Care Home: Russets

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What the care home does well The home provides key-workers to plan the care for the large number of people who use the service. One person said “I enjoy Russets -they look after me well”.Staff support people to continue with their regular day to day activities when staying at the home.There are lots of pictures to help people understand where things are.One person said they had "space to do own things" and staff "help me do activities".The home arranges stays at the same time as friends when possible.Help and equipment is provided to meet health, medical and personal care needs.The home and garden are well equipped for relaxing and finding things to do.The staff and management listen to what people say about Russets and make changes when needed.The manager arranges regular training for staff including an annual three day session.The home is well organised and systems are in place. What has improved since the last inspection? The manager asks people what they think about the service. As result of this he has made changes. What the care home could do better: The manager needs to make sure that full checks are made and records held when employing staff. Key inspection report Care homes for adults (18-65 years) Name: Address: Russets Gatcombe Drive Hilsea Portsmouth Hampshire PO2 0TX two star good service The quality rating for this care home is: 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: Sue Kinch Date: 3 0 0 6 2 0 0 9 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: 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 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 Information about the care home Name of care home: Address: Russets Gatcombe Drive Hilsea Portsmouth Hampshire PO2 0TX 02392663780 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : www.portsmouthcc.gov.uk Portsmouth City Council care home 15 Number of places (if applicable): Under 65 Over 65 15 0 learning disability Additional conditions: The maximum number of service users to be accommodated is 15. 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 A bit about the care home Russets is a purpose built home run by Portsmouth County Council, which provides respite care for up to 15 adults with learning disabilities. Accommodation is split up into smaller living units and can support people with physical disabilities. Russets can provide daycare although most service users attend local day services. 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 How we did our inspection: This is what the inspector did when they were at the care home We visited the home for the first time since 5th July 2007. We collected information in surveys from people who stay at Russets staff and met a service user. We looked care plans and other records. We looked at information provided by the manager and other records. What the care home does well The home provides key-workers to plan the care for the large number of people who use the service. One person said “I enjoy Russets -they look after me well”. Staff support people to continue with their regular day to day activities when staying at the home. There are lots of pictures to help people understand where things are. One person said they had space to do own things and staff help me do activities. The home arranges stays at the same time as friends when possible. Help and equipment is provided to meet health, medical and personal care needs. The home and garden are well equipped for relaxing and finding things to do. The staff and management listen to what people say about Russets and make changes when needed. The manager arranges regular training for staff including an annual three day session. The home is well organised and systems are in place. What has got better from the last inspection The manager asks people what they think about the service. As result of this he has made changes. What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Sue Kinch The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 01622724950 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 set out on page 4. The report of this inspection is available from our website http:/www.cqc.org.uk/. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. 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 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. In order that their needs are met whilst having short stays at the home people and /or their representatives are consulted about their needs before admissions. Evidence: The service offers overnight, weekend and longer stays but the purpose is for short breaks rather than long term accommodation. The service is currently provided to approximately 90 people using the service regularly. It does respond to emergencies but work takes place to minimise the risk of people staying in the service beyond four weeks. From records and conversations we noted that the service does assess the needs of people before they use the service and for some people in transition from child to adult services the preparation and planning can take place over a period of time to enable to service to respond to individual needs. The manager told us that there are plans to improve the transition for people further by having a care manager based at the service one day a week to liaise regarding this. A service user’s guide is available for people to use. It reflects the facilities and services provided in the home. People told us that they had enough information about the service before they started to use it. There is an admission process and it is detailed in the service user’s guide. We looked at records of pre admission work and found that information is obtained and includes consultation with carers, families and other professional agencies. We looked at a sample of the records and information for five people and found that much assessment work takes place including information from previous services, relatives and the people. However, although some work was clearly carried out before people use the service, it Evidence: was not always clear when people first used the service and if enough information was available. However, we saw evidence of staff attending meetings to obtain information about people before they come to the home and most staff said that they have enough information to work with the people using the service. One said that liaison was good and that there was time for that before people use the service again. Another said that work takes place and that the service is only provided if the service has enough information to meet needs. