Care Home: Rutland Crescent (25-27) Care Home

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What the care home does well Each resident is helped to make decisions about how they live their life and to take responsible risks as part of an independent lifestyle. Staff have the experience and training to assist the residents to identify and achieve their life goals. Individual needs and aspirations are explored with the full input of each resident and recorded in person-centred plans. The plans are detailed and regularly reviewed to ensure that they are accurate and up to date. The residents are encouraged and supported to integrate within the wider community in order to pursue development opportunities and to also enjoy the social rewards that this can bring for them. Residents living at the home tell us that they like all of the staff and that the staff help and support them. Comments from residents that we spoke with included: `Staff very good. I like all of them` and `Like it here. Like it all`. The service provides a safe and well-maintained home for the residents. Management utilises quality assurance and quality monitoring systems to promote the residents` safety and welfare. What has improved since the last inspection? There was a requirement made at the last inspection for ramp access to be provided to the garden. Ramp access has been provided to the garden area at the rear of the premises. The service has addressed a further requirement from the last inspection in respect of written guidance for the recording of the disposal of unwanted medications. There are no outstanding requirements from the last inspection. The service has continued to increase the input of the residents in the way that the service operates. In addition to listening and acting on the views of the residents, the residents are increasingly involved in the recruitment and training that takes place. What the care home could do better: It has not been necessary to make any requirements at this inspection. Assessment processes for any older people living at the home should routinely include the use of screening tools for risk assessments covered with the National Minimum Standards for Older People, such as the prevention of falls. There are quality assurance and quality monitoring systems in place, which include annual satisfaction surveys. Summarising and publishing the results of satisfaction surveys to share with current and prospective users of the service could further improve the system. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Rutland Crescent (25-27) Care Home 25 - 27 Rutland Crescent Harworth Nottinghamshire DN11 8HZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Andrew Bailey     Date: 2 6 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.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: Rutland Crescent (25-27) Care Home 25 - 27 Rutland Crescent Harworth Nottinghamshire DN11 8HZ 01302759636 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) : Royal Mencap Society care home 7 Number of places (if applicable): Under 65 Over 65 1 learning disability Additional conditions: 0 The home is registered to provide care for services users of both sexes whose primary needs fall within the following categories:- Learning Disablity (7) including Learning Disability over 65 years (1) Date of last inspection Brief description of the care home Rutland Crescent is a home for seven adults with a diagnosis of learning disability. At the time of the inspection one service user is over 65 years. The home is situated in a residential area of Howarth and is within walking distance of local amenities. The house is an adapted pair of semi-detached houses, which blends completely with the surrounding housing. Fees are assessed based on individual needs. Care Homes for Adults (18-65 years) Page 4 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 last inspection of this service was on 17 August 2006. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for the people using the service. The process considers the homes capacity to meet regulatory requirements and minimum standards of practice. The inspection visit was unannounced and took place over a 6 hour period. There were seven residents living at the home on the day of the inspection. Four residents, the registered manager, deputy manager and another member of the support team were spoken with during the visit. Care Homes for Adults (18-65 years) Page 5 of 29 We looked at information that we have received since the last inspection. The information included the Annual Quality Assurance Assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. The service has also told us about things that have happened at the home and these are called Notifications. Records were examined during the inspection, including the care records of four of the residents. This was part of the process called case tracking. Where possible we also spoke with these people during the inspection visit. The service has told us that the people living at the home prefer to be referred to as residents. This terminology is used within the inspection report. What the care home does well: What has improved since the last inspection? What they could do better: It has not been necessary to make any requirements at this inspection. Assessment processes for any older people living at the home should routinely include the use of screening tools for risk assessments covered with the National Minimum Standards for Older People, such as the prevention of falls. There are quality assurance and quality monitoring systems in place, which include annual satisfaction surveys. Summarising and publishing the results of satisfaction surveys to share with current and prospective users of the service could further improve the system. Care Homes for Adults (18-65 years) Page 7 of 29 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 www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 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 9 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have the opportunity to visit the home before choosing to live there, and there is suitable information provided to help them decide if their needs can be met. Evidence: We received the Annual Quality Assurance Assessment (AQAA) from the service before this visit. The service told us that the assessment process fully includes the input of the individual, and the parent or carer. They told us that pre-admission visits and overnight stays are encouraged. The deputy manager told us at the inspection that the Statement of Purpose was reviewed in December 2008. The latest admission to the home was three years ago. Therefore, there was no recent evidence within the care records for us to fully evaluate the admission procedures. We examined the most recent admission records relating to one of the residents and we were able to confirm that a community care assessment had been taken into account at the time of this admission. The manager and deputy