Care Home: Salisbury Road

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What the care home does well The registered manager and her staff are working hard to improve the quality of the care and support offered to residents, all of whom have a range of complex needs. The assessment and care planning documentation seen was of a high quality, to help meet the needs and preferences of residents in a sensitive way. Much of the physical environment of the home has been refurbished to make it a more pleasant place for residents to live. A relative told us, "The residents have a comfortable home, nice bedrooms, good meals. My son likes living there". A social worker told us "I think the service has improved significantly under the (current manager). There is evidence of greater leadership and focus on structure for the service users". What has improved since the last inspection? At the last key inspection six requirements were made and we were pleased to see that all of these had been complied with. The six requirements that had been met were in the following areas: two areas relating to improving care planning documentation, to further help staff provide a sensitive service; to record more fully activities residents undertake, to better monitor these; to improve the maintenance of the property, to provide a more comfortable place for people to live; to have more comprehensive staff recruitment documentation available for relief staff, to further demonstrate how the recruitment processes assists in protect residents and to ensure outstanding work regarding the home`s fire risk assessment was completed, for the safety and protection of all. What the care home could do better: At this inspection no requirements are made. One good practice recommendations is made for the home to record any minor concerns that are raised, to further contribute to the home`s quality assurance processes. Key inspection report Care homes for adults (18-65 years) Name: Address: Salisbury Road 22-23 Salisbury Road Leyton London E10 5RG     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Peter Illes     Date: 1 4 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 31 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 31 Information about the care home Name of care home: Address: Salisbury Road 22-23 Salisbury Road Leyton London E10 5RG 02085568147 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): l.walker@mcch.co.uk www.mcch.co.uk MCCH Society Ltd Name of registered manager (if applicable) Mrs Lesley Walker Type of registration: Number of places registered: care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 7 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Learning disability Code LD Date of last inspection Brief description of the care home Salisbury Road is registered to provide personal care and support for up to seven residents of either sex. The home comprises two terraced houses forming one large home. Accommodation is on two floors and includes seven single bedrooms all with their own wash hand basins. There is a large lounge, day activity room, separate dining room, fitted kitchen, utility room, sleepover room and office. The home has two bathrooms with toilets and a separate toilet. There is a rear enclosed private garden and a small garden area to the front. The home is located in a residential area of Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 7 1 5 0 1 2 0 0 9 Brief description of the care home Leyton, North East London. It is close to shops, community facilities and is well served by public transport. A stated principle of the home is to support and encourage residents with regard to Choice, Dignity, Respect, Privacy, Independence, Rights and Individuality. Information about the service is displayed in the home, including the Commissions inspection reports, and is also available on request to interested people. The weekly fees charged at the home are from £1200 per week, depending on peoples assessed needs. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of this service took place on 15th January 2009. This key inspection took approximately 6.5 hours and was undertaken by the lead inspector. However, terms such as we, our and us are used where appropriate within this report to indicate that the inspection activity was undertaken on behalf of the Commission. There were six residents living at the home at the time, one vacancy and no new residents had been admitted to the home since the last inspection. The registered manager and deputy manager were available to assist throughout this inspection. The inspection activity included: meeting and speaking to the majority of the residents present although conversation was limited due to their communication needs, detailed discussion with the registered manager and independent discussion with the deputy manager and other care staff on duty at the time. We also spoke independently by Care Homes for Adults (18-65 years) Page 6 of 31 phone to a social worker from LB of Westminster and a senior community nurse from Redbridge and Waltham Forest Learning Disability Partnership, both of whom have had recent contact with the home. Further information was obtained from a tour of the building, documentation kept in the home and from survey forms sent to us by residents, relatives, health and social care professionals and from staff working at the home. The home sent us an Annual Quality Assurance Assessment (AQAA) when we ask for it and this contained a range of detailed information about the progress the home has made over the past year. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 31 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 31 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. The home has updated in accessible format the information it provides about the service, to assist prospective residents and their representatives to make informed decisions about living at the home. Peoples needs and preferences are properly assessed when they are first admitted to the home and are reviewed regularly to assist staff be aware of any changes in these. People living at the home, and their representatives, benefit from having clear information about their rights and responsibilities in relation to living at the home. Evidence: The homes annual quality assurance assessment,AQAA, states, We have an up to date statement of purpose, we have a pictorial service users guide, we have also devised a service users guide in widget format, to enable service users with communication difficulties to have an understanding of what is offered within our service, these