Care Home: Seabrook House

What the care home does well Seabrook House provides people with a comfortable homely and well maintained environment to enjoy. The registered providers have made sure that the facilities are maintained to a high standard and people who live there said they appreciated this. Comments included `This is the best place I have been, its very homely here, I like my room and I have chosen just how I want it to be.` People can be confident that they will be treated with respect and that they will receive the help and support they need to maintain their health and independence. The systems for the administration of medication are good with clear and comprehensive arrangements being in place to ensure peoples medication needs are met. There is a good range of activities for people to take part in dependent on their wishes, needs and gaols set within their personal plan of care. One person said ``I have art classes that I really love and staff are very supportive. I also do five-a-side football and we went to Sandy bay on holidays.` Staff are well trained, supported and in sufficient numbers to ensure that the needs and wishes of the people they support are well met. The management of the home is open and inclusive and ensures that good systems are in place to give individuals opportunities to have a say in how the home is run. What has improved since the last inspection? Plans of care have been improved so that they now exceed the National Minimum Standards. The new plans have been developed around a system called Wellness, recovery, action plan approach (WRAP) This aims to support the person using the service to look at a plan to help them stay well and a plan of action and possible support if they should become unwell. Staff spoken to were very aware of the recent changes to the homes care planning system and said they had been fully involved in the review of these procedures. One staff member said that the new system has given people who use the service greater independence by allowing them to be more involved in identifying their needs and planning the support required to reach their goals. The outside of the building has been repainted and the conservatory refurbished. What the care home could do better: Ideally the laundry area should be accessible to all individuals without those from the main house having to go through the main entrance of the cottages. This is being looked at by the registered provider. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Seabrook House Seabrook House Topsham Road Exeter Devon EX2 7DR     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Joanne Walsh     Date: 3 1 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.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: Seabrook House Seabrook House Topsham Road Exeter Devon EX2 7DR 01392873995 01392877177 seabrookhouse@tiscali.co.uk www.ukhcg.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Seabrook House Limited care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users that can be accommodated is 26 The registered person may provide the following category of service only: Care Home only - Code PC to service users of either gender whose primary needs on admission to the home are within the following category: Mental Disorder (Code MD) Date of last inspection Brief description of the care home Seabrook House is registered to provide personal care for up to 26 people who have or have had mental health problems. It is situated on the main road, a regular bus route, from Exeter to Topsham. Seabrook consists of two separate buildings. One is a large detached converted property with a recently added extension; this building has a variety of accommodation and a training kitchen. The other building, occupied by more residents, has two lounge areas and a kitchen for residents to use. All the Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 26 Brief description of the care home bedrooms are single occupancy and some have ensuite shower and toilet facilities. The home has a large level garden which individuals use and help to maintain if they wish. Staff are available in the home 24 hours a day. The current range of fees can be obtained directly from the home. Copy of the most recent inspection report is available on request from the home manager. 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: This inspection took place during a week day in March 2009 with two inspectors and lasted for approximately 6 hours. During this time we spoke with some people who live at the home, and to staff on duty. We also spent time looking at some of the key documents, including plans of care, pre-admission assessments, records relating to medication and individuals finances and staff files relating to recruitment and training. This helps us to understand how well the home runs. We sent out surveys to people who live at the home and to a sample of staff. Their views and those gathered during face to face interviews are included in the main body of the report and have helped us to make judgments on the quality of outcomes for people who use the service. The home are asked to complete an Annual Quality Assurance Assessment (AQAA) Care Homes for Adults (18-65 years) Page 6 of 31 which gives us information about how the home ensures a safe environment, how it uses the views of people who live their to improve the quality of care and support provided. It also enables us to see what improvements have been made to the service in the last 12 months and what further things are planned for the future. This helps to inform the inspection process. 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 set out on page 4. Care Homes for Adults (18-65 years) Page 8 of 31 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 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 10 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A thorough approach to assessing the needs of potential new people helps to make sure that their needs can and will be met if they move into the home. Evidence: The home has information to give to people who may wish to use this service such as a Statement of Purpose and Service user Guide. These provide information about the homes aims and objectives, the services provided, staffing, accommodation, and contact details. When initial referrals are made to the home the Registered Manager and senior staff carry out an assessment of need with the person who will be receiving the service, relatives if appropriate and other professionals involved in the persons care, demonstrating excellent practice. The pre-admission assessments of two people who had recently moved into the home were seen during the inspection. These contained clear information about their social and medical history, personal goals and support needs. The manager said that before admission to the home, hospital and community mental health staff are also asked to complete forms providing assessment Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: information and examples of this information were available. As part of the homes admissions process people who may wish to move into the home would be invited to visit, meet the staff and residents and whenever possible