manager described the admission process to us. Referrals are usually via the social services department, but it Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: is possible for direct contact to be made with the service, for example, by family. The staff at the home undertake their own assessment in either case, even where a social services assessment has been provided. As stated in the AQAA, the management explained that the assessment process is a partnership process, with full inclusion of the prospective resident. There is often a gradual process of trial visits, perhaps commencing with a short visit and building up to an overnight stay. Where an admission goes ahead there is a trial period before the resident makes the decision about the suitability of the placement. Consideration is also made by the service about the suitability of the placement, for example, the impact this may have on other residents living at the home. We found documentary evidence of reviews involving social services within the records of the residents that we examined as part of the case tracking process. Person-centred plans are developed as part of the detailed admission process and each resident has an individual Service User Guide. The Service User Guide includes details about the residents room, fire safety, contact information and the complaints procedure. Additional records for each resident include a health file, hospital file and finance file. The resident and staff sign the records to confirm that they have been jointly agreed. Emphasis is placed upon ensuring that the records are presented in a format that is suitable for the individual resident. One of the records that we examined as part of the case tracking process had a particular pictorial and photographic emphasis. Care Homes for Adults (18-65 years) Page 11 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs and aspirations of residents are recorded in their care plans, and residents are supported to take responsible risks as part of an independent lifestyle. Evidence: In the AQAA self-assessment that we received the service told us that each resident has a detailed person-centred plan and that each plan is regularly updated. They told us that they were aiming to develop plans onto DVD and memory stick (subject to individual resident wishes). When we visited the service the management told us that this process was in the early stages, with a My House DVD having been produced with one of the residents. The DVD covers a tour of the building and includes leisure details. The case tracking process placed specific emphasis at examining the records of selected residents. We found that there had been regular review of the content of the records to ensure that the person-centred plans were up to date. Staff and residents had signed to acknowledge agreement with the care records, including the risk Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: assessments. The care records demonstrated that residents had been directly involved in the care planning processes that the home had undertaken. The support care plans were detailed and included plans for health and social needs. There was evidence in the care records of multi-disciplinary reviews. The manager told us that the reviews are usually arranged by the social services team, where applicable, and are combined day centre placement and home placement reviews. We found that consideration had been given to the competency of people to make their own decisions, in line with the Mental Capacity Act 2005, with written assessments included in the care plan documentation. The assessments covered decision making for matters such as medical consent and finances and had been closely linked to the risk assessment process. The manager told us that he is continuing to look at how competency assessments are recorded. We were also informed by the manager that Royal Mencap Society is exploring ways that recording can be further developed with reference to the Deprivation of Liberty Safeguards that come into force from April 2009. The manager is involved in these discussions and is a cascade trainer for the registered provider on mental capacity issues. Examination of records as part of case tracking and discussions with staff focused on how residents had been supported to take risks as part of an independent lifestyle. There was evidence that the risk assessment process was well developed and that the service promotes the achievement of each individuals goals. Efforts had been made to support residents to take responsible risks. Examples included residents social interaction within the community and the degree to which residents had engaged in activities independently. In one instance that we examined, the degree of independence for a particular residents leisure activity had subsequently been reassessed and had needed to decrease, but there had been obvious efforts to explore the boundaries in a measured and considered manner. The manager explained that the service does not operate a fixed keyworker system. Residents are encouraged to approach any member of staff with issues that they may wish to discuss. Staff undertake specific roles e.g. medicines and residents health care on a rotating basis, in addition to their day-to-day duties. Regular meetings are also held with individual residents on a one-to-one basis as part of the inclusive review procedures. When we spoke with some of the residents they gave us positive feedback about the service. Comments included: Staff help me a lot and They listen to me. Care Homes for Adults (18-65 years) Page 13 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to achieve their individual goals and lead a lifestyle of their choosing. Evidence: In the AQAA self-assessment that we received before this visit the service said that all menus are decided upon by individual preferences and that residents plan, prepare and cook food, with appropriate support. They said that alternatives to social services day centres are provided, but that one of the barriers to improvement had been budget restrictions. These restrictions limited the ability to develop alternative day placements that had been requested by residents. They were seeking other sources of funding and recruiting volunteers to reduce the impact of barriers. They told us that leisure activities on offer included horse riding, swimming, dancing, voluntary work, rambling, football, cinema and gardening. They told us that two of the residents attend Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: church. Each year each resident is invited to make a special wish. Examples of wishes that residents had followed had been a pamper day and a London theatre trip. We examined the records relating to lifestyle during this inspection and where possible we did this as part of the case tracking methodology, so that we followed the experiences of specific residents. We found that the lifestyle choices were reflected in the person centred plans, and had been