Care Home: Shernbroke

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What the care home does well Every person has a care plan. This plan describes how the person wishes staff to help and support them. The plan tells staff what the resident likes and dislikes. Staff care for residents and look after then well. Residents told us that staff listen to them. Residents have medicine and treatment they need. Staff listen to resident`s complaints and put things right. Staff protect residents. The home is clean and safe and residents have space to spend time alone or in groups when they wish. What has improved since the last inspection? Each person`s needs are assessed before they move into the home to help ensure that it is the right place for them. What the care home could do better: We did not find any areas of concern and the manager continues to make improvements to the experiences of the people who live in the home. Key inspection report Care homes for adults (18-65 years) Name: Address: Shernbroke 1-6 Shernbroke Road Waltham Abbey Essex EN9 3JF     The quality rating for this care home is:   two star good 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: Carolyn Delaney     Date: 2 9 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 28 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Shernbroke 1-6 Shernbroke Road Waltham Abbey Essex EN9 3JF 01992700545 01992761735 ged.elliott@essexcc.gov.uk www.essexcc.gov.uk Essex County Council Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Samuel Crawford Ms Geraldine Sonia Elliott Type of registration: Number of places registered: care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: One named service user, over the age of 65 years, who requires care by reason of a learning disability Persons of either sex, under the age of 65 years, who require care by reason of a learning disability (not to exceed 25 persons) Persons of either sex, under the age of 65 years, who require care by reason of a learning disability who also have a physical disability (not to exceed 6 persons) The total number of service users accommodated in the home must not exceed 25 persons Date of last inspection 1 3 0 3 2 0 0 9 0 6 Over 65 1 0 Care Homes for Adults (18-65 years) Page 4 of 28 Brief description of the care home Shernbroke is a purpose built home for people with a learning disability. The building is in keeping with the local community. There is a communal administration area and five separate houses/bungalows. Accommodation is arranged on a unitary basis, each house having domestic style facilities. Two of the houses are designed to meet the needs of people with a physical disability. The home is situated reasonably close to local shops and amenities. The cost of a place in the home is £1246.00 per week with residents paying £69.90 per week as their contribution to these costs. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We spoke with residents and staff about the home. We looked at how residents were involved about making decisions about how the home was managed. We looked at what improvements had been made since the last inspection. We looked at care plans and how people were helped to do the things they want during the day. We looked at how complaints were dealt with and how residents were protected. We looked at how many staff worked at the home and how they were trained. We looked at the home to see if it was safe and comfortable. Care Homes for Adults (18-65 years) Page 6 of 28 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 7 of 28 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 8 of 28 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. People know when they move into the home that their assessed needs will be met because there is a process for assessing these need, which they are involved in. Evidence: The manager told us in the Annual Quality Assurance Assessment that the home worked in conjunction with other professionals to ensure that they could meet the assessed needs of service users according to the statement of purpose. They told us that introductory tea visits and overnight stays were provided before any firm decision about service provision was made. They said that this gave the service user the opportunity to familiarise themselves with the home and staff and for staff to identify if any additional support or resources were required. They told us that only when they had completed this transition work and obtained adequate information from significant others, eg families, social workers and health professionals, that they would agree to provide a service. We received completed surveys from four residents following the inspection visit. Each of the four told us that they had been asked if they wanted to move into the home Care Homes for Adults (18-65 years) Page 9 of 28 Evidence: and that they had been given enough information so that they could decide if it was the right place for them. One health care professional completed a survey and they told us they felt that the assessment arrangements sometimes ensured that the right service was planed for people. They commented that Respite care appears to have better arrangements than long term residents. When we last inspected the home we identified issues around the arrangements for assessing the needs of people before they moved into the home. A number of people had moved in without an assessment of their needs completed. We made a regulatory requirement and asked the manager to tell us in an improvement plan how they were to address these issues. The manager told us in the plan that they would ensure that no person was offered a place in the home until a detailed assessment of their needs had been carried out. When we visited the home the manager told us that five people had moved into Shernbroke since the last inspection. We looked at the pre-admission assessments, which the manager had carried out for two of these people. We saw that the manager had visited each person and carried out an