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service have clear individualised care plans to enable staff to ensure that their decision-making is supported and needs are met taking risks appropriate to their development. Evidence: Care plans and risk assessments are available for people using the service and records and feedback from people and staff tell us that people are consulted about the service that is to be provided including care needs and preferences. They also include details of how the support is to be provided. Care plans are in place for each person, where sampled, and included lots of pictures to help make the information accessible as far as possible. More detailed staff guidance is in place as needed, and some relate to risk assessments showing that risks to people are considered and action planned to minimize risks. Key workers are responsible for ensuring that liaison takes place. There is evidence that care plans are updated and people consulted but when we visited some information was not organised for immediate access and some information was in need of updating. One person commented that during the day there is often time for staff to liaise and update records. There is a system in the home so that care plans for the people who will be using the service each evening are obtained from a secure place and made available for the shifts. The home aims to provide care based on the choices of the people using the service and the feedback that the service had received for May-December 2008 indicated that they had said that they get help when they need it. Evidence: Comments about the care from people using the service or relatives/carers were positive and included that there is space to do own things staff help me do activities, a carer said that staff act on what is wanted and usually understand what is needed. Another person said that the staff listen and help with the things that they want help with. People also told us that they can make decisions about what to do each day. Staff gave examples of activities being planned, based, where possible on the preferences of people using the service and gave examples of choices that people have made and changed. This was presented positively as the right of people using the service to have control over their lives. There is also a service users’ committee that meets regularly and provides another way in which people can be involved in the day to day decision –making about the running of Russets. People have also been involved in recruitment. Staff also have an understanding of working with the rights of people using the service and the needs of relatives. This was evident when talking with them. They spoke about people’s choices and decision making and showed sensitivity to confidentiality respecting people’s privacy. 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 using the service are encouraged to take part in activities they enjoy in the community and at Russets and with friends. People are provided with a diet based on choice and meeting individual special requirements and the manager is reviewing this in respect of the nutritional quality. Evidence: The service aims to provide a range of activities for people while they are away from their usual home. There are many shared spaces through out the home and garden for people to use. These are equipped with various types of items for recreational use such as art and craft materials, equipment for sensory stimulation ,a poole table, bowling items, computers,DVDs, equipment for listening to music and a kitchen for cookery. A member of staff pointed out that the range of areas recreational use was good, particularly for people needing space from other people. We noted that each area is identified by picture signs to help people locate where they want to be. The service user guide includes many pictures and has information about the types of activities that people might choose to do and other opportunities in the community. Staff said the mini buses and public transport are used. They also said that people able to go out alone are supported to do so. People staying at Russets stay for different lengths of time and where some people have their own regular day time commitments such as using day services, Russets staff support them to continue with this if they wish. Evidence: What people are going to do while they are staying at Russets is included in their assessment and care plan and staff try to ensure that people get to do the things they like to do. In the surveys from people using the service and relatives/carers they said that they were able to do the things that they want to do. The home carries out a six monthly audit of people using the service including questions about the activities provided while staying at the home. For the period July -December 2008 they found that 70 out of the 72 people surveyed said that enjoyed the activities that they took part in. 66 had done their favourite activities. When we visited the manager was about to analyse findings for the next 6 month period. The service also provides reports of what people did during their stay to families and usually keeps a copy for the service file. Feedback from staff and records showed that when planning for stays at the service social needs and friendships are taken into account where possible. In written and verbal feedback from staff comments included: good personalised packages” are provided,” we have a lot of social events and service users have the choice of activities. There are further plans for the service and this information was provided by the manager in the AQAA. He said that the service development would include provision of a sensory garden and a music festival including the service users committee in the planning. He also spoke about other plans to develop the use of the service in the day time. A discussion was held about these being provided within the conditions of registration. Rights of people are taken into account by the service. Feedback from service users indicated that most people we heard from felt they can make day to day decisions at the service. One person told us that they had choices and gave an example of being able to have a television in their room so they dont miss their favourite programmes if the main one is in use. We also had examples in information from staff, about how people are assisted with their rights, such as to make decisions and one person told us that people do not do anything that they do not want to do and gave examples of this in practice regarding times to get up and about medication. An acknowledgment of rights is reflected in the care plans and policies of the home. Food at the home continues to be provided by external caterers. This means that some of the food is prepared freshly on the premises but some meals include re heated preprepared meals and mixed views were received about the quality of these. Menus show that there is choice and variety and there is also a small kitchen for preparation of snacks. There are varied views about the food including some concerns about the quality and how it may impact on health. The manager has taken steps to make improvements and ensures that items other than pre cooked meals are available. The manager is aware that concerns about the food remain. He is involving other agencies in a nutritional assessment of the food because of comments received and when people stay at the service for longer periods is making arrangements for some independent cooking. 