documents are continually reviewed and updated to ensure that any changes are reflected in them. At the last inspection a good practice recommendation had been made that the home Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: should produce the statement of purpose in a pictorial format. This had been acted upon. At this inspection we saw a copy of the homes statement of purpose and service user guide, which were accessible, detailed and gave clear information about what services prospective residents can expect from the home. No new residents have been admitted to the home since the last key inspection. We looked at the files for three people living in the home, all of whom had lived there for a number of years. The files contained a range of current assessment information about the person, to help staff be aware of any changing needs. The home has a clear admissions policy that was seen, including in the service user guide. This told us that a prospective resident will be offered introductory visits/ stays to the home as part of the assessment and admission process, which meets the the the requirements of the national minimum standards. We also saw evidence that placing authorities were undertaking annual reviews of people living in the home. We spoke independently by phone to a social worker from L.B. of Westminster, who had recently reviewed the placement for one of the residents. He told us he was satisfied with the progress the person was making and commented that he thought there had been a marked improvement in the service over the past year, which he felt was largely due to the current manager who was appointed in 2008. At the last inspection a good practice recommendation was made that residents terms and conditions for living in the home should be fully completed and signed. This had been acted upon and the three residents files inspected contained satisfactory information and had been appropriately signed. Care Homes for Adults (18-65 years) Page 11 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from their needs and preferences being recorded in their care plans and person centred plans, with guidance to staff on how to assist the person meet these. People are supported to make as many decisions for themselves as they can to maximise their independence. People are also supported to take appropriate risks to help them safely enjoy as many everyday experiences as they can. Evidence: The homes annual quality assurance assessments, AQAA, states; We have care plans in place that are person centred, the care plans are completed with the involvement of the service users and anyone who is involved with their life, these plans are reviewed and updated at stated times within the care plan, or if there are any changes in that person life. We also have person centred plans for each service user, which have been devised with personalised pictures. These have captured historical events that may be important to that person, but have also included things that must happen to ensure that the persons day/life happens the way that they want to. Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: At the last inspection two requirements were made regarding peoples care plans. These were that the home must have person centred plans in place for all residents and that the home must review residents needs and preferences, at least six monthly. Evidence was seen that both of these requirements were being complied with. Another requirement, that the home must ensure that all (care plan) records are reviewed regularly and are up to date, had been restated at the last inspection. Evidence was seen at this inspection that this requirement was being complied with. We inspected the files of three residents and saw they contained up to date care plans that detailed peoples current needs and preferences, including guidance to staff on how to meet these. The plans were informed by current assessment information and included areas such as health, communication, hygiene, dressing, eating and drinking, sexual and emotional expression, mobility and sleeping pattern. The care plans had been reviewed at least six monthly with evidence of regular key worker involvement. Key workers spoken to were knowledgeable about peoples needs and preferences and how the home was helping people achieve these. In addition to the care plans residents files also contained a pictorial person centred plan (PCPs). It was clear to us that the manager and staff have invested a lot of time and effort in developing these over the past year with residents and their representatives. The PCPs are also kept under review with the person and their representatives as appropriate. The PCPs contained detailed information on the persons likes, dislikes and aspirations and staff confirmed that these were useful in helping to understand what is important for the person in their day to day lives. In addition, the home is working hard with the speech and language therapist from the local learning disability team to review and further develop communication passports and also to develop health action plans in a format suggested by the learning disability team. A speech and language therapist told us in a returned survey, Salisbury Road staff are very proactive with regards to understanding service users expressive language/ receptive language levels, and how to better work with service users. People are encouraged to make as many decisions as they can for themselves. People are regularly consulted regarding such things as day to day activities and choice of food. This occurs in a number of ways including through discussions with key workers and staff on an individual basis and through regular residents meetings. Evidence of both of these were seen and daily notes written by staff help in this process. We were told that the home has access to a local voluntary advocacy organisation with an advocate contributing information to some reviews. All the residents need support Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: with managing their finances and evidence was seen of robust arrangements in place to assist protect residents in this area. All the residents have complex needs and a range of potential vulnerabilities. A range of detailed and up to date risk assessments were seen on the files inspected, including assessments under the Mental Capacity Act where required. Staff were able to tells us about potential risks and the actions the home were taking to minimise these. Care Homes for Adults (18-65 years) Page 14 of 31 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 home encourages and supports residents to enjoy a range of relevant activities, both within the home and in the community. Residents are also supported to maintain contact with relatives and friends to the extent that they wish. They also are encouraged to have as much control over their lives as possible, including by make decisions and choices for themselves wherever they can. Residents are supported to choose healthy and nutritious meals that they enjoy. Evidence: The homes annual quality assurance assessment, AQAA, states; We support service users to have meaningful day opportunities, we encourage them to participate in day services which access community facilities. We support service users to attend college where applicable. We encourage service users to be as independent as possible and this is reflected in their care plans. Staff are continually seeking out new opportunities for service users. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: All the six residents have some structured day activities outside of the home each week. This included individuals attending college, a work placement at a nearby farm and local authority day services. The home also has access to an aromatherapist who visits the service on a weekly basis. One persons placing authority has agreed for additional one to one staff support for day time activities for that person and this was seen to be working well. In addition, the home runs a weekly activities programme that includes an art and other leisure activities. The home has an activities group that we were told forges links with other services to identify and locate further potential leisure activities in the local community. At the last inspection a requirement was made that the home must develop a weekly activity planner for each individual resident. This requirement was being complied with and an up to date weekly planner was seen with the activities for the week of the inspection being up to date. Three of the current residents are white European in origin and three are Caribbean in origin. Peoples needs and preferences with regard to their culture, faith, gender and sexuality are recorded in their care plans and person centred plans. Evidence was seen that staff support residents appropriately in regard to equality and diversity, including with regard to their personal care, food and attending their preferred place of worship if they wish. Residents are supported to maintain contact with relatives and friends to the extent that they wish and which meets their needs and preferences. Records seen and staff spoken to confirmed this as did feedback from relatives in returned surveys. One relative told us, The service does well in supporting both service users and their relatives. Another relative told us, The residents have a comfortable home, nice bedrooms, good meals. My son likes living there. It was also noted that the home holds regular relatives meetings and family members are invited to attend reviews at the home and appreciated this. Another relative told us in their survey, (The home) treats residents as individuals; the three month meetings are very informative. From discussion with staff, interaction with residents and records seen it was clear that the home is working hard to involve residents in the day to day running of the home and to make decisions for themselves where they can. Residents can get up and go to bed when they wish, albeit they are also supported to attend their day time activities. Residents are also encouraged to get involved in the daily routines of the home where appropriate, including such things as helping keep their rooms clean and tidy. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: The home operates a weekly menu that residents are consulted on and the menu for the week that the inspection took place on showed a range of healthy and nutritious meals. It was noted that the homes kitchen had been fully refurbished, that there was sufficient food in the home and that this was appropriately stored. One evening is designated for a take away meal of individual residents choice, which we were told they really enjoy. Care Homes for Adults (18-65 years) Page 17 of 31 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. People living in the home receive sensitive personal support in accordance with their needs and preferences. People are supported in meeting their healthcare needs including by accessing an appropriate range of healthcare professionals. People are also protected by the homes medication procedures that are being properly implemented. Evidence: The homes annual quality assurance assessment, AQAA, states; All service users are supported with their healthcare needs, this is done in a sensitive manner, key workers will support service users to attend medical appointments. Records are kept in the service users medical file of all appointments attended, the outcomes and action necessary, this is conveyed to the service users in a manner which they can understand. All the residents need assistance with their personal care and guidance to staff on how to do this was seen recorded on the files inspected, in both their care plans and their person centred plans. Residents who were able to indicated that they were happy with the way they received personal care. Staff spoken to were clear how people preferred Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: their personal care to be delivered Evidence was also seen that residents have a meaningful choice about the gender of the staff that provide their personal care. Evidence was seen from the files inspected that residents are properly supported to meet their physical, mental and emotional health needs. The records showed evidence of appointments, including with the persons GP, learning disability specialists, general hospital outpatient appointments, optician, chiropodist and dentist. Evidence was seen that key workers monitor residents health, including at monthly evaluations. The home is working hard to develop health action plans in a format recommended from the local learning disability team. We received positive comments from a speech and language therapist, see the Individual Needs and Choices section of this report. We also received positive comments from a learning disability community nurse, including; Good balance of male and female staff, good care plan/ management guidelines and good individualised care The homes annual quality assurance assessment, AQAA, states; All staff have training in medication administration, they are then observed three times, then an assessment is carried out within the service to deem their competency to administer medication. Staff are aware of how to order medication, also about the storage and disposal of medication. We looked at the medication and medication administration record (MAR) charts for three residents and these indicated that medication was being safely administered. Two staff sign for medication administered and these records were up to date with no omissions. Evidence was seen that staff receive training in the safe administration of medication. The manager told us she has undertaken medication assessor training (regarding staff competence in this area) and evidence was seen that the manager audits medication records on a regular basis. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home, and other interested parties, can raise complaints and concerns and have these acted upon appropriately. The home has clear policies and procedures for protecting people from abuse, which staff are aware of. Evidence: The homes annual quality assurance assessment, AQAA, states; The complaints procedure is clearly set out within the service users guide, the service has a pictorial complaints procedure, all service users have received a copy. The complaints procedure has been discussed at family meetings and all the families present understood the complaints procedure. We saw a copy of the homes complaints procedure, which was accessible and satisfactory. No complaints had been recorded since the last inspection although evidence was seen from records of relatives meetings and residents meetings that the homes procedures for making complaints were discussed for peoples information. We discussed how minor concerns/ queries were dealt with and were satisfied that any such occurrences are properly dealt with. However, a good practice recommendation is made that the home also keeps a record of minor concerns and queries, to aid the homes overall quality assurance processes. No complaints about the service have been received since the last inspection. The home had a copy of the latest LB of Waltham Forest Safeguarding Adults (adult Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: protection) policy and procedures and a satisfactory in-house policy. Staff spoken to and records seen indicated that staff had received training in safeguarding adults and knew what action to take should an allegation or disclosure of abuse be made to them. One safeguarding adults referral had been made to the LB of Waltham Forest since the last inspection and evidence was seen that this was properly dealt with. This was also confirmed by a learning disability service community nurse, who was spoken to independently by phone. No other safeguarding concerns had been recorded at the home or received by the Commission since the last inspection. The home has a satisfactory whistle blowing policy and staff spoken to were aware of this and how to raise concerns if they needed to. Care Homes for Adults (18-65 years) Page 21 of 31 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 physical environment of the home is comfortable, homely and meets peoples current needs. People who live in the home, staff and visitors benefit from the building being kept clean and tidy. Evidence: The homes annual quality assurance assessment, AQAA, states; .......We now ensure that the service is well maintained since all the refurbishments have been completed. We support the service users to personalise their bedrooms and support them to look after their personal space. We encourage the service user to take an active part in keeping their home clean and tidy. We ensure that the toilets and laundry areas are kept clean and fresh and ensure that infection controls measures are adhered to. The home comprises two terraced houses converted to form one larger home. It offers seven single bedrooms all with their own wash hand basins. There is a large lounge, day activity room, separate dining room, fitted kitchen, utility room, sleepover room and office. The home has two bathrooms with toilets and a separate toilet. There is a rear enclosed private garden and a small garden area to the front. At the last inspection a requirement was made that the home must complete all the repair, replacement and redecoration work to the individual and communal areas of Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: the home. This was because of a range of outstanding work that was in the process of being completed at that time. This included refurbishing the kitchen and the replacement of identified furniture and equipment and the completion of identified redecoration work. The manager wrote to us in January 2009 to state that this work was in the process of being completed and this was confirmed at this inspection. On a tour of the building we were impressed by the overall condition of the fabric of the home given the complex needs of the residents. The refurbished kitchen was bright and clean, bedrooms seen had been personalised and we were told that the residents were fully involved in choosing the colours of their rooms and in choosing new furniture and equipment. One relative told us in their survey; The residents have a comfortable home, nice bedrooms and good meals. My son likes living there. The homes bathrooms/ showers and toilets were clean, bright and met the needs of the residents. The home has up to date infection control procedures, which staff were aware of. The home was clean and tidy overall and free from unpleasant smells throughout the inspection. Care Homes for Adults (18-65 years) Page 23 of 31 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 benefit from a staff team that work in sufficient numbers to meet their needs and who are properly trained and supported. Residents are also protected by the homes recruitment procedure, which is being properly implemented. Evidence: The homes annual quality assurance assessment, AQAA, states; Over the past year Salisbury Road has had a consistent staff team, with no leavers, any void shifts have been covered by MCCH (the provider organisations) relief staff and agency use has been kept to an absolute minimum. The home currently deploys a minimum of three care staff on the morning shift, three care staff on the afternoon shift and one waking staff and one sleeping-in staff at night. We saw a copy of the homes staffing rota which accurately recorded the staff on duty at the time of this inspection. The registered managers post is in addition to the staff shown on the rota. The home does not employ separate domestic staff or a cook with care staff undertaking these duties and encouraging residents to be involved as much as they can. Care staff spoken to told us that this arrangement was satisfactory for them and indicated that the staffing levels in the home were satisfactory to meet the current needs of the residents. Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: At the last inspection a requirement was made that evidence must be available to verify recruitment checks for relief staff working in the home. At this inspection we checked the recruitment files of a bank worker who was working in the home at that time. This evidenced that the requirement was being complied with. The staff members file contained all the necessary documentation including: proof of identity, two satisfactory references and the proper Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks. The registered manager confirmed that staff turn over at the home remained low and that no new permanent staff had been recruited since the last inspection. A current and satisfactory staff training needs analysis was seen, which the manager uses to check when training, including refresher training, is required. Training records sampled confirmed that staff received proper induction training and a range of other training in key areas. Records of staff training provided in the past year including: assessing risk, care planning, safeguarding adults, safe administration of medication, infection control and managing challenging behaviour. Staff spoken to confirmed that they received regular training, which they found helpful in doing their jobs, and that they found the provider organisation committed to staff training. We were also told that the manager and deputy manager had just received training in equality and diversity and that they intended to cascade this to all staff soon. Evidence was seen that staff receive formal supervision at least every two months and an annual appraisal. Those staff spoken to said that this was useful and that they felt well supported by management. One staff member told us in their returned survey; They (the home) provide relevant training to meet the needs of the service user. Respect each individuals belief and consider all cultural differences. Keep staff up to date with new legislation and upcoming policies and procedures. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home benefit from it being effectively managed. People accommodated and other stakeholders are consulted to promote and monitor the quality of the service they receive. A range of effective health and safety procedures generally protect people living in the home although attention is required to identified fire doors to maximise safety in this area. Evidence: The homes annual quality assurance assessment, AQAA, states; The manager has 16 years experience in registered care, she has her RMA, NVQ 4 in care, Diploma in Management studies and has held registration in three difference community care settings. The deputy manager has 8 year experience in registered care, she has NVQ 3 and is currently finishing her NVQ 4 in care. The manager was appointed to the home in 2008 and presented as being competent, knowledgeable, experienced and committed to further developing the home for the benefit of residents. It is our judgement that the home has made considerable improvements to the quality of life of residents over the past year and evidence of this Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: is reflected throughout this report. Feedback from external stakeholders and staff was very positive about the work she has undertaken in the home in the past year. A social worker from LB of Westminster, who had recently undertaken a review of that boroughs resident in the home, told us; I think the service has improved significantly under the (current manager). There is evidence of greater leadership and focus on structure for the service users. A senior community nurse from the local learning disability partnership told us; The service has moved on significantly under the new manager. A relative told us; The quality of care has improved a great deal and my son seems to be more settled there of late. We were also assisted during the inspection by the deputy manager who also presented as being competent and knowledgeable about the needs of residents and staff. The home has a number of ways of monitoring quality at the home. An effective key worker system is in operation and we judge this as being important for obtaining ongoing feedback from residents, especially those with complex communication needs. We also saw evidence that the home gives residents pictorial quality assurance questionnaires on a six monthly basis; sends out questionnaires for relatives regularly, the last one in June 2009; holds weekly residents meetings; regular relatives meetings, the last in November 2009 and reports of monthly unannounced visits to the home by the provider organisation to check the quality of care provided. We were told that this information is collated, acted upon and contributes to the homes current aims and objectives, which were seen included in the homes statement of purpose. At the last inspection a good practice recommendation was made that the home should separate current working documents from the old documents, and file or archive them as appropriate. At this inspection evidence was seen that this recommendation was being acted upon; the files seen were accessible and contained current information. At the last inspection a requirement was made that the home must review the homes fire risk assessment and act on the recommendations made in it. This requirement had been complied with. We saw a current fire risk assessment that had been reviewed in April 2009 and no outstanding issues from this were identified. The homes fire log also indicated that the fire fighting equipment had been serviced at the Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: beginning of December 2009. We also saw a range of other satisfactory health and safety documentation. This included: a gas safety certificate, electrical installation certificate, a portable appliance certificate and evidence that the homes water supply was being regularly checked to minimise the danger of legionella. Care Homes for Adults (18-65 years) Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 31 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 22 The home should record minor concerns/ issues raised, to further aid the homes quality assurance processes. Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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