assessment of their physical, mental and social care needs. The assessment covered areas including managing personal and oral care, sight, hearing and communication, foot care, mobility, continence , health and medication. There was detailed information about each persons needs and abilities in respect of daily activities of living. The views and wishes of individuals were included within the assessment as were the opinions of health and social care professionals. The manager told us that when a person moved into the home that regular reviews were carried out so as to ensure that their needs were being met and that the home was suitable for individuals. We looked at the review for one person. We saw that the resident had been involved in the process. As part of the review the manager identified where any extra support was required so as to improve the experiences and daily lives for residents. During the inspection we spoke with four residents. While they did not comment about their experience of moving into the home they did tell us that they were happy living there. One person told us I love it here, its the best. Another person said I love living here. Care Homes for Adults (18-65 years) Page 10 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home have a care plan, which reflects their needs and wishes and staff listen and act on what residents say. Evidence: The manager told us in the Annual Quality Assurance Assessment that the home had individual support plans in place, which provided clear information as to how residents personal, health, social and emotional needs were to be met. They told us that significant events or perceived changes to each individuals care needs were recorded and the relevant people were informed. One of the four residents who completed surveys told us that they always made decisions about what they did each day and three said that they usually did. They told us that staff always treated them well. Staff who completed surveys told us that they felt the ways in which they shared information about residents with the manager and other staff worked well. Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: When we visited the home we looked at how the manager and staff supported residents to make decisions and choices about the support and care they received. We looked at the care plans for four residents. The manager told us that a lot of work had been done so as to make care plans more individualised to ensure that they reflected each persons needs, choices and preferences. We saw that care plans had been developed with input from both residents and information obtained from other people such as families and health and social care professionals. Each persons care plan included photographs of the individual carrying out tasks such as preparing to go out, assisting with meal preparation, laundry and domestic tasks. There was information recorded about what each person was capable of doing in relation to daily activities and tasks. Each care plan included information about the things, which the individual liked to do such as going out shopping, gardening, cooking and crafts. There was information recorded around that things that residents disliked and how staff minimised residents distress. For example it was recorded in one persons care plan I used to get distressed when I had a shave but now I have an electric shaver. This had improved the experience for this resident. We spoke with four residents and they told us that staff listened to them and that they could do the things they wanted to during the day, in the evenings and at weekends. Residents told us that they enjoyed going out to shop, have meals and coffee in local restaurants and to go swimming etc. We looked at how residents were enabled to take responsible risks as part of living their lives as independently as possible. Residents who were able were supported to manage their money with assistance if needed. Residents were encouraged to access amenities and facilities within their local community and further afield. There were risks assessments in place to identify and areas where the resident may be at risk or vulnerable, such as risks around road and personal safety. The risk assessment also identified where members of the public may be at risk due to an individuals unpredictable or aggressive behaviour. Staff were provided with information and training so as to support residents and minimise risks, while ensuring that individuals could continue to enjoy being part of their local community. Care Homes for Adults (18-65 years) Page 12 of 28 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 living in the home are supported and enabled to live their lives as independently as possible and to be part of their local community. Evidence: The manager told us in the Annual Quality Assurance Assessment that Shernbroke encouraged ordinary lifestyle principles and encouraged residents to engage in activities, which interest them as identified on their support plans. They told us that they did not have their own transport but that they arranged activities within the home whilst people stayed in the home and also supported people to go out in the local community where possible. The manager said that prior to a person staying/ being admitted that they also worked with social workers to ensure that people were still able to pursue their normal day time activities. When we last visited the home we saw that not all residents were supported to do the Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: things they likes to during the day such as going out. When we visited on ths occasion the manager told us how he had made improvements in this area. He told us that he had secured extra support for some residents so that they had more one to one support. Each of the four residents who completed surveys told us that thye could do what they want to do during the day, in the evenings and at weekends. One health care professional told us that they felt