view the room that they would stay in. The manager said that the arrangements prior to a person moving in will vary depending on the needs and wishes of the individual concerned. Examples were given of new residents visiting and staying for tea and possibly overnight, and others having a more planned introduction to the home, which may take several weeks or even months. Following the pre-admission assessment of new residents a care plan had been completed detailing their short and long term goals and the support needed to achieve these goals. Discussion with new people using the service confirmed that they had been fully involved in agreeing this initial plan of care and support. The Registered manager said that at the time of admission people are given clear information about any rules or restrictions, which have been agreed for the benefit of all people using the service. Examples of this included guidelines relating to behaviour, smoking and consumption of alcohol on the premises. Written contracts had been agreed and signed between the home and the person using the service. Care Homes for Adults (18-65 years) Page 12 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 who live at Seabrook House are involved in decisions about their lives, and play an active role in planning the care and support they recieve. Evidence: The care records of five people who use the service were looked at in detail during the inspection. We were also able to talk with staff on duty about these people and in some cases meet and talk to the individual themselves. The manager said that at the point of admission all people would have a care plan which would look at the skills and support they need to eventually move on. This plan and the amount of time it may take to move on is likely to vary for each individual. All files seen contained a detailed plan of care, highlighting the individuals short and long term goals and the identified steps and support required to help them achieve these goals. The manager described a recent review of the homes care planning process, which had been aimed at simplifying the way information is recorded to Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: ensure that the people who use the service are fully involved in issues concerning their care. The new plans have been developed around a system called Wellness, recovery, action plan approach (WRAP) This aims to support the person using the service to look at a plan to help them stay well and a plan of action and possible support if they should become unwell. Staff spoken to were very aware of the recent changes to the homes care planning system and said they had been fully involved in the review of these procedures. One staff member said that the new system has given people who use the service greater independence by allowing them to be more involved in identifying their needs and planning the support required to reach their goals. Care plans provided a good level of description about how the identified needs should be met, describing actions that both the staff and individual should take. For example one persons care plan detailed their wish to manage their money independently. The plan included what steps I need to take, and what support I need. The budgetting plan had been agreed and signed by the individual and keyworker. The plan focused on encouraging the individual to take responsibility, to recognise the skills they need to develop and to request support when required. Daily evaluation sheets completed by staff demonstrated that a record is kept by staff of the support provided to meet this identified need. The evaluation sheets are then used to assist the staff when they undertake reviews of an individuals needs and care plan. Records confirmed that the home undertakes regular reviews of all aspects of an individuals needs and support arrangements. In addition to the completion of daily evaluation sheets a review meeting also takes place at regular intervals to look at all areas of an individuals care and support. People spoken to during the inspection confirmed that they are fully involved in the review of their care plan and that they can also invite family and other professionals involved in their care to the review meetings. Detailed risk assessments were seen in peoples files. The assessments gave clear information about the risk concerned, a plan to minimise the risk and the action to take in the event of the risk returning. An example of this involved a person who may at times choose not to take prescribed medication. The risk assessment detailed for staff the type of behaviours which may occur if medication was not being taken and the steps they would need to take if this occured. A daily risk evaluation sheet is also completed by staff detailing any issues or support required by the individual to manage and minimise the risks. Staff confirmed that they do not restrain residents in any way, but said that they regularly remind residents of restrictions agreed with them in their care plan and individual service user contract. Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: All records relating to the home and individuals using the service were recorded and stored in a way that ensured confidentiality at all times. Care Homes for Adults (18-65 years) Page 15 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. People who use the service are able to make choices about their lifestyle, and are supported to develop their life skills. Evidence: Pre admission records confirmed that information about peoples social needs including important contacts and relationships is gathered before they move into the home.This information is then used to start developing an individuals plan of care during their time at Seabrook House. Each of the files seen during the inspection included a detailed profile of the individual describing their likes, dislikes and particular interests. These had been written by the individual with support from their key worker. The plans seen had a particular focus on assisting people to develop the life skills Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: needed to move on and live in a more independent setting. Where possible people are encouraged to attend to daily chores such as cleaning their rooms and doing laundry. Some of the people using the service are being supported by the home to look at alternative accommodation, and have a care plan which clearly identifes the steps they need to take to move on. There is also accommodation, which is detached from the main part of the home where people who are looking to move on can live more independently with staff support as and when required. Staff spoken to confirmed that social and leisure activities are planned and agreed dependent on the needs of the individual. Some people need support to develop their social skills, therefore their care plan specifically states the steps needed to support the individual to access community facilities and other social contacts. Some of the people using the service are able to make their own social arrangements with minimal support from staff. Staff spoken to said that some people need a very clear plan of the activities they will be involved