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. Systems, policies and procedures in the home include arrangements to meet health, personal support and medication needs and are used to effectively meet them. Evidence: In the sample of four assessments and care plans viewed, we noted that they include details about the health and personal care routines that people need and want. In one care plan, for example, we noted that picture guidance was included for moving and handling and a risk assessment was also in place. There was also evidence of health monitoring in the day to day records. For another person guidance for staff to follow about a specific health issue was prominent in their file and records were held of action taken to support that person. Feedback from staff indicated that they did get updated information about people and that systems were available for staff to use to get up to date information before re admission. During our visit staff were undergoing some training in supporting people with personal care and this included dental care. They also receive moving and handling training and some staff were last trained in May 2008.The manager had identified moving and handling refresher training as a priority for staff. We noted that throughout the home there is specialist equipment such as baths, bath chairs and hoists in various bathrooms and shower rooms to enable the service to meet a diversity of personal care needs. Most of the written and physical feedback from staff indicated that they felt they were mostly able to meet the individual needs of the people using the service. One person commented that the service adapts to meet different needs. Evidence: In the information from people using the service and relatives/carers a relative said that they were happy with the care provided and that staff had been trained specifically to deal with a particular health need. Another said that they were treated as a special person and others said that they were looked after well. We noted that one person was not able to use the shower facility closest to their room because it was out of use and in need of maintenance. We were informed that this was to be fixed the next day. At the time of our visit the manager told us that he was undertaking a quality audit of the medication policies and procedures for the home. We noted that training is provided for staff in medication and staff confirmed this. Training has been provided in medication and two staff are trained as trainers. The manager said that staff competence was about to be assessed in medication. He was able to show that some staff have received training in more specific medication training from appropriate health professionals and said that further training was planned for November 2009 from community nurses. Records were discussed with the manager. Not all staff are trained in each procedure and he said that only those likely to be involved are trained. Medication is securely held in the home with clear system and procedures identified for staff including the promotion of self medication. Information from staff demonstrated an understanding of the system in place and elements of the system viewed such as recording and as required guidance were in place. 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. Various copies of the complaints procedure are available and the home welcomes feedback of any sort responds to complaints promptly, learning from experiences and takes peoples wishes into account in the provision of the service. Systems are in place to train staff in responding to concerns and adult protection and this offers safeguards to people staying at Russets. Evidence: The service positively encourages feedback from people using the service and their carers/families. The manager said that there is regular consultation and meetings and the service is honest when they get things wrong. He said that all parents have been sent up to date complaints procedures and we noted that this is also included in the service user guide available for people at the home. People using the service and relatives/carers say that they know who to speak to if they have concerns and they know the complaints procedure. One person said they help me and listen. Another said that they take care of me and make sure I am happy. Another said that they are looked after. In the homes own audit for the second half of 2008 70 of 72 relatives and people using the service said that the staff listen to them .The home has identified makaton training for staff to improve communication with people relying more on non verbal communication. Staff confirmed with us that this training had taken place on the second day of the training on July 1st 2009. The home has a complaints log and complaints are recorded and responses documented. This showed that the home responds to complaints. However, use of the internet was yet to be resolved and the manager had raised this with the registered provider. The manager explained action that he had taken but that this was beyond his control. He said that the service user committee had raised the matter but it was yet to be resolved. Staff say that they know what to do if people are concerned about the service provided. Evidence: One commented that it is part of their role to attend to the issues and concerns raised on a day to day basis o order to have matters addressed as soon as possible. The manager said that safeguarding has been provided for staff, some in induction and agreed that refresher training is needed and said that some is planned. Information from one staff member about safeguarding showed an understanding of the need to act if an allegation is made and would refer the matter to a manager or senior. The person said they had training last year and was aware that there are procedures to follow including involving the care manager. 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 staying at Russets are provided with comfortable, safe and clean accommodation. Evidence: Russets has a lot of shared living space to meet the needs of the people using the service. This includes an outside area to the rear of the building. Staff comments included those about the space being beneficial for people who prefer not to be always in social groups, although there are plenty of rooms of adequate size to also accommodate those who wish to be in group situations. The home is clean and staff are provided for this and the laundry tasks so that care staff can focus on care roles. During the first day of our visit part of the home was being decorated and the manager said that some of the people using the service had been involved in the colour choice. The home is well ventilated and offers a bright and well equipped environment. Various pieces of hoisting, bathing and showering equipment were noted to be shared across the first and ground floor facilities available so that a diverse range of choices can be made and needs met for people who also have physical disabilities. The home also has a functioning shaft lift which one person using the service used and said was always working when they were there. All shared parts of the home visited were accessible to all people but the arts and craft room was locked. A discussion was held about ensuring that any restrictions are risk assessed and relating to the people staying at the service. The building continues to be owned and managed by an external company who has responsibilities for all facilities and maintenance. Staff said that things were fixed quite quickly and there is a maintenance worker on site while we visited .They confirmed that the out of action shower on the first floor was to be fixed on the day after our second visit. Staff confirmed that there was a system in place for referring maintenance work and we saw the record and noted that items are ticked when completed. Evidence: People responding to our survey said that the home is always clean and fresh. Items of equipment such as bins, gloves and aprons are in the bathrooms and available to aid infection control. Staff are offered training in infection control and the homes records noted that 16 staff had been trained in it. Recent risk assessments have been reviewed, by the manager, of areas of the home showing that these are monitored. The manager has an ongoing plan of improvement which he referred to in the AQAA and said that they had improved the facilities in one room to meet a specific persons needs and in others wider beds had been provided. The latter was seen in the bedroom viewed. Other plans include, involving people in the decor, more visual aids, a sensory vegetable garden with wheelchair access and a new activity room for younger users. 