Care Home: Rose Farm House

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What the care home does well Assessments are carried out thoroughly before a person moves in and then is reviewed and updated as individual needs change and skills develop. People said they are listened to. Meetings to talk one-to-one are arranged for each person so that they can say what they want and if there is a problem. People are supported to have an active lifestyle. They are encouraged and supported to do as much as possible for themselves. People are supported with their communication and challenging behaviour to increase the opportunities available to them. There is a person centred support team and a consultant psychiatrist employed by the company to provide direct support to the people living in the home. The home meets the physical and healthcare needs of the people who live there. There is input from specialists and local GPs. There is a good range of training including person centred planning and managing challenging and potentially destructive behaviour with positive behaviour support. What has improved since the last inspection? The staff communicate between each shift involving the person. At the beginning of the day they have a handover meeting with each person individually and then a house meeting where they plan the day. The people living in the home said they prefer this. The grounds are much tidier. Parts of the garden have been landscaped. They have started to create a farm and have sheep and chickens. The people living in the home are learning how to look after them and take some responsibility and said they are enjoying this. There has been a period of change with the management of the home that caused some unrest. This is settling down now and staff are being given new roles to take some ownership in the running of the home along with the people living in the home. What the care home could do better: It would be good to have a registered manager for this service. The manager has put an application in to the care quality commission to be registered, so this is in the process of being completed. The manager is aware that the documentation in the home needs to improve and has plans to resolve this. We were able to see most of the paper work that we needed to in order to check that the right things were happening in the home. The support systems for people who need help to communicate their wishes need to be in place as soon as possible. Assessments have been carried out by the speech and language therapist and occupational therapist and further staff training has been organised. Parts of the home look worn out and some redecorating and repairs are needed. The manager has already identified this and plans are underway to address this. Key inspection report Care homes for adults (18-65 years) Name: Address: Rose Farm House Haine Road Ramsgate Kent CT12 5EG     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: Julie Sumner     Date: 1 7 1 2 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 29 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 29 Information about the care home Name of care home: Address: Rose Farm House Haine Road Ramsgate Kent CT12 5EG 01843583380 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.hqls.org.uk High Quality Lifestyles Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 4. 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 Rose Farm House is a detached property located in a rural setting. It is close to the seaside towns of Ramsgate and Margate and approximately 16 miles from Canterbury in Kent. This home is part of a group of homes owned by a private company: High Quality Lifestyles. The home is designed to accommodate up to 4 adults who have a learning disability, are on the autistic spectrum and who could present challenging behaviours. Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 4 Brief description of the care home Rose Farm house provides a spacious homely environment that is split into a main house and an annexe. Three people live in the main house and one person lives in the annexe. Rose Farm House has 3 large bedrooms, two bathroom/shower rooms, a large lounge/diner and a separate lounge, a large modern kitchen and a separate laundry. There is also an office for the manager, people living in the home and staff to use. The annexe consists of a bedroom, shower room, lounge and small kitchen. There is also a conservatory attached to the annexe. Rose Farm has a spacious, landscaped garden with seating available and two large paddock areas to the rear of the building. There is a trampoline and a swing placed within that area. There is also a fish pond to the back of the house which is surrounded by a fence for safety reasons. To the front of Rose Farm House is a large driveway where staff and visitors park their cars and some outbuildings and stables that are currently not in use. There is a car for the people living in the home to use. The current fees for the service at the time of the visit range from £3750.00 to £9000.00 per week. Care Homes for Adults (18-65 years) Page 5 of 29 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 manager sent us an annual quality assurance assessment (AQAA) which tells us about the service provided, what improvements have been made and how they plan to develop it further. The AQAA was very clearly written and gave us all the information we needed to plan the inspection visit. We visited the home without telling anyone we were coming so that we could see what they do on a usual day. We were in the home from 9.15 in the morning to around 3 oclock in the afternoon. We talked to two people living in the home and also had lunch with them. We said hello to one person and were not able to talk to the other person who lives there as he was in hospital. We talked to the manager and the staff who were working during the morning that Care Homes for Adults (18-65 years) Page 6 of 29 day. Some of the families and people who visit the home gave us some comments and their views about the home. We had a look around in the house and outside. We looked at some of the policies and procedures. We looked at plans and records for supporting the people living in the home. We also looked at staff records like what checks have been made before they started work and training they have been given. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: It would be good to have a registered manager for this service. The manager has put an application in to the care quality commission to be registered, so this is in the process of being completed. The manager is aware that the documentation in the home needs to improve and has plans to resolve this. We were able to see most of the paper work that we needed to in order to check that the right things were happening in the home. The support systems for people who need help to communicate their wishes need to be in place as soon as possible. Assessments have been carried out by the speech and language therapist and occupational therapist and further staff training has been organised. Care Homes for Adults (18-65 years) Page 8 of 29 Parts of the home look worn out and some redecorating and repairs are needed. The manager has already identified this and plans are underway to address this. 