Care Home: St Andrew`s

Similar services:

• Hillview Farm
• Dalewood Respite Care
• Orchard,The
• REACH Upton Court Road
• Fairways
• Treloar College
• Kestrel House, St Anne`s Opportunity Centre,
• Pinta

What the care home does well The manager provides good leadership for the staff team and makes sure that the wishes, safety and support people need is in the care plans . People are confident they will get the help they need.Health wellbeing and and personal care needs are met by staff who know them well and involve health professionals when needed. Staff keep good records of this. Staff are respectful and friendly staff showing good listening skills. Staff wish to promote independence and help people have the lifestyles they want. Staff know their job including dealing with any concerns or personal safety so people living in the home feel they can ask for help.The house is clean and homely with enough space for activities. People can bring their own things to the home and can used all shared areas of the home.There are enough staff so they have time to talk, do activities and go out people. Rota changes mean that this can happen more often in evening. What has improved since the last inspection? The manager is keen to make changes and improvements and has done this in several aspects of the home including care plans, staff levels and support, the environment and activities. There are more plans to make changes based including ideas from people living in the home. What the care home could do better: We have not made any specific requirements or recommendations following our visit.The manager was aware of the small number of shortfalls such as gaps in fire training and induction and accepted that some things must be done following the fire risk assessment and agreed to take action. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: St Andrew`s 114 Kiln Road Fareham Hampshire PO16 7UN three star excellent service The quality rating for this care home is: 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: Sue Kinch Date: 2 6 0 5 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. They reflect the things that people have said are important to them: 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. 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. Internet address www.cqc.org.uk Information about the care home Name of care home: Address: St Andrew`s 114 Kiln Road Fareham Hampshire PO16 7UN 01329827323 01329827323 standrews@truecare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Truecare Group Ltd Name of registered manager (if applicable) Mr Stephen Conway Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 5 0 care home 5 learning disability Additional conditions: The registered person may provide the following category/ies of service only: Care home only - 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 The maximum number of service users who can be accommodated is: 5 Date of last inspection A bit about the care home St Andrews is registered to provide care and accommodation for five people with learning disabilities between the ages of 18 and 65. Information provided by the manager confirms the fees are currently 1478.33 to 1843.45 pounds a week to live in this service. The home is situated on the outskirts of Fareham and on a main road. The home is on one level and all people living in the home are provided with a single bedroom with en-suite facilities. Service users share the use of a lounge, kitchen / diner and a bathroom. The home has a large, split level garden to the rear. 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 How we did our inspection: This is what the inspector did when they were at the care home This is the first key unannounced inspection of this home since its last visit on 8th June 2007. For this inspection we looked at information we hold about the home. This included the report of the annual service review (ASR) completed on 30th June 2008. The outcome of that ,was good. We have also looked at of events in the home which we were told about , the Annual Quality Assurance Assessment (AQAA) sent to us from the manager. We looked at : two surveys returned from health and care professionals: eight staff and four of the people living in the home. We visited the home on 26th May 2009 for 5.5 hours.We spoke with all people living there and staff on duty, the manager and the operations manager. We looked around the home,at records and saw how staff were helping people. What the care home does well The manager provides good leadership for the staff team and makes sure that the wishes, safety and support people need is in the care plans . People are confident they will get the help they need. Health wellbeing and and personal care needs are met by staff who know them well and involve health professionals when needed. Staff keep good records of this. Staff are respectful and friendly staff showing good listening skills. Staff wish to promote independence and help people have the lifestyles they want. Staff know their job including dealing with any concerns or personal safety so people living in the home feel they can ask for help. The house is clean and homely with enough space for activities. People can bring their own things to the home and can used all shared areas of the home. There are enough staff so they have time to talk, do activities and go out people. Rota changes mean that this can happen more often in evening. What has got better from the last inspection The manager is keen to make changes and improvements and has done this in several aspects of the home including care plans, staff levels and support, the environment and activities. There are more plans to make changes based including ideas from people living in the home. What the care home could do better We have not made any specific requirements or recommendations following our visit. The manager was aware of the small number of shortfalls such as gaps in fire training and induction and accepted that some things must be done following the fire risk assessment and agreed to take action. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Sue Kinch 33 Greycoat Street London SW1P 2QF 02079792000 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535 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 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 . Although the home has not recently admitted a new household member ,systems are in place for them to be assessed and assured that their needs can be met before moving into the home. Evidence: The organisation has an admissions policy and process for use in all of its homes. No recent vacancy has arisen at this home and the last person to be admitted was in 2007 just after the last inspection visit. We sampled records held in respect of this and noted that there was evidence of the homes procedures being followed prior to admission. We noted that the previous manager had carried out an assessment including the person and relatives and covered a range of relevant support and care needs and a care plan from the care manager. There was also a statement about compatibility with the other people living in the home. We noted that a comprehensive care plan and risk assessments were in place for that person with evidence of recent reviews. The manager said that the home has a policy of offering introductory visits to prospective people considering moving in, although this was not discussed with people during our visit. However, in the four completed surveys that we received from people living in the home they said that they had enough information before moving into the home and were asked if they wanted to move in. We had eight respondents to staff surveys and seven said that they are given up to date info about the needs of the people they support and care for. Evidence: In two surveys from a care manager and a health professional , they said the home usually or always ensures that accurate information is gathered and that the right service is planned for people. Contracts are offered to people. The manager said that he was unable to find a current contract for one person and that this was being sought. The person had come from another care home in the Truecare group. Information is available about the home for people to refer to. Service user guides and a statement of purpose are in the front hall with a complaints procedure including a pictorial format and lots of other information about who is on duty,bus timetables and local events. 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 living in the home are aware that the support they need to lead their lives as they wish, is documented in the care plans and risk assessments and are confident that they will be consulted and have their needs met. Evidence: From written information received in the managers assessment of the home, surveys, verbal information from people living in the home and staff, and the sample of records viewed at the home when we visited, we noted that the service is developing around the needs and wishes of the people living in the home. For example one person is wishing to live more independently and we were given information about this is being planned for and worked on, and for another person we were given examples of activities that they prioritize and evidence that these are happening regularly. We received surveys from people living in the home before we visited. In these people confirmed that they can mostly decide on what they want to do and all said that they can decide what to do at weekends,during the day and in the evenings. We had a survey from a health professional and one care manager both said that people are supported to live the life that they choose. One stated that the service respects the wishes and opinions of the residents. Both commented on the responsiveness of the service to seek support from other professionals and use it. A care manager said that the atmosphere in the home is very good . Staff encourage the service users to make their own choices and encourage service users to be as independent as possible. We met and spoke with all people living in the home. We Evidence: held separate, longer conversations with two people about the care and support received. In each conversation a member of staff was present some of the time following negotiation with the individuals involved and the current care plan was viewed and discussed. We found: that peoples needs and support to meet them were recorded in detail; that staff spoken with were aware of peoples needs and highlighted differences in need and support; and recognized the importance of people leading the lives they choose. Both people we spoke with were aware of the care plans and the monitoring and reviews of them. These care plans and others viewed were up to date. Risk assessments have been completed and recently reviewed and in one folder we saw that one person had signed some of them. Both people spoken with had comprehensive care plans and said that they are doing the things that they want to do. One person said that they get the help they want and is happy here. In the staff surveys five commented that the home is good at promoting independence or meeting individual needs. We had eight respondents to staff surveys and seven said that they are given up to date information about the needs of the people they support and care for. All except one said that the system to share information passed between people who use the service and staff ( including the manager ) works well. During our visit we spoke with a staff member about how information is shared to ensure that care plans are worked on and support provided. We noted that the up to date care records were accompanied by a range of systems for promoting communication among the staff including :a communication book indicating where information is recorded; verbal and written hand overs; regular staff meetings and supervision. We also noted that a record is held of who staff are working with.The member of staff said that the systems have increased accountability. Staff also spoke about working in key worker teams so that more than one person is responsible to ensure that things are followed up with people that they support. Positive and supportive interactions between management, staff and people living in the home were noted during the visit. Management and staff showed knowledge of the needs of people and were very respectful in their attitudes. Staff said that what people want to do is the priority of the home. 