that peoples social and health care needs were usually properly monitored, reviewed and met by the service. They commented that Occasionally the social needs appear to be sacrificed in order to meet health care need. Care Homes for Adults (18-65 years) Page 14 of 28 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 are supported and well cared for in relation to their personal, health and medical care needs. Evidence: The manager told us in the Annual Quality Assurance Assessment that each persons support plan would indicate any personal and health needs to be met and that they included risk assessments if applicable. They told us that they obtained detailed information (if applicable) from the care manager and relevant health professionals prior to admitting a person such as for example risk assessment protocols for managing conditions such as epilepsy. The manager said that if a resident becomes poorly during their respite stay at Shernbroke that they will seek advice from local GP surgerys and Hospital and attend appointments with individuals if necessary . They told us that the home was equipped with special care equipment such as hoists, mobile hoists, shower trolley, so as to enable staff to meet the personal care needs of a wide range of people. They also said that all staff had training in administering medication and other relevant training to meet the health needs of residents eg epilepsy training. Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: When we visited the home we looked at how staff supported residents for their health and personal care needs. We looked at the care plans for four people. Each person had a detailed care plan, which described the level of support they needed to wash and dress and how they would like to be supported for these activities. Staff encouraged residents to be as independent as possible according to their capabilities. Residents we spoke with told us that staff helped them as needed. Residents we spoke with told us that staff treated them well. They told us that they saw their doctor regularly and if they were unwell. We looked at care plans for four people. We saw that in each there was detailed information recorded about their medical conditions or specific illness and how these impacted on their daily lives. Where a person had a specific medical condition such as epilepsy there was detailed information for staff to be able to support the person and to treat them in the event of a seizure. We saw that staff had undertaken specific training in relation to the health needs of residents and that they were trained to administer anti convulsant medicines (to control seizures) such as diazepam and midazolam. We saw that residents were registered with local doctors and were supported to attend routine appointments for health checks. We saw from records we looked at that when a resident became unwell that staff acted quickly to ensure that they were seen by their doctor and that appropriate medicine were obtained and administered. The manager told us that one person who was capable was being supported to take control of and administer their medicines. We spoke with this resident. They told us My key worker and staff are helping me so that I can look after my tablets. They said staff remind me so I dont forget sometimes. We saw that staff had undertaken training around the safe handling and administration of medicines and that there were polices and procedures for staff to follow in relation to the storage, administration and recording of medicines. The manager had informed us of two incidents where a member of staff had failed to follow the homes policy and had not administered medicines to some residents. We saw that the manager had taken appropriate action, including staff supervision, training and reinforcing the homes policy to help ensure that this did not occur again. Care Homes for Adults (18-65 years) Page 16 of 28 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 in the home know that their complaints and concerns will be listened to and acted upon and that they will be safeguarded from harm or abuse. Evidence: The manager told us in the Annual Quality Assurance Assessment that the home had a robust complaints procedure in place to ensure that any concerns were listened to and resolved quickly. They told us that there was the Essex County Council Policy and also a policy specific to Shernbroke. They told us there was also an adult protection policy and a whistle blowing policy and that all staff had training in relation to safeguarding people who are vulnerable. They said that all staff have had a Criminal Records Bureau check and that they ensured that no agency staff were employed without these checks in place. Each of the four residents who completed surveys told us that they knew who to speaak with if they were unhappy and that thye knew how to complain. One health care professional who completed a survey told us that the service usually responded appropriately if they raised any concerns. Each of the four members of staff who completed surveys told us that they knew how to act if a resident or other person had concerns about the home. When we visited the home we spoke with staff and residents. Residents told us that they knew who to speak with if they were unhappy. One person said I would tell my Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: key worker if I am unhappy. Another person told us The manager always listens to me and my worries if I have any. Staff we spoke with told us that they knew what to do if they if anyone had any concerns about the home. Two members of staff told us that they had received training to safeguard people from harm. We spoke with the manager as to how they enabled and supported residents who have communication difficulties to complain and raise concerns should they wish to. The manager showed us a copy of the complaints policy and procedure. This was written in simple terms with pictures to help people who have communication