in during the week. An example of this was provided for one person who needs the information to be written down as a regular weekly activities chart. The homes manager said that people attend a variety of activities including local social clubs and leisure centres, college and training courses, and voluntary work. Some of the residents enjoy partaking in activities as part of a group including fishing, Art classes and football. One person spoken to had a season ticket for the local football team and is supported by family or staff to attend all the home matches. Within the home residents have access to a pool table and during the summer can work or relax in the garden. Most people have a TV and music facilities in their room. Peoples care records contained information about family and other important contacts. The home supports people where necessary to maintain these contacts and family and friends are welcome to visit the home. Staff spoken to said that there is always enough staff on duty for people who need support to go out. People are also supported by staff to plan a holiday. These arrangements are detailed as part of the individuals care plan and people are encouraged to partake in all the planning of the holiday including choosing the destination and budgeting. The main part of the house has two kitchens, one for the main daily preparation of meals and the other a smaller training kitchen used by people who want to prepare snacks and develop their skills. There is also a kitchen within the separate cottage facility for people who are preparing to move on into a more independent setting. Several people also have facilities in their rooms for preparing drinks and storing small Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: amounts of food. Information is detailed within individual records regarding any specific dietary needs or particular dietary likes or dislikes. The manager said that people have a choice of meals and are involved in the planning of the homes menu. The home has sought advice from a dietician and as part of promoting a healthy lifestyle offers all people who use the service a varied and healthy diet. Care Homes for Adults (18-65 years) Page 18 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 can be confident that they will be treated with respect and that they will receive the help and support they need to maintain their health and independence. Evidence: The files of five people who use the service were looked at in detail. Each of these files contained a physical health support plan. This plan detailed the type and amount of support required as well as information about other agencies involved in the individuals care. Staff also complete a daily health care evaluation sheet, which documents the support provided each day and highlights any areas of need such as medication reviews and other general health checks. Files also contained Mental Health support plans. These plans detailed the individuals current mental health, the support needed to stay well, signs the individual is not well, and action to take if the individuals mental health deteriorates. One of the plans seen stated that the individual needed to be well occupied to prevent a deterioration in their mental health. The care plan confirmed that the individual had a structured plan of activities during the week and daily evaluation sheets confirmed that this was closely monitored. Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: Discussion with the manager confirmed that the home works closely with the specialist Mental Health services and other health care professionals. The home has appropriately secure storage for medications. There was a separate fridge for medication requiring cold storage but it was noted that this required a new locking facility to ensure that this medication is stored safely. A sample of peoples medication administration charts seen contained clear record of the medication received into the home and of administration. A senior staff member said that two staff administer medication to reduce the risk of errors and those who administer medication must have training first. Individual files contained good information for staff about the reason the individual is taking the medication and any possible side affects. The home has very clear policies and procedures for supporting people who have been assessed as being able to administer their own medication. Self medication plans were in place, which included a risk assessment and four step programme designed to manage risk and gradually increase the level of responsibility the individual takes. Safe storage facilities were available for people who self medicate and agreements in place for staff to carry out checks of the medication with the individual concerned. Care Homes for Adults (18-65 years) Page 20 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals views are listened and acted upon Evidence: The home have a stated complaints process and people spoken to on the day of the inspection and those who returned surveys said they knew how and who they could make their concerns known to. We looked at records relating to complaints and saw that detailed records are kept of any action taken to resolve issues. We are satisfied that all complaints had been dealt with fairly and within stated timescale. The homes AQAA states Complaints audits continue to be carried out on a monthly basis and reviewed by the Operations Manager to ensure that the home is correctly following the company complaints procedure and investigating any complaints in line with company policy. All staff receive training regarding the management of complaints and are made aware of the appropriate procedure to follow. Staff receive training in recognising and reporting abuse. A whistle blowing policy, reviewed as required, continues to be in place at the home and training is provided to all staff with regard to the implementation of this policy. Staff spoken to said they had training in the protection of vulnerable people and when asked knew what might constitute abuse and what they should do if they suspect Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: abuse taking place. Care Homes for Adults (18-65 years) Page 22 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Seabrook House provides a comfortable homely and well maintained environment. Evidence: During this inspection all communal areas and some of the individual bedrooms were looked at. We were impressed by the high standard of cleanliness and quality of redecoration and furniture, that made the home a very pleasant place to live in. The home stated in their AQAA An on going programme of repair, maintenance and redecoration is in place within the home. Two maintenance staff continue t be employed to ensure that all areas of the home are maintained to a high standard. The home continues to maintain a contract with a Health and Safety advisory service which ensures that full assessments of the environmental safety of the buildings are carried out annually and any needs for environmental changes are promptly identified and acted upon. Service users continue to be encouraged to be involved with maintenance in their rooms and communal areas in