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 to do the things that they like doing in the home and in the local community. They also have support with family and other relationships and support with choices about the food provided and household routines whilst their differences and need for independence is promoted. Evidence: People living in the home and staff confirmed that there are activity plans for each person in the home and that these are based on the things that people like to do. These needs and wishes are recorded in the care plans. Staff are allocated to working with specific people so that activities can happen.Some people have regular weekly activities such as college and volunteering. Other regular activities are timetabled but people can change their minds and do different things if they choose to. The manager said that he was keen for people to do what they want to do and to make life choices and gave examples of people choosing to no longer use a day service and another person planning to move on as examples of this. It was noted that in the hall of the home much information is displayed to give people visual information about things happening locally. A care manager said that the home made good use of communication aids. From more detailed conversations with staff and two people living in the home about the things they like doing such as visiting places and holidays ,we learned that Evidence: arrangements have been made for these things to happen. They told us about options to be involved in household activities such as planning meals,shopping, cooking and domestic chores . Feedback told us that people are encouraged to be involved in the areas that most interest them showing that individual needs are taken into account. One person told us about support received for preparation for more independent living. We noted that the home records the activities that people are involved in and for one person those sampled showed a range of activities out of the home including drives,going for coffee,shopping and visiting places. In discussion about this with the person and the staff and observation of the their room there was evidence of personal interests and hobbies being supported . Records for the day of our visit showed that people had all been offered support ,some with one to one staffing to use the community and this included use of public transport. People have access to a garden and a shed which has been provided for recreational purposes. This was shown to us by people and included leisure equipment for example for art and music. Evidence of involvement in hobbies was displayed in various areas of the home. We also noted that one person is supported to keep a pet. The manager spoke of recently increasing the staffing levels in the evenings. Two staff were spoken with separately about this and they said that the new level provided more opportunities at that time of day including those out of the home and spontaneous activities meaning that it was possible to meet more immediate needs as they arise. We noted that the right to free access to all shared areas of the home and garden is promoted. This was discussed with two staff separately who said that this based on assessed needs of the people in the home and risk assessment. Staff said that the key pad on the front door noted to be in use at the last inspection had been de-activiated and was not used. Rights of people are also being considered by provision of information about the Mental Capacity Act which has been brought to staff attention on the from cover of the handover file and promotes the decision making of people living in the home. The manager said that more information would be shared with staff at the next staff meeting.Staff have not yet had training in this. In the AQAA the manager spoke of plans to improve the communication between staff and families and said that this was result of a recent quality survey. He said that future events to aid this were being discussed with the people living in the home in their regular meetings. Support with social relationships was discussed with one person living in the home. They said that they talked about behaviour and those of others with staff and that staff helped to sort things out. How to support this person with behaviour is documented in the care plan. This person was feeling positive about their current behaviour and support provided. They also said that they could have friends over if they wanted to, had regular contact with parents and that they are welcomed into the home. A discussion was held in the kitchen about the menus,food shopping and cooking. One person living in the home explained the choices for each meal and brought a file to our Evidence: attention. The file includes details of a variety of meals provided and includes pictures to aid choice, recipes and shopping lists. The person said that these meals are provided and that the food is quite good actually. Staff said that people are involved in all aspects of the food provision. The meals provided in the evening were on the menu and staff said that they record the food provided. Some records were viewed. One person said that they now shopped and cooked a meal for themselves each week as part of a plan for independent living. 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 excellent 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 in receipt of good systems in place to provide consistent support to meet their personal care and health and medication needs in a individualised way. They also benefit from staff being alert to their general health and well being and promotion of their independence and decision-making. Evidence: We noted that care plans include details about personal and health care needs of people and how these are to be supported. As stated in the section on individual choices we noted that these care plans and risk assessments had been reviewed recently and with people living in the home. Subsequent to the inspection we received a notification of an incident which has lead to another review of a risk assessment for someone when bathing. This showed that the home managed a risk well while promoting privacy and dignity and the manager said they are reviewing the risk assessment again in consultation with the person. A conversation with staff and person, living in the home whilst viewing a care plan included discussion about support to visit the dentist and consultation that had taken place about treatment. The member