difficulties to understand who to speak to and how to complain if they were unhappy. We saw certificates for staff in relation to the safeguarding training they had received. We saw that staff had undertaken training around safeguarding people from harm and abuse, while promoting decision making and choices. We discussed safeguarding alerts, which had been raised since the last inspection. The manager told us that staff were more vigilant and proactive now and reported any issues or poor practice and that this had led to an increase in the number of alerts. We saw that where concerns were raised that the manager took appropriate action including reporting incidents to the local safeguarding team and the police where necessary and followed the safeguarding policy so as to help protect people living in the home. We saw evidence in staff folders that all staff including those who were employed to work in the home on a temporary basis had satisfactory Criminal Records Bureau disclosures and PoVA First checks so as to help safeguard people living in the home by ensuring that only those suitable to work with vulnerable people were employed. Care Homes for Adults (18-65 years) Page 18 of 28 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 in Shernbroke live in a clean, safe and comfortable home, which suits their needs. Evidence: The manager told us in the Annual Quality Assurance Assessment that Shernbroke employed three domestic staff who ensured that the home had a clean environment at all times. They told us that the home was well maintained and decorated. The manager told us that residents were encouraged to have their rooms decorated according to their personal tastes and that they were consulted about any changes to the environment at Shernbroke. Three of the four residents who completed surveys told us that the home was always fresh and clean and the other said that it usually was. When we visited the home we spoke with four residents. They told us that the home was always clean and that they helped staff to keep their houses clean and tidy. Two residents invited us to see their bedrooms. Both rooms were decorated and furnished as the residents wished and both reflected each persons individual tastes. Residents had access to clean, comfortable and nicely furnished communal areas Care Homes for Adults (18-65 years) Page 19 of 28 Evidence: including lounge and dining rooms. Since the last inspection the activities room had been redecorated and furnished with flat screen television, X Box and Wii games consoles. This room was also used for residents birthday parties and other events and celebrations. We looked at records and other documents and saw that the home was well maintained and that equipments and other installations such as hoists etc were regularly checked so as to ensure that they were in good, safe working order. Care Homes for Adults (18-65 years) Page 20 of 28 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. People living in the home are well cared for by staff who are recruited robustly and who are trained and supervised to meet their needs. Evidence: The manager told us in the Annual Quality Assurance Assessment that there was a good mix of staff in terms of age, experience and competencies. They told us that staff had a very good rapport with residents and relatives. They said that staff were generally flexible and professional in their approach to their work and had undertaken a wide range of training and development opportunities. They said that there were regular staff meetings and unit meetings and staff received supervision with their line manager. When we last visited the home we identified issues around how people were deployed to meet the needs of residents. There were insufficient staff available to take a resident out to the pub and there was only one member of staff available to support staff in two of the houses, which were adjoined. We also were concerned that not all staff working in the home had undertaken training in relation to the needs of residents or safeguarding them from harm or abuse. At this time we made regulatory requirements and asked the manager to tell us in an improvement plan how they were to address the issues identified. Care Homes for Adults (18-65 years) Page 21 of 28 Evidence: The manager told us in the improvement plan that extra support staff had been employed and that staff received training, which was relevant to their roles and the needs of residents. Staff told us that they met regularly with the manager for support and to discuss their work practices. Two of the three staff told us that they felt more staff would benefit the home very much. Staff told us that they felt they had the skills and experience to care for individuals needs and that there were enough staff to support residents. Each of the three members of staff who completed surveys told us that all of the checks, including references and Criminal Records Bureau disclosures had been obtained before they started work at the home. They told us that were being given training, which was relavant to their roles, helped them understand the needs of individual people, kept them up to date with new ways of working and gave them knowledge about heath care and medication. When we visited the home we looked at the arrangements in place for ensuring that there were sufficient numbers of staff employed, who were trained and supported to meet the needs of residents. We spoke with four residents to ask them how they felt they were supported by staff. Each of the four commented positively about staff and how they were supported. Residents told us staff here are great and My keyworker helps me with what I need. We saw that extra staff were employed to support residents who needed extra supervision and to support residents to go out shopping etc. Residents commented that staff were lovely and kind. One person told us My key worker is the best and always listens to me. Another person said Staff look after me very