Care Home: Scotch Orchard

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What the care home does well People are able to spend time in the home before making a decision to move in and have information in different formats to support people to understand. As part of the assessment staff ask people how they want to be supported and write down this information. A care plan is written which explains how people like and need to be cared for; these are well written and staff understand people`s needs. The service responds well to people`s changing needs. Where people require additional support, health and social care professionals are consulted and the plan of care is reviewed. If necessary, suitable equipment and training can be provided and the staffing is reviewed to ensure that people`s needs are met and they continue to be safe. The bedrooms are all different sizes and people are able to decorate their room to reflect their interests and preferences. Many rooms display photographs of family and important past events. Family and friends can visit the home whenever they want to, and family members are able to play an important role in the ongoing support people want. There are activities arranged within the home and community and individuals can choose whether to be involved. People have complex needs and staff know how people are supported in the community to make sure they are safe. People dress in their own style and if they need support, staff help individuals and people are encouraged to take a pride in their appearance. Staff provide any personal care where required and people in the home are well-presented. Staff like to develop good relationships with people and will spend time talking and taking an interest in people`s lives. Staff have a good knowledge of the care needed and what people may want. There are procedures in place to make sure that complaints are listened to and acted upon and to protect the well being and safety of people who live in the home. Staff know how to report information where they think someone is at risk. What has improved since the last inspection? People continue to benefit from receiving an excellent service. The service is managed to promote independence and rights, and enables people to live a lifestyle of their choice. The service provided exceeds the National Minimum Standards and the home has systems in place which reviews the service they provide. This means that there are constant improvements to the service delivery, which takes into consideration new skills and knowledge gained and developments for good practice. What the care home could do better: Medication systems are good and daily checks take place to ensure everybody has taken their medication at the right time. This could be more robust as a Small amount of Medication Administration Records have been hand written. Where this is required, two people should record this to reduce any risk of errors. Where a part of a table is not given, this should be safely destroyed to ensure it is not given to people. This would mean that all tablets are free from possible contamination and safe. Key inspection report Care homes for adults (18-65 years) Name: Address: Scotch Orchard 55 Scotch Orchard Lichfield Staffordshire WS13 6DE     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: Mandy Brassington     Date: 1 5 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Scotch Orchard 55 Scotch Orchard Lichfield Staffordshire WS13 6DE 01543264755 F/P01543268970 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Staffordshire County Council Social Care And Health Directorate care home 13 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: 13 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 categories: Learning disability (LD) 13 Date of last inspection Brief description of the care home 55 Scotch Orchard is a Local Authority Home that can accommodate thirteen younger adults with learning disabilities; two of the beds are for respite care. The home is located within private grounds in a residential area of Lichfield. Local shops are within walking distance, and the town centre is accessible by public transport. Service users have the use of a seven seated car. The accommodation comprises of ten single bedrooms on the first floor and three bedrooms on the ground floor. There are four bathrooms, two of which have an Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 13 Brief description of the care home assisted bath, and adequate toilet facilities. The ground floor consists of three lounge/dining rooms, a patio lounge, and a hallway with a seating area. There are adequate service facilities including kitchen and laundry areas. There is a separate respite area on the ground floor incorporating a kitchen/diner, a lounge and two of the ground floor bedrooms. There is a patio area to the rear leading to a large grassed garden. The home provides accommodation to individuals with learning disabilities and complex needs. Individuals use a local Day Care facility during the week and staff support individuals to access community facilities and services in the evening and at weekends. There is a high staffing ratio in the home and the community as individuals may require a one-to-one or two-to one support ratio. A registered manager, and a team of care managers and support workers provide care. NHS professionals and facilities are accessed as and when required. A local GP practice and a pharmacist support the home. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: We visited the home for 7.5 hours and used the National Minimum Standards for Younger Adults as the basis for the inspection. The people who live there and the staff did not know we were coming. Before our visit took place we looked at information from the homes Annual Quality Assurance Assessment (AQAA) and any notifications they had sent to us about events that affect the well being of the people who live there. The AQAA gives us important information about the way the home is meeting National Minimum Standards in care and the improvements planned to create better outcomes for the people who live there. There were questionnaires sent to people who use the service, professionals and staff members. We received one completed from a family member, three surveys from health and Social Care professionals and two surveys from staff Care Homes for Adults (18-65 years) Page 6 of 29 We case tracked three people who live in the home. Case tracking includes meeting people and talking about the care they receive or watching staff supporting them, looking at their care records and medicines and the way that people are helped to make choices and decisions. This assists us to understand the experiences of people who live in the home. Time was spent talking to the staff team on duty during our visit and observing the way they interact with the people they care for. We spoke to three people about their experiences of living in the home. We looked around the building to make sure that it was clean, warm and comfortable and looked at three bedrooms, the lounge areas, the dining room, and bathing facilities on all floors. We inspected the storage system and medication procedures and we looked at records of staff training and recruitment, health and safety records and the food people are offered. There were no immediate requirements made after our visit. This means that there was nothing urgent that needed to be done to protect people who live in the home. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: Medication systems are good and daily checks take place to ensure everybody has taken their medication at the right time. This could be more robust as a Small amount Care Homes for Adults (18-65 years) Page 8 of 29 of Medication Administration Records have been hand written. Where this is required, two people should record this to reduce any risk of errors. Where a part of a table is not given, this should be safely destroyed to ensure it is not given to people. This would mean that all tablets are free from possible contamination and safe. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with relevant information to enable them to make a decision of the homes suitability to meet their assessed care needs. This information is provided in a format which people are able to understand. Evidence: The home has a Statement of Purpose which has information about the service and facilities available to people. Information includes the number of bedrooms and communal areas, social activities, and how to make a complaint. People have a Service User Guide, which is in a pictorial format to promote peoples understanding. The Guide informs people about what they can expect from staff and how they will be supported, and also clearly describes how people in the home are expected to respect others. There have been no new referrals for living in the home since our last visit. Discussion with staff revealed that people would be able to visit the home and spend time with people, including having meals and an over night stay before moving into the home. Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: The home provides a respite service and we looked at two assessments for people receiving respite care and found that an assessment had been completed with the person and important people to them. This assessments has helped to develop a plan of care. Where possible, respite care is a planned service although staff reported that this service can be used at short notices if required in an emergency. Care Homes for Adults (18-65 years) Page 12 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident their assessed care needs will be met and are able to make decisions on the support and assistance they need to ensure their health and welfare. Evidence: We looked at three plans of care and saw that each person has a detailed person centred plan. The plan is written in a way that supports people to understand their plan and records responses to how people want their care to be given. For example, it records what a person would like to do when they are older and where they want to live, and for daily care, how I like to wake up and my morning routine. The plan is supported by pictures to help understanding. One plan was developed through graphic facilitation by local Day care staff. This means finding out what the person wanted and what they needed and recording on large flip chart paper and using colours and drawings. The manager told us that all information is considered important and the person using the service and family members are supported to talk about what they want and need. A photograph of the Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: flip chart paper was taken to keep as a record in the file. There are comprehensive assessments of risk in place to provide staff with guidance on how to manage complex behaviours and other potential risks such as bathing, and visits in the community. These assessments promoted peoples independence whilst ensuring their safety. The plans gave very specific instructions, and discussion with staff demonstrated people had an in-depth knowledge of the plans and how to support people. Staff commented we all work together, and we work well as a team., we know whether plans change and we are able to discuss how people need to be supported. Discussion with the manager confirmed staff had received comprehensive training about the management of complex behaviours as part of their induction which is reviewed annually. This should ensure staff members are skilled and competent to manage behaviours properly. Care records showed plans were reviewed regularly to reflect peoples changing care needs. The manager stated a Person centred plan review took place every six months with the individual and important people, including care professionals. Staff are to receive training in order that this can be done though graphic facilitation. This will ensure people receive the appropriate support and assistance to meet their needs. Care Homes for Adults (18-65 years) Page 14 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. Routines are very flexible and people can make choices in all areas of their life, and support is given to promote peoples rights and independence. Evidence: People are able to be involved in a variety of leisure activities. Discussion with staff revealed that people are able to choose to go to places of interest, and staff are flexible to enable activities where support is required to take place. Staff told us that recently people have visited the safari park, been to concerts including dancing on ice at local concert arenas and regularly go out for meals, shopping and to the pub. People who live in the home have complex needs and may require one-to-one or twoto-one support in the community. We looked at peoples plans of care which records how people ought to be supported with in the community including the staffing Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: required. The plans and assessments of risk ensure that people have access to community facilities and keep safe whilst allowing people to take responsible risks and experience new activities. People attend a local daycare provision and staff told us that there is a verbal handover each day to ensure good communication between the two services. Staff told us that people use the local Day service as a base and are able to access community services from this location. The registered person told us that they are currently reviewing how people are involved in education and activities during the day and what could be carried out in the best interests of people who use the service. 