linked to the risk assessment process, where appropriate. For example, there were risk assessments for swimming and horse riding in one of the records we inspected. One of the residents told us that they particularly enjoyed swimming and horse riding, whilst another said that they enjoyed shopping. Some of the residents have cars, arranged through the Motability scheme. There are written agreements in the records describing the arrangements for use of the vehicles e.g. who is allowed to drive the vehicles. The range of activities available indicates that residents are supported to enjoy full and stimulating lifestyles, with a variety of options to choose from. Residents are supported to undertake educational and occupational activities. One of the residents that we case tracked is part of a pilot scheme with a catering business. This funded placement means that the resident has been able to undertake City and Guilds training over the past two years and hopes to complete the qualification in the near future. Another resident that we spoke with attends an agricultural work placement and told us that they enjoyed working on the farm. This resident also attends a social services day centre three days per week. Holiday arrangements for the residents are flexible and led by them. Many of the residents have previously chosen to take short breaks. For example, two of the residents had a short break in Blackpool last year, supported by staff. One of the residents that we spoke with was pleased to tell us that they had enjoyed a holiday with their family last year in Devon and Cornwall. Family input is encouraged by the service and the person centred plans we looked at contained much evidence of family contact information. Families and friends are invited to visit the home. Last year a Pie and Pea supper and a barbecue were examples of events held at the home. There are no fixed routines, and this includes the catering arrangements. A monthly menu is compiled, with the wishes and preferences of the residents foremost. The menu is a guide and is adjusted to meet needs and preferences as appropriate. Residents prepare meals on a rostered basis, with help from staff as necessary. Dayto-day routines are also driven by residents on an individual basis. One of the residents told us that they get up and go to bed at a time of their choosing. The service actively supports residents to be independent. For example, the records of one of the residents that we looked at described the risk-assessed process for the resident Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: to independently use a taxi service and attend a local hairdressers. 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. Residents personal and healthcare support is promoted by the assessment and monitoring systems. Evidence: The AQAA self-assessment told us that detailed person-centred plans are held for each resident. The service told us about the hospital files that have been developed for each resident. These files are condensed person centred plans. They provide summary information to accompany the resident in the event of hospital admission and include information such as medical information, comprehension, and likes and dislikes. We case tracked residents living at the home and looked at the detailed care records in place. The records described the input required to support each resident. Records contained evidence that they had been based on the rights and abilities of each resident. This included the rights to privacy and dignity. We noted during the visit that staff respect these rights in practice, for example by knocking on the bedroom door before entering the room. The plans had been compiled with full inclusion of the individual resident and they had signed to signify their agreement with their plans. Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: When we spoke with residents some of them were able to confirm that they had been involved in the care planning process. The documents also included record of contact with other health professionals, such as the General Practitioner. We spoke with residents about how staff support them and some told us: The staff are good, I like all the staff and Staff help us. One of the residents living at the home is over 65 years of age. The manager is applying the principles of the National Minimum Standards - Care Homes for Older People with this resident. It was clear from the records that the health needs of this person had been considered and there had been input from other professional agencies to meet specific health needs, including nutritional needs. We discussed with the manager about introducing the routine use of risk assessment scoring tools, for example, for nutritional screening, falls and pressure ulcer prevention. The manager has agreed to review the assessment processes in line with preventive element of the National Minimum Standards. We looked at the system for handling medications in respect of the residents that we had case tracked, and the records were satisfactory. Records of administration were clear and there was suitable reference information available for staff to refer to. The community pharmacist had inspected the medication systems in September 2008 and there were no outstanding matters from that inspection. The service has addressed a requirement from the last inspection in respect of written guidance for the recording of the disposal of unwanted medications. A member of staff that we spoke with confirmed that they had undertaken medication training. The manager confirmed that all staff receive medication training, which promotes the safety of the residents living at the home. 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 home has systems for dealing with concerns and complaints and aims to protect people from harm. Evidence: In the self-assessment that we received prior to the inspection the service told us that they have a written policy and procedure for dealing with any complaints. During the last year the Commission for Social Care Inspection was made aware of concerns about one of the residents. The concerns related to the displayed behaviour of the resident. The service has taken appropriate steps to seek a resolution by involving relevant agencies and the appropriateness of the placement is under review. The home keeps a register of complaints and concerns and there have been no other recent significant events to record. The complaints procedure is included in the Statement of Purpose and the Service User Guide provided by the service. The manager told us that staff receive training about complaints (and compliments). A member of staff that we spoke with confirmed that training had been undertaken on this subject. This person also confirmed that staff receive training on safeguarding adults (adult protection). The manager delivers training on safeguarding and is booked to undertake social services training to train the trainer in February 2009. Staff training includes the recognition and reporting of abuse and covers the Nottinghamshire multi-agency guidance. Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: We spoke with residents and feedback suggests that they feel able to raise any concerns that they may have. When we spoke with residents about whether they felt they could raise concerns one person told us: They listen to me. 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 service provides a safe and well-maintained home for the residents. Evidence: In the self-assessment that we received from the service before the inspection they told us that residents choose the decor for their rooms and that the kitchen and bathrooms had been redecorated within the last year. They told us that the rear garden access had been improved by the provision of a ramp (a requirement from the last inspection) and that the driveway had been resurfaced. Electric gates now protect the rear of the premises and there is Computer Controlled Television surveillance of the grounds of the building. We spoke with two of the residents about their bedrooms and they confirmed that they had chosen the decoration for their bedrooms. We were able to see the bedroom of one of the residents that we were case tracking. The bedroom had been personalised and had several family photographs on display. Another resident was pleased to tell us that they had a TV and DVD in their room. We briefly toured the building and we found that it was clean and tidy, with no apparent maintenance issues. The laundry area is equipped with a washer and dryer. Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: Each resident has a specified day to launder his or her clothing. The manager told us that staff had received training from the local hospital infection control team. We spoke with a member of staff who was able to confirm that infection control training had taken place. There are written infection control policies and procedures for staff to refer to when needed. 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. Residents welfare and safety is promoted by the training and recruitment systems in place at the home. Evidence: The AQAA self-assessment told us that residents are involved in the recruitment of staff and also have input into the staff training programme. The service told us that there was funded one-to-one support for a resident, to meet their needs. This had entailed the use of agency staff, which had resulted in some loss of continuity (not always the same staff). The service had worked with the agency to limit the number of different staff visiting the service to provide this one-to-one support. In the selfassessment the service told us that pre-employment checks are undertaken for staff joining the team and that staff receive induction and development training. We looked at a sample of the staff recruitment files and we found that the necessary checks had been undertaken before the member of staff had commenced employment at the home. This included Criminal Records Bureau clearance checks and two written references. We spoke with a member of staff and they told us that there are good training Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: opportunities. This person had completed National Vocational Qualification (NVQ) Level 3. Other training received included fire safety, first-aid, moving and handling, and food hygiene. The staff member said that morale is good and there is a good atmosphere at the home. The manager confirmed that two out of the seven staff have completed NVQ Level 2/3 training. Whilst this is currently below the target level, a further five staff are in the process of undertaking recognised training at NVQ Level 2 and the manager anticipates that they will complete their training by May 2009. The manager described the input that residents have in the recruitment and training at the home. Residents have been involved in designing the adverts and have sat in on the interview panel. Some residents have also taken part in the staff training programme, for example, a resident took part in person-centred training. This demonstrates that residents are seen as the central focus of the service and is indicative of the inclusive approach at the home. 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 management systems in place promote the health, safety and welfare of the residents. Evidence: In the AQAA self-assessment the service told us about the satisfaction surveys that they undertake and that past surveys have indicated complete satisfaction with the service. They also told us that they hold regular residents house meetings so that they can listen to and act upon the views of the residents. A resident told us: Staff ask us what we like. The manager has completed the Registered Managers Award and aims to complete National Vocational Qualification Level 4 in care during the early part of this year. Residents and the staff member that we spoke with spoke positively about management listening to their views. We spoke with the manager about the quality assurance and quality monitoring Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: systems in place at the home. We confirmed at inspection that the mandatory monthly visits and reports by the registered provider are taking place. These visits are part of the quality monitoring processes, which act in the interests of residents living at the home. The registered manager completes a range of audits of the service on a monthly basis. These cover issues such as medication and care records monitoring. Annual surveys take place of the views of family/carers and of the views of the residents that live at the home. We discussed with the manager at inspection how the satisfaction survey process might be developed to provide feedback in a report format that could be included within the written information about the home that is available to current and prospective users of the service. The manager told us about the training that takes place for safe working practices. There is a range of training and updates that staff undertake including fire safety, firstaid and food hygiene. We received feedback from a member of staff to confirm that the person had received the required health and safety training to enable them to support and protect the people living at the home. We examined a sample of the maintenance and servicing documentation and this supported that the home was being maintained satisfactorily to protect the residents living at 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 1 19 Risk assessment scoring tools should be utilised as part of the homes routine assessment processes with any older persons living at the home, as per the National Minimum Standards - Care Homes for Older People (NMS 7 and 8). The results of residents surveys should be summarised, published and made available to current and prospective residents. 2 39 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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