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 29 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 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Admissions are not made to the home until a full needs assessment has been made and the person has had the opportunity to decide if they like it. Evidence: The home has a clearly written statement of purpose and service user guide. The manager said she modifies the service user plan to suit each person who is planning to move in. If a person is considering living in the home they are able to visit and have short stays to see if they like it. One person has moved into the home in the last few months. We were not able to speak to him as he was not at home during the visit. We looked his assessment information and talked to the manager about the moving in process. One of the other people living in the home said that they liked the person who had moved in. There was a good range of information forming the assessment and the manager was able to visit the person to get to know him as part of the assessment process. The person was also invited to visit the home to meet everyone. Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: The assessments are undertaken by people who have been trained to do so and are also members of the Person Centred Approaches Department within High Quality Lifestyles. Care Homes for Adults (18-65 years) Page 12 of 29 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 service recognises the right of individuals to make their own decisions and support people in a positive way. Evidence: Each person has a person centred plan. One of the people living in the home showed us his and talked about it. He explained that he has written it with the manager and another person from the person centred approaches team. He said then all the staff know how he wants to be supported and what he likes and does not like. We also looked at another persons plan. The plans contain clear information about the person and how they would like to be supported. We saw the staff follow the guidelines when interacting with two of the people living in the home. The staff spoke in a reassuring way and the people soon calmed. The manager explained that they are designing a new communication assessment and behavioural assessment package. Most of the people living in the home are able to Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: speak and some need help with their understanding of what is being said. One person uses some Makaton signs to assist his speech and also has some picture cards. The manager is organising further Makaton training to make sure the staff are able to use the signs needed in everyday speech and to encourage the person to develop his use of signs and speech further. The company have a risk assessment format and risks are also assessed as part of the positive behaviour support analysis. Risk assessments contained clear information and were relevant to day to day activities that the person participates in. They contain clear guidelines for staff to describe how to respond in each situation to minimise and manage potential negative responses. Risk assessments are also completed prior to going out to make sure a person will be supported appropriately when out. Care Homes for Adults (18-65 years) Page 14 of 29 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. The people living in the home are involved in meaningful daytime activities of their own choice and participate in the day to day running of the home. Evidence: Everybody living in the home has the opportunity to say what they like to do and to try new activities. The activities each person likes and what they regularly do is written in their plan of support. We looked at two activity timetables. During the day people went out for walks and shopping ready for Christmas. One person was later playing a computer game and staff said he is really good at it. One of the people showed us some certificates that he had achieved in football training. He explained he regularly plays for a football team but has recently had an injury so was planning to watch the game that evening instead. Families are involved with each persons support and they attend the reviews of their Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: care. People spend time with their families and some go and stay for long week ends. The manager explained that they take photos of what people are doing and send them together with an updating letter to the families. Some of the people living in the home can write so they keep in touch by letters and also by telephone and e-mail. The people living in the home are supervised by staff and supported in the home. They are able to access any part of the home and garden. Each person has a lockable bedroom to protect their belongings and they have a key. Menus are planned and everyone joins in with this. Meals vary and an alternative is provided if people change their minds about what they want. Each person can also cook their own meal and have something different to the others. People are supported to cook and also to participate in the preparation of the main meals. One of the people said how much he enjoys cooking. Care Homes for Adults (18-65 years) Page 16 of 29 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. Individual personal and healthcare needs are met. The people who use the service are given the support they need to manage their medication. Evidence: Each person has guidelines written in their person centred plan that explain what is important to them and how they would like to be supported. This includes support with their personal care and their general day to day routine. The staff find out what people want by having one-to-one meetings with them. These are organised to suit each persons needs like how long and how frequent the meeting are. We saw staff talk to the people living in the home and respond to their wishes. People said staff listen to them. Each person has a health action plan. People are being supported to manage their health and improve health conditions that they have. One of the people moved into the home on high levels of medication and this is being gradually reduced in line with the persons wishes. The staff are supporting people to eat more healthily and finding different ways to make this more acceptable to