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. People can be assured they will be given the relevant support and guidance so their needs will be met the way they prefer. Evidence: The AQAA and care records we looked at show people have access to health care services when needed, such as a doctor, community nurse, optician, dentist and dietitian. We saw evidence that one person had received a speech and language assessment due to the risk of choking, the assessment recorded how the person should be supported to eat and drink safely. People are registered with a local General Practitioner, who will visit people in the home. The doctors reported with in a completed survey that the staff are very caring and supportive with a high level of skills in managing very severe disabilities and challenging behaviour, and I have been very impressed at the high level of caring and skill of the staff, who give the best quality of life to people living in the home. The service has developed a good relationship with local health care professionals including community nurses, who visit people on a regular basis and also support with Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: training staff for individuals specific needs. Within completed surveys, community nurses told us the service supports peoples health and social care needs and actively welcomes input from the community learning disability team, and any recommendations made by the learning disability team regarding health care needs of people is actioned appropriately. People living in the home have very complex behaviour and detailed emergency restraint procedures have been recorded which inform staff of how any restraint needs to be carried out and under what circumstances. Discussion with staff revealed that people have had comprehensive training about how to manage behaviour and staff work closely as a team to support people to manage their behaviour through positive working, and using techniques to deescalate any behaviour. These arrangements and practices supports peoples understanding and ensure their health care needs are met. Discussion with staff and inspection of records revealed where health needs had been identified, prompt action and advice is taken. We saw that people were supported sensitively to meet any need. People are dressed in individual styles that reflect their age, cultural background, their gender and the weather. Staff told us that people are able to buy their own clothes. People looked clean and attention had been given to their personal care so helping to raise individuals self esteem. People living in the home were from different ethnic backgrounds, and the staff confirmed they are able to provide a service for people from different ethnic groups and access relevant services to assist with communication and culture awareness. Records and discussion with the manager indicates that all staff who administer medication have been appropriately trained to do so. At the front of the persons Medication Administration Record (MAR) there is a photograph of them so that unfamiliar staff would know who to give the medication to. Some people are prescribed as required (prn) medication and detailed protocols are in place stating how, when and why this should be given so it is not misused. Staff demonstrated a good knowledge of how to administer and manage medicines to ensure peoples health. Medication administration records were examined and there were no gaps in recording. We saw that were two entries where medication administration directions had been handwritten on MAR charts; these had not been checked and signed by two staff to make sure they were accurate and reduce the risk of errors. The registered Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: person revised the procedures in the home on the day of our visit to ensure that two staff were involved. An internal audit of all medicines is carried out by the care managers and tablets are counted daily to ensure all tablets are accounted for and have been given. One tablet is broken in half and the other returned to the blister pack. The registered person sought advise regarding dosages of the medicine; the tablet is not manufactured in smaller doses. It is recommended that this practice be reviewed to ensure medicines are not contaminated and to safely destroy any unused tablets. The registered person agreed to review this to ensure all practices in the home were safe. Care Homes for Adults (18-65 years) Page 19 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. People and their relatives have access to the homes complaint procedure, enabling them to share their concerns and promote their rights. The Policies and procedures adopted by the home protect people from the risk of abuse. Evidence: People have access to the homes complaint procedure which is published in plain English and pictorial format to promote peoples understanding. Individuals, their relatives, friends and any advocate are encouraged to raise any concerns and a record of concerns and complaints are maintained. The staff reported that all complaints, concerns and compliments are recorded. Where any concern is identified a record is kept in the persons personal notes along with a copy of any investigation and the outcome. This means that people can be sure they will be listened to and the service will take appropriate action to address any concern. The AQAA recorded that a copy of the local safeguarding procedure is in the home and staff, as part of their induction have an opportunity to read and understand this policy. Staff training records and the services Statement of Purpose showed staff members had received safeguarding training. This should ensure staff are aware of the various aspects of abuse and are able to recognise the signs to ensure peoples protection. We spoke to two staff members who confirmed they had received safeguarding training; they also informed us that signs or allegations of abuse would be reported. Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: The manager told us that the care managers had received training and staff have basic information about the Mental Capacity Act and the Deprivation of Liberty Safeguarding Legislation. The Act governs decision making on behalf of adults, and applies when people do not have capacity to make a decision. The manager told us that there have been no applications for Deprivation of Liberty Safeguards and is aware of how to make an application when peoples freedom may need to be restricted. Care Homes for Adults (18-65 years) Page 21 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. People who use services are encouraged to see the home as their own. The home is a pleasant, safe place to live and people have personalised their home to reflect their interests. Evidence: The service is a large home situated in Lichfield. The building does not present itself as a ordinary home but is set back from the road and is within private grounds. Internally the home has been decorated and equipped to a high standard, with large communal rooms and each person has a large single bedroom. People are able to style their room according to individual preferences and all bedrooms inspected contained a variety of personal electrical equipment. One person was very enthusiastic to show us their bedroom which had displayed many photographs of activities, pets, and family occasions, along with personal possessions. One bedroom has been adapted to meet the changing needs of one individual, including providing a new bed. Where additional equipment had been provided to meet the persons needs, staff have received training to use any equipment safely and the plan of care has been reviewed to record how the person wanted and needed to be supported. This demonstrates how the service is able to adapt and respond to changing needs to ensure people continue to receive a high quality service. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Skilled and competent staff ensure peoples assessed care needs are met to ensure their safety and welfare, and staff recruitment practices ensure people are protected from potential abuse. Evidence: The usual pattern of shifts is five support staff working each day shift and a care manager. Staff reported that they are able to support people and meet identified needs. The staff stated that the roster is flexible to allow activities within the home or the community, and where there is a change in support needs. The manager demonstrated how the staffing responds to peoples needs as additional staff have been provided during the night as one person required constant monitoring to ensure they are safe. The home supports people with very complex needs who may exhibit behaviour which challenges and member of staff on duty people has a personal alarm and a pager and there are alarm call points around the home. At the beginning of each shift a record is kept of which staff has which alarm. Staff told us to ensure they are working safely when staff are leaving communal areas they let the staff on duty know, this means that if an alarm is raised staff on duty know where to go to support people. Staff told us that they work closely as a team and there are suitable staffing arrangements to Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: ensure that people and staff are safe. Where restraint is used as a last resort, senior staff on duty give people an opportunity to discuss and review the events to see what could have been done differently and if any improvements could be made. Staff told us that if necessary additional support can be provided, and there was evidence that for one person behavioural specialists were consulted to ensure that the plan was suitable and that staff had the knowledge and were trained to manage the identified behaviour. Staff personnel records showed the homes recruitment procedure was thorough to ensure people were protected from potential abuse. Three staff records were inspected and demonstrated the organisation has robust recruitment practices. All records included a photograph, an application form, two written references, a Protection of Vulnerable Adults (PoVA first) check and a Criminal Records Bureau Check (CRB). Staff confirmed they had these safety checks. These checks should provide some assurance that staff members are suitable to work in the home. We looked at staff training records and talked to staff about the training they had received which demonstrated that people have attended the training required to meet the needs of people who use the service. Recent training has included the management of complex behaviour, safe administration of medication, understanding and working with people who have challenging behaviour and Food hygiene. The manager reported that staff receive refreshers training for Health and Safety and Moving and Handling though the regular staff meetings that take place each month. The managers have received training about the Mental Capacity Act and Deprivation of Liberty Safeguard legislation. The manager told us that all staff will receive this training to ensure people are safeguarded. Keeping up to date with skills and knowledge enables staff to assist people to meet their needs and ensure the persons health, welfare and safety. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to benefit from a management style based on promoting independence and rights and enabling people to live a lifestyle of their choice. Evidence: It is evident from observation and discussion with staff, that the manager is extremely enthusiastic and committed to promoting peoples rights and providing a quality service. The manager discussed her commitment to providing a excellent service. The staff told us that the management team are very supportive, especially when supporting people with complex needs. Staff told us, we work well as a team, we always support each other, and we can always rely on the support of the managers. Staff spoke very positively about the experiences of working in the home and there has been a low turnover of staff. This means people benefit from this staff and a managerial group that provides consistent care and support and are knowledgeable about the support needs of people who use the service. Prior to our visit the manager completed an Annual Quality Assurance Audit (AQAA) for us. The AQAA was completed to a high standard and related to the National Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: Minimum Standards for each outcome area. Evidence within the AQAA was sampled and found to be accurate. The service carries out an annual quality assurance audit; the last audit was carried out in February 2009. The registered person told us that this is evaluated and is fed into information provided for the overall performance assessment of the local council. Internal audits take place monthly and are targeted; inspection of records demonstrated a recent audit has involved inspecting the care plans and finances. A monthly visit is carried out by a senior manager and the visits include looking at records, talking to staff and people who use the service, as well as observing how people are supported. This means people benefit from the managerial team quickly identifying areas which need to be improved. 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 20 Hand written Medication Administration Records need to be recorded and signed by two people to ensure the accuracy of dispensing instructions so people receive the correct medication. To ensure all medicines are kept safe and are not contaminated, any unused tablets should be safely destroyed and not placed back in packet to be administered. 2 20 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!