of staff showed a respect for the persons wishes. Guidance is in place regarding oral hygiene with evidence of consultation with a health professional and the person we spoke with confirmed to have had help with it from a staff member that morning. Use of a special toothpaste was recorded. The member of staff who was not a key worker for that person, had good knowledge of day to day personal care needs and support to be given.This showed that information is shared among staff and care plans read so that people are consistently supported. A discussion was held with another person living in the home about support with personal care, this was recorded and the person was receiving the help that they Evidence: wanted. They also spoke of regular appointments with health professionals and they were aware of a dental appointment planned. There are records in the home for people about the appointments that have been attended showing that monitoring takes place. A staff member spoke of the specific current health needs of one person living in the home following a medication change and showed evidence of monitoring that persons wellbeing. This had included involvement of an out of hours doctor and a visit, on the morning of the inspection, of a psychiatrist. Detailed records were held of the monitoring and action taken and staff reported an improvement in the persons well being. This shows that the staff in the home are alert to changes in people and of responses taken with positive outcomes. We had surveys from a care manager and a health professional involved in the services to people in the home. They said that staff always or usually have the right skills and experience to support the peoples health needs. Both said that peoples health needs are properly monitored, reviewed and met by the care service. The health professional said that there are regular review appointments and the service asks for advice and implements recommendations promptly. The home has a medication policy in the front of the records of administration file for staff to read. In May 2009 the manager reported to us that a medication error had been made and that someone living in the home had not been given their medication twice in one day. This had been reported by the manager through the local safeguarding procedures , as required for investigation, and this was still ongoing during our inspection. At this inspection we sampled elements of the medication system to check that correct procedures were being followed and that people were receiving their medication. We looked at a sample of administration records for people in May 2009 and found that records were signed. Some tablets for one person had been dropped and disposed of properly. Records were seen of their return to the chemist and of the recording in the home about this. We noted that some medication is provided as required and examples were discussed with a member of staff. We noted that difference in support needed for two people was being taken into account in the approach staff were taking to the use of this medication but one record of support provided was not recorded.The manager agreed to do this. We noted at the last inspection that no one was involved in self administration of medication. At this inspection consideration of this had been given and one person spoke of being involved and had lockable storage in their room for this. A staff member showed how the person was involved, that recording took place and that a risk assessment had been completed, involving the person. The member of staff responsible for medication during the inspection said that checks are made to ensure that medication has been given. They also said that the home is changing to a different monitored dosage system and that some staff and two people living in the home had been at a training session in the previous week. This was confirmed with one of the people who had attended (as this was identified in a recently Evidence: reviewed self - medication risk assessment ) and another member of staff. The manager said that all but one of the staff who do medication had recently had a medication re-assessment of their abilities. We looked at an example of this and noted that this re assessment includes some testing of knowledge. From a recent review by the manager his records showed that nine staff had been trained in medication. For one person we noted that this had been completed four years ago but the persons competence had recently been re assessed. They and others had been noted by the manager to be in need of training although no date had yet been set for this. The manager said that he was working on dates for training and this would be provided. 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 benefit from a clear complaints procedure and are protected by the homes safeguarding policies and practices. Evidence: The home has a prominent complaints procedure including the use of pictures in the hall and we noted that people also have been provided with copies in their rooms. The manager said that they strive to provide an open and inclusive environment allowing service users to feel at ease and able to approach staff to express their concerns they may have . He also said that staff need to be open minded to behaviours and understand why they may be happening. People living in the home told us in the surveys that they feel able to to talk to if they were not happy and who to complain to. We had a conversation about this with two people who said that would talk to staff if necessary. One gave an example of how staff had helped in relation to behaviour and and said that if they raised anything staff would deal with this. They agreed that they were confident about this. All staff responding to our survey said that they knew what to do if a service user/ relatives/advocate or friend were unhappy with the service. The manager has a complaints log and complaints were recorded and there were records to show that these had been investigated and followed up. In the AQAA, in this section the manager, had said that there were plans to improve communication and discussion with people living in the home including discussion about concerns by redesigning the key teams for supporting people. During our visit we noted from discussion with staff that the changes had been made. We noted