them. For example a person eats more fruit and vegetables and no longer needs the same level of laxatives that he had Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: before. One of the people living in the home was in hospital on the day of the visit having had surgery. The staff said that they felt that the way he had been supported whilst in the hospital by the hospital staff was really good. The staff from the home have stayed with him to support him. The staff said that they have been discussing plans with him for the support he will need when he comes out of hospital. We could see that people are getting support from community health care services for specific medical conditions and as required. The Occupational therapist has recently visited the home to carry out sensory assessments with two of the people living in the home. They are currently trying out some of the aids that have been suggested. The speech and language therapist has also been involved supporting the development of the new communication support plan for one person. The manager has reviewed the medication procedures and put a new system of monitoring into practice. This is following an incident where some medication went missing (although it was later found intact) and some omissions with recording. We had a look at the medication storage and administration records and found that all was correct. The home uses a Boots domestic monitored dosage system or it is administered straight from containers if it cannot be blister packed. The administration and storage system has been checked by the deputy manager and manager regularly and there have been no further mistakes or incidents. We discussed making the medication administration person centred with the manager, which she agreed with and said it will be included in the homes development plan at a later stage. Care Homes for Adults (18-65 years) Page 18 of 29 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 are supported to voice their concerns and the procedures in the home protect people from abuse. Evidence: The complaints procedure is displayed on the office wall for all to see, this is also available to any visitors to the service or anyone who wants to make a complaint or raise a concern. People said if they want anything or are worried or unhappy about anything they talk to the staff or manager and if needed they have a meeting. The complaints procedure is straightforward for the people living in the home to understand. There have been two complaints both of which have been resolved. We saw that the staff were responsive when one person did complain about something that happened during the day and he was reassured. The company reviewed the safeguarding adults training last year to make sure that it is giving the staff the right skills and knowledge. The training takes place over a full day. Staff work with individuals and monitor behaviour so that they can recognise when a person is unhappy and take appropriate action. We looked at the staff training records and the daily recording logs. We could see that staff have a good range of training to support people to say what they want and staff know what to do if there is an incident. The service is active in making sure that if there is an incident that they think may need reporting that they contact the local social services safeguarding team and they report incidents to us. Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: There have been two safeguarding alerts raised since the last inspection. The first one has been investigated and a follow up meeting is planned. The outcome was that the people living in the home were not considered to be at risk but there was some criticism about some of the homes paperwork and the medication checking procedures at the time. The second one was raised anonymously concerning an alleged abuse of one vulnerable adult against another. This is currently being investigated. We saw that staff were motivated and positive in their interactions with the people living in the home. And we saw that they responded in a sensitive and calming way when one of the people was distressed and exhibited challenging behaviour. Care Homes for Adults (18-65 years) Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the people who live there. Evidence: Three people live in the main house and 1 person lives in the annexe. All the people living in the home were encouraged to assist with the decor of their bedrooms and with what they wanted within their living space. Parts of the home have been redecorated and the people living in the home and the staff were talking about what they are going to decorate next. Some parts of the home were looking worn out and there were some signs of damage to walls and ceilings. Everyone was getting ready for Christmas and were putting decorations around the main parts of the home. The company have employed an accommodations officer and the manager explained that she feels there is a lot of untapped space in and around the home. There are plans to discuss how this can be developed. There are spacious grounds around the building with a fish pond and parts of the garden are landscaped. There is a specially made swing that belongs to one of the people living in the home and a large trampoline for everyones use. They are planning an allottment. Last year one of the people grew tomatoes successfully. One of the Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: people has been supported to do some gardening by a handy man. The grounds in the front and back looked well maintained. The people living in the home talked about the animals that they have and said how much they like having them. They currently have sheep and chickens and hold meetings to decide who is responsible for what. One of the managers from one of the other homes in the company comes over to teach the people how to look after the animals. The staff take turns to make sure all parts of the home are clean. The people living in the home participate with the household chores. The kitchen is large enough for people living in the home to help prepare meals if they wish to. One of the people said he enjoys cooking and shopping for food. The laundry facilities are suitable for the type of home and are in a separate room with washing facilities. Staff have attended infection control training. Care Homes for Adults (18-65 years) Page 22 of 29 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 people living in the home have confidence in the staff who care for them. Evidence: The company has a thorough recruitment process to make sure the people applying for the job are who they say they are and will work in the right manner. The company asks for identification like a passport and 2 references from people who know the person including their previous employer. They request a Criminal records bureau (CRB) check and protection of vulnerable adults list (POVA) check to make sure they have not done anything in the past that will indicate that they are unsuitable or cannot be trusted. Staff work for a trial period of time in the company while everyone gets to know each other and the member of staff decides whether this is the right job for them. We looked at two staff files with the manager and saw that all these checks had been carried out. One of the people explained that he interviews possible new staff with the manager. He has prepared the questions with the manager and they agree who is doing what. He said he enjoys this. The manager said it is a really good way of assessing the prospective staff and plans to involve more of the people living in the home when they feel confident to do it. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: We talked to the staff about their roles and how many staff are usually working at each time. At the time of the visit there were less staff working in the home because one person was in hospital and two staff were there supporting him. We also looked at the duty rota and some of the shift planner sheets. Most people need one-to-one support in the home and each person needs a higher level of support out in the community. We could see that there were enough staff to support the preferred lifestyles of the people living there. There are house meetings each day. This was as a result of one person living in the home saying they did not like the staff handover meetings because they were talking about him. Now each person is involved in their own handover communicating from shift to shift and a house meeting is held to plan what everyone is going to do. We talked about this to the people living in the home and they said it was going well. We talked to the manager about training and later with the staff. We looked at the training records for what has been completed and what is planned. We could see that there is a good range of relevant training to make sure staff have the skills to support the people. The courses include training required by law like health and safety and training in specific skills related to individuals. The manager has recently arranged some Makaton (signing for communication support) training. This has been individually designed following a communication assessment by the community speech and language therapist. Training is undertaken both in house and at local colleges. Specialist training on issues relating to learning disability are accessed from the Tizard Centre, which is part of the University of Kent. The staff have received training in positive behaviour support and person centred planning at the Tizard Centre. Nine staff have achieved their NVQ awards and all other staff are scheduled to achieve the award over the next 12 months. Staff spoke enthusiastically about their roles and we saw that they behaved in a calm and confident manner and were respectful and positive when talking to the people living in the home. The manager holds one-to-one meetings with the staff and each person will have an annual appraisal. These meetings and the appraisal give them the opportunity to discuss any issues and to consider their knowledge and skill development. Care Homes for Adults (18-65 years) Page 24 of 29 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. The manager gives the staff and people living in the home confidence and has a clear idea of the improvements needed. Evidence: There have been some changes to the management of the home since it opened. The new manager has many years of management experience and has worked for High Quality Lifestyles for a number of years. She is also part of the person centred approaches team within the company. She has started her application for registration. The manager said she likes to have an open office where people can feel free to come in and talk or work as needed. One of the people living in the home likes to help with some of the administration in the office and this is encouraged. Families and other professionals visiting the home said that the manager is approachable and has made improvements to the service which are continuing. We talked to the manager about quality monitoring in the home. The manager said that surveys are given to the people living in the home and are sent out to people who Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: are involved in the service provided. New surveys have been designed with symbols and pictures which will be given out next time. The director of operations visits the home each month and checks records, talks to the people living in the home and staff and makes a report. The manager has given staff responsibility for various tasks like health and safety and routine fire equipment checks. This gives staff a role and means they are part of the running of the service. The manager carries out monthly audits which feed into the companys overall audit. People have the opportunity to express their views in general conversation with each other and the staff and at their individual meetings with their key worker. The people we spoke to said that the staff listened to them. One of the people showed us what he has written down and explained that if he wants something changed he talks to the manager or staff and they have a meeting. The manager talked about some of the improvements planned for the home based on the views of the people living in the home and on her own assessment of what is currently being provided. These include developing the communication and behaviour support systems and making them more straight forward, making the home more comfortable and utilising the space better and developing the grounds and farm. The manager talked about the organisation of the office and record keeping. She knows that some improvements need to be made with the paperwork. She has plans to make this more efficient, as some things that could be written down to show what is happening have not been. The AQAA shows that health and safety checks of equipment and premises are carried out. The hot water temperatures in the bathrooms are thermostatically controlled and staff check the temperatures weekly and prior to people having a bath. The manager has made sure that the maintenance and checks to fire equipment have been carried out by companies employed to do so and the fire risk assessment is due to be reviewed by the fire safety officer this month. This is also part of the managers audit of the home. Care Homes for Adults (18-65 years) Page 26 of 29 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 27 of 29 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 28 of 29 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. 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