the home with them taking an active part in decisions about furniture and decoration. Each service user has their own bedroom and this is treated as the service users own individual space and all are encouraged to set out and use their bedrooms to suit their needs and lifestyles, within the boundaries of maintaining safety in a communal environment. A sufficient number of bathrooms and showers are provided for individuals with out en-suite facilities to Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: ensure that their needs are met. A variety of communal spaces continue to be provided so that varied lifestyle choices can be maintained. Domestic staff are employed and continue to have detailed responsibilities, reviewed as required, to ensure that the home remains clean and hygienic. They say that they have made ongoing improvements over the last year and particularly that they have repainted the outside of the building and ensured the outside areas have been well maintained, in order for people to enjoy the outdoor space. The laundry area has recently been re-sited to the cottages and we discussed the fact that individuals who live in the main building now have to access the front door of the cottages in order to use the laundry. We were assured that when the cottages become more of a separate moving on facility they will look at putting in a door that would mean access to the laundry would not have to be via the cottages main entrance. Individuals spoken to and those who returned surveys all express a high level of satisfaction in respect of their home and the environment. Care Homes for Adults (18-65 years) Page 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff team are well trained and supported to do their job effectively. Evidence: The staff rota and pattern of how individuals are supported was discussed with the manager. The home has sufficient staff per shift to ensure that the assessed needs of individuals are well met. Recently the home reviewed the need for a chef and talked to people who live at the home. The decision that was made was to not employ a chef but to increase support worker hours to help facilitate individuals taking a greater part in meal preparation. The staff who we spoke to said this was working well and had encouraged more individuals to develop their independent living skills. The recruitment files for the three newest staff were looked at and all relevant checks and references were in place prior to them commencing work at the home. This helps to ensure that vulnerable people are protected. Training files were also looked at and staff available on the day of the inspection were asked about what training opportunities they had had. The home offers a good range of core skills training to ensure people can do their job safely and effectively. They also strive to ensure specialist training is in place so that staff fully understand the needs of the people they support. Some staff had been on a three day support time Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: recovery training programme. One staff member said the training here is brilliant, they are always giving us training and new areas of learning, I have learned so much. The home stated in their AQAA QA practices encompass the receipt of feedback from service users regarding their views of staff within the home. Feedback regarding staff and staffing levels continues to be positive. Staff files demonstrate compliance with legislation regarding all pre employment information required. A training programme continues to be in place for each individual working at the home and these are compiled to make an annual training plan / matrix for the home. A high level of training is carried out to ensure that all training needs are met. All new staff continue to undertake accredited common induction programme training at the start of their employment as well as completing a comprehensive home based induction. A programme of NVQ training is in place within the home for all staff once their induction has been completed. This ensures that the levels of NVQ trained staff in the home exceeds that which is required. Training relating to any new admission to the home continues to be identified during the assessment phase of an admission and put in place accordingly. The staffing structure within the home continues to ensure that a designated senior member of staff is on duty at all times and that responsibilities are appropriately allocated. Ancillary and administrative staff continue to be in place to ensure that support staff time is appropriately allocated to service user support. The level of staff provided in the home remains in excess of the level of needs that is identified as required based upon guidance from the residential forum and dependency and needs analysis of the service users in the home. Care Homes for Adults (18-65 years) Page 26 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. The home is well run and in the best interest of the people who live there Evidence: The registered manager is qualified and experienced to run the home. Individuals who we spoken to during this inspection said that they could talk to the manager about any issues that concerned them. She ensures there are good systems in place so that individuals who live at the home have a regular opportunity to have a say about how the home is run. The AQAA states Monthly QA audits continue to be carried out on a monthly basis. This continues to include a review of any complaints to ensure that any concerns raised are dealt with in an appropriate fashion and with prescribed time scales. Service user meetings continue to be held within the home so that service users can directly raise concerns. The staff member hosting the meeting is varied to ensure that approachability is not an issue. Any suggestions raised are reviewed and where appropriate incorporated into our practice. Quality assurance questionnaires are now sent out annually as six monthly was not giving enough time between reviews for changes and was being seen as intrusive by service users. An open door management policy is employed to encourage direct exchange of views, opinions and concerns at all Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: times. Staff spoken to and those who returned surveys also said that they were confident their views were listened to and they were kept informed of any changes to policy and procedures. One staff member said We have a handover meeting each Friday that is more comprehensive than our usual feedback to each other, then once a month we have a complete staff meeting, so we get to see all staff and make sure we are all working in the same way with our residents. Another staff member said we all work well as a team here, ideas or suggestions are always listened to and we have regular meetings as well as a communication book. The AQAA gives us details about how the home ensures that all areas of health and safety are covered via policies, procedures and ongoing training. Staff confirmed that the home did this well. 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 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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