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. An effective staff team with appropriate training support the people staying there in an individualised and caring way but recruitment procedures are not robust enough to ensure that people are cared for by fully checked staff. Evidence: The home provides opportunities for staff to attend regular training courses. In addition regular annual training for all staff over a three day period is provided and this was taking place on the first day of our visit. Staff were receiving training in personal care, fire, makaton, mental health and having a team building day. Staff told us that that induction covers what they need to know to do the job and that training is relevant keeps them up to date and gives them enough knowledge to meet individual needs. We had one comment about the needs for more specialised training but the manager spoke of such training provided and records supported this. He has plans for this to continue recognising the varied needs of people using the service. The training of staff is monitored and records are held showing that staff cover a range of training, including health and safety related matters. The manager has plans for further training. Currently these include an update in a specific approach for dealing with challenging behaviour, safeguarding, moving and handling and use of a specific medication. NVQ assessment is encouraged and the home currently has four staff at NVQ level two, sixteen at NVQ level three, and two at level four. Feedback from staff showed a good understanding of their roles in providing services based on the wishes of the people using the service and feedback on aspects of policies and procedures showed that staff were clear about their roles and responsibilities. They also say that they have regular support and supervision from the management of the home. We had positive feedback about the staff towards people using the service with several Evidence: comments about being looked after well and being helped. All said that they were treated well by staff. One said that they all listen and deal with the matters that are raised. Comments and rosters indicated that staff levels vary within the home depending on the needs of the people using the service and the numbers in the home which fluctuate daily owing to a number of people using the service overnight or for slightly longer stays. Staff said that there are usually four to five staff a shift with more at the weekends mainly due to physical needs. Some comments were made in the feedback from staff about sometimes being short staffed and wanting to use less agency staff. The home has recently recruited new staff to fill vacancies and although comments were received that regular agency staff have been used it is anticipated by the home that continuity in care will be more consistent. Staff records or recruitment were a sampled and two of three sets of records were found to have some information missing. One persons reference was not signed and dates were unclear in another. For another person it was not possible to identify who the applicant had proposed as referees. So it was not possible to tell if previous employers had provided one. This was discussed with the manager who said he would take it up with the human resources department. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are able to influence the development of the home. The home is well organised to meet their needs and there is a clear system to promote their health and safety and regularly review and improve the service. Evidence: The manager is registered and has the relevant training and experience for the post. In the AQAA that he submitted before the inspection he demonstrated that he evaluates the service provided, makes improvements and has ongoing plans to improve the service continually to ensure that the service is meeting the needs of the people using the service. In the AQAA the manager placed an emphasis on obtaining views about the service from those who use it and their carers. We found that people using the service are given opportunities to give feedback individually and generally. The service, every six months, evaluates responses and we noted that in the last report of this feedback in second half of 2008 many positive responses were noted. This information is used to influence the plan of development for the unit. We note that the manager currently has feedback for the next period to evaluate. A service users committee has also been formed and meets regularly with minutes taken.The manager gave an example of trying to obtain internet access for people using the service as something he is actively pursuing. A number of other examples of improvement based on listening to people have been identified by the manager showing that diverse needs are being addressed and we noted for example that wider beds have also been provided in some rooms. He has also identified that the service needs to work more on communication to find out ways of improving consultation with people with profound communication difficulties. Evidence: Information from staff indicates that they feel they get the support that they need from the management and are encouraged to voice their views about the service they provide. In verbal and written feedback we obtained from staff they confirmed that they are receiving health and safety training relevant to their role. Training records referred to in the section on staffing included this information. Fire training for example was included in the three day training for staff during the inspection week. We noted that the home has risk assessment for the workplace in place carried out by the manager and include some recent reviews in the first part of 2009. The home has a large file of service records and where sampled we found the information needed evidence that regular checks are made to ensure the systems of the home are working. The exception to this was lack of evidence that the fire system is tested externally by specialists and the manager agreed to follow this up and ensure that this is in place. Recent internal tests had been made and are made regularly. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action 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 Description Timescale for action 1 34 19 The registered person must 10/08/2009 ensure that pre employment checks are fully carried out and evidenced. This is to ensure that a robust system of vetting staff prior to employment minimizes risks to people living in the home. 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 Description 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 Helpline: Telephone: 03000 616161 or 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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