 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. The people living in the home are supported in a manner that protects their privacy and dignity. Each person is supported to access professional healthcare input based on their individual needs. People living in the home receive the correct medication but some of the records could be improved. Evidence: The clients choose whether to have a bath or a shower. They go out to buy their personal toiletries. They choose when to go and get out of bed. They all access beauty salons for a hair cut and manicure. (Extract from the AQAA prepared by the home) I have seen the doctor, optician, dentist and chiropodist. I also went to the hospital for an appointment. (Quote from a resident) We observed during the inspection that the people living in the home were given support with their personal care based on their individual needs. The residents were all well dressed and groomed and what they were wearing was very age appropriate. Most of the people living in the home have en suite bathrooms and this helps to maintain their privacy. Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: The healthcare records were inspected for the four people living in the home. They had all been supported to access the GP, dentist and optician in the last six months. Previous healthcare records had been archived and so it was not possible to see when residents had last seen the psychiatrist or other healthcare professionals. One person had received some specialist healthcare checks but this was not clearly recorded. All the people living in the home are supported to check their weight on a monthly basis. The recording of their weights was confusing as sometimes it was in kilograms and at other times in stones and pounds and so it is recommended the each persons weight is recorded consistently. This recommendation is restated from the previous inspection. The medication system and records were inspected. The medication is stored in two large medication cupboards in the dining room. These are not secured to the wall. The home uses a blister pack system. Medication received in the home and returned to the pharmacist is recorded so an audit trail is available. The temperature of the medication cupboards were monitored daily and are at an appropriate level. Some of the records were not clear, for example one resident had finished a course of antibiotics and yet the medication record did not make this clear and it appeared that the medication had not been administered. One resident has a cream that he keeps in his room and applies himself and the administration record is blank and does not say that the medication is self administered. Another resident has a medication that is given as required when his behaviour is very agitated, but there are not clear instructions about when this should be given. The training records show that all the staff have received medication training. Care Homes for Adults (18-65 years) Page 20 of 32 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. The people living in the home have access to an appropriate complaints procedure. Procedures and training on safeguarding vulnerable adults are in place to protect the residents. Staff have been trained on how to appropriately support people who have complex and challenging behaviours. Procedures are in place to ensure residents personal monies are used appropriately. Evidence: We welcome complaints and suggestions as a way of improving our service. (Extract from the AQAA prepared by the home) If I have anything the matter, I tell the staff and they would do something. (Quote from a resident) We looked at the complaints record and saw that there had been two complaints since the previous inspection and these had been addressed appropriately. An appropriate format is available to record complaints and this monitors the time taken to resolve the complaint. The complaints procedure was also inspected and this was in a format accessible for the residents. The inspector saw that the home had a protection of vulnerable adults procedure prepared by the company. The staff training records were inspected and showed that all the permanent staff had received training on safeguarding vulnerable adults. There Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: have been no safeguarding referrals in the last six months. The staff training records also showed that almost all of the permanent staff had received training on how to work positively with service users who have complex challenging behaviours. The staff were able to describe how they support residents when they are unsettled and this is very appropriate. They were observed during the inspection speaking to the residents in a very calm manner. The records of four residents personal monies were inspected including their building society books, expenditure records, cash and receipts. These show that they are only buying items for their own use. The record of expenditure was correct and receipts available. The company has decided to establish an activity budget and this means that residents will not have to pay for sessions such as cycling or the exercise class. They are also reimbursing residents for this expenditure over the last few months. Care Homes for Adults (18-65 years) Page 22 of 32 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 adequate 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 are benefiting from an environment that is clean, tidy and homely. Work is needed to ensure ongoing maintenance issues are addressed. Evidence: We individually personalize service users rooms including having their own furniture. (Extract from the AQAA prepared by the home) We did a tour of the building and the home was clean and tidy. The furniture in the communal areas is designed to meet the needs of the residents by being strong and yet a style that is in keeping with the home. Each resident has a single room. Three residents have a futon bed or mattress on the floor, one because he had previously wanted to sleep on the floor and has been supported to move onto a low bed and the other because his epilepsy puts him at risk of falling and the third person because he jumps on his beds and they keep breaking. One resident who has mobility issues has a ground floor bedroom and a bathroom with a shower and shower chair that meets his specific mobility needs. Hygiene is promoted in the home by antibacterial hand wash and disposable hand towels being available in shared bathrooms and toilets. Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: A number of improvements had taken place since the last inspection including the provision of new dining chairs, new sofas, some redecoration and a new dishwasher. The people living in the home frequently damage the fabric of the building and the AQAA explains that a new maintenance person has been employed to help address this. It was noted that the bathroom on the ground and first floors were both in poor decorative condition. The staff said some repairs to the ground floor bathroom had been reported to the handyman. It was also observed that there was no suitable garden furniture available. It was also observed that the fire doors throughout the home were appropriately closed. Window restrictors were working properly. Additional fans had been purchased as the weather was very warm at the time of the inspection. Care Homes for Adults (18-65 years) Page 24 of 32 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. The residents are supported by a committed and stable team of staff. The staff are receiving a range of ongoing training. This enables them to work to a high standard and deliver good care. Evidence: Staffing levels offer a good skill mix. The majority of staff have a minimum of an NVQ level 2. Staff support each other and share skills and knowledge. (Extract from the AQAA prepared by the home) I have been working in the home for about two months and the staff team was very welcoming. (Quote from a member of staff) We always have enough staff and we are working better as a team. (Quote from a member of staff) The team are always eager to explore new ways of promoting the residents welfare and well being. (Quote from a survey completed by a member of staff) We checked the rota for the home and this showed that there is a team of nineteen staff working in the service. The staffing structure consists of the manager, deputy Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: manager and a team of support workers. There is also a cleaner who works twenty hours a week. During the day there are nine or ten staff on duty and at night there are two waking members of staff. The manager and deputy are shown as being supernumerary. The staff turnover has been low with one staff leaving since the last inspection. One new member of staff has started and two more are about to start working in the home. Most of the staff spoken to during the inspection had worked in the service for several years. The manager explained that residents now have an opportunity to meet prospective staff as part of the recruitment process. The manager and care staff explained that staff team meetings take place on a monthly basis. The staff said that the meetings are much more open and staff are encouraged to discuss specific topics they want to raise. The AQAA prepared by the home stated that fourteen staff have completed an NVQ in care qualification. We looked at the recruitment records for the one member of staff who has joined the team since the last inspection. It was found that they had two references, ID, POVA check and a CRB disclosure. The staff member said he had a detailed induction that included two weeks of shadowing. He is completing the common induction standards. We inspected the training records. The home has a training matrix and it was possible to accurately tell who had received training and when this had taken place. An ongoing training programme is in place including all the mandatory training. We spoke to the staff who were able to describe their ongoing training and said they found this very useful. We looked at the supervision records. This is carried out by the manager and deputy. This is generally taking place every two months. Staff said this was a two way process and allowed them to agree actions. Care Homes for Adults (18-65 years) Page 26 of 32 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. A permanent manager is in place who provides effective leadership and has started the registration process. Health and safety measures are available to safeguard the people living in the home. People involved in the home have their opinions sought as a way of improving the standard of the service. Evidence: The manager is now much more approachable. (Quote from a staff member) The management is accessible and open to reforms and suggestions. (Quote from a survey completed by a member of staff) The manager explained that he has completed the registered managers award and will be doing the NVQ level 4 in management and care. From talking to staff and reading the surveys it is evident that the manager has reflected on and changed his management style and is now more approachable and flexible. This is much appreciated by the staff team. Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: The Regulation 26 monthly monitoring visits to the home had taken place regularly and the manager was able to access these reports so that he can follow through any action that is needed. The home has completed its own internal quality assurance exercise this year including the views of residents and relatives. The views of care professionals had been sought. The results of the quality assurance exercise had been collated and an action plan prepared. Progress with completing these actions need to be monitored. The AQAA completed by the home shows that all the maintenance checks are in place. The fire safety records show that fire drills are taking place every one or two months and the fire alarm is checked weekly. The staff training records show that the staff have either completed or are booked to attend most of the health and safety training including food hygiene, moving and handling, first aid and infection control. Two staff need to have their fire safety training refreshed. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 32 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 20 13 the registered person must ensure that the arrangements for the recording of medication in the care home is completed correctly. This is to ensure the medication is correctly administered 07/08/2009 2 24 23 The registered person must 07/08/2009 ensure all the bathrooms are appropriately maintained and decorated and provide some garden furniture. This is to ensure the home is properly maintained and equipped. 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 3 The registered person should ensure a training date is Page 30 of 32 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 booked for staff who need their epilepsy training refreshed. 2 3 4 3 6 8 The registered person should offer staff training on the Mental Capacity Act and deprivation of liberty safeguards. The registered person should ensure the person centred plans are completed fully for each resident. The registered person should explore the most effective way for residents to contribute to decisions and choices about how the home is run. The registered person should start to explore activities that the residents can participate in during the winter so the current programmes can be maintained. The registered person should ensure the outcome of all healthcare appointments are recorded clearly so they can be referred to as needed in the future. The registered person should ensure the medication cupboards are safely secured. The registered person should ensure the progress with completing the actions identified from the quality assurance exercise are monitored. 5 13 6 19 7 8 20 39 Care Homes for Adults (18-65 years) Page 31 of 32 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. 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