well. The manager told us that seven members of staff were employed during the day and and four during the night. They told us that staff were deployed according to the needs of residents. They told us that one member of staff supported up to five residents and that an extra member of staff was employed in one of the houses where residents were more dependent on staff support. We looked at staff duty rotas and saw that these staffing levels were maintained and that staff did not work long hours without appropriate off duty time. We looked at how staff were recruited and trained to meet the assessed needs of people living in the home. We spoke with three members of staff and they told us that all of the checks including references had been obtained before they started work at the home. They told us that their induction covered everything they needed to know about the job when they commenced their employment. We looked at the recruitment files for two members of staff who had been employed Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: to work in the home since the last inspection. We saw that information was obtained in relation to each persons employment history and that references were sought and obtained from both individuals most recent employers. Satisfactory Criminal Records Bureau disclosures and PoVA First checks had been obtained before individuals commenced work at the home. We saw that people were interviewed by the manager so as to further determine their suitability to work and support residents living in the home. Staff we spoke with told us that they received training, which was relevant to their jobs, kept them up to date with new ways of working and helped them to meet the needs of people they supported. The manager told us of the improvements made in training staff so that they were skilled to support and care for residents. We saw that staff undertook training around medication including special procedures such as administration of diazepam and midazolam (for controlling seizures). Staff had received training in epilepsy awareness, supporting people with dysphasia (difficulty in communicating), first aid, managing aggression, safeguarding people and helping vulnerable people to make choices. In addition all staff who did not have National Vocational Qualification in social care were undertaking the Learning Disability Qualification. This is a qualification specific to the needs of people who have a learning disability and staff complete training units around caring, supporting and safeguarding people. Staff told us that they met regularly with the manager to discuss working practices and training and development. We looked at records the manager kept in relation to these meetings. We saw that staff were praised when they worked well and improved the lives and experiences of residents and that they were supported through supervision and training where areas for improvements were identified. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Shernbroke is well managed and residents views and opinions are taken into account in the day to day running of the home. Evidence: The manager told us in the Annual Quality Assurance Assessment that they had National Vocational Qualification Registered Managers Award and City and Guilds Advanced Management for Care qualifications. They told us that they had sixteen years experience of working with adults who have learning disabilities in a variety of different settings. They told us that the deputy manager also had National Vocational Qualifications in social care and the Registered Manager Award and had considerable experience of managing staff. They told us that the management approach was to be supportive and to communicate openly and provide a clear sense of direction in accordance with the homes aims and objectives. The manager told us that they aim to deliver a high quality of service to the people who live at Shernbroke. They said that the management team met on a regular basis and discussed ways in which the management of the home could be improved. Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: When we visited the home we looked at how it was managed and how the views of residents were obtained and acted upon so as to improve the quality of the service and experiences of people. We saw that there were regular residents meetings where people were given the opportunity to discuss the things that mattered to them such as meals, outings, how they were supported and any issues or concerns that they might have. We saw that as part of reviewing and monitoring the quality of service provided that residents, their families and health and social care professionals were asked to complete surveys to tell the manager what they felt the home did well and any areas where they felt things could be improved. Residents were asked what they liked most and least about living in the home. They were asked if they knew who their key worker was, who the manager was and if they knew how to complain if they were unhappy. We looked at the results from the most recent surveys. One resident said I feel safe. Another person said I like going on holiday. Relatives and health care professionals commented that they were satisfied with the service provided by the home and commented that staff were polite and caring. We saw that there were policies and procedures in place, which underpinned the day to day management of the home and that staff had access to these. The manager ensured that regular checks were carried out for the equipment, gas, electrical and mechanical installations needed to support residents and to ensure that the home was well maintained. Care Homes for Adults (18-65 years) Page 25 of 28 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 26 of 28 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 27 of 28 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 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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