that since being in post the manager has used the local safeguarding Evidence: procedures to alert authorities including CQC to safeguarding matters. The manager attended a safeguarding and deprivation of liberty training session on the morning of our visit and was planning to cascade information to the staff team at the next team meeting. In the AQAA he had said that staff are given regular training and briefings on safeguarding matter. We spoke with two staff. They said they had received training either at this home or at another home and had an awareness of their roles and responsibilities in safeguarding people living in the home. We note also that staff have demonstrated a willingness to raise concerns with the management of the home. The manager said that all staff do deal with behaviours challenging to the understanding of staff and others and provides training in a specific set of techniques for dealing with this to protect people living in the home and others from harm. Staff confirmed that they had received training in this and records showed that training is provided. The manager said that restraint is not used in the home and staff confirmed that physical interventions are not used. Guidance for one person was viewed and included verbal support . Procedures are in place for managing finances for some of the people living there. This includes regular checks by staff on a day to day basis. Records sampled for two people were accurate. 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 are provided with a comfortable, homely,clean and hygienic environment, with a range of shared spaces to use in additional to their personalised rooms. They are encouraged to take part in aspects of cleaning and household tasks and to feel that it is their home. Evidence: The environment was observed and we noted that people have been provided with very clean, fresh and homely shared living spaces including a kitchen/diner and lounge overlooking the countryside. As planned at the last inspection an additional shared space for arts and crafts has been provided, with heating, in the garden which people say they enjoy using. Areas of the home viewed included four bedrooms with en suite facilities ,viewed with the agreement of the people using those rooms. These contained lots of personal possessions and people said that they had support to clean them. They also said that everyone is expected to help with the general cleaning. We noted that the home was well maintained and in good decorative order. The manager said that there is allocated funding for improvements to the home and referred to new staff lockers, a bedroom floor ,sofas and kitchen flooring. The latter two were seen and spoken about with staff. In the AQAA the manager had said that communication could improve with the maintenance department and at the visit we noted that there had been recent repairs .Records were held of this. We noted, when looking around the home that there were no obvious outstanding maintenance issues for attention. The speed of items being fixed were discussed with two staff who said that they were fixed as they arose. A person living in the home said that the electricity had been off for a few hours the week before but had been told what was happening. They were confident that the manager would sort anything out. In the AQAA the manager said that procedures are in place for regular cleaning of the home and that all staff are/will be trained to prevent the spread of infection control. In Evidence: the AQAA he said that nine staff had been trained in infection control. It was discussed with one member of staff who confirmed to have had infection control training. We noted that guidance is in place in the kitchen and laundry about elements of infection control. We noted that questions and answers had been posted on the wall in the hall about swine flu showing that information is up dated and one of the staff said that guidance had also been circulated about it. Two people spoken with said that they can use the laundry and access is not restricted. Staff said that they help depending on need. One staff member said that people have two days a week when they have priority for using the laundry but washing can be done on any day. 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 protected by the homes recruitment policies and procedures and benefit from suitably trained and skilled staff . There are some gaps, however, in training putting people at risk of not developing the skills that they need to meet the needs of people living in the home. Evidence: Staff were asked about recruitment at the home in their surveys and they all confirmed that checks had been completed before they started working there. We sampled the recruitment records held at the home. It was noted at the last inspection that the orgnisation had an agreement to hold staff records centrally and that a form should be held at the home for each person working there with details of the checks that have been completed. In the sample we viewed for two people, we noted that the forms were complete indicating that checks had been completed including references, Criminal Records Bureau checks and gaps in employment. Staff on duty during our visit were friendly,caring and respectful to the people living in the home. They agreed that the levels had been changed to provide three staff later into the evening to offer people a wider choice in activities. This was reflected in the rota which also showed that two staff are employed at night. Three staff work a day shift with some over lap in the middle of the day and the staff spoken with thought that they were able to meet peoples needs in this time. The manager has been reviewing the training and development of staff and had just identified the training needed. He said that nine staff have been assessed to NVQ level two or three. Records and information from staff show that staff are being provided with training. One staff member spoke of recent training in infection control, elements of medication, epilepsy and dealing with challenges. They thought that moving and handling was planned. Another said they had fire, protection of vulnerable adults and interventions for challenging behaviour. We looked at the training plans and some of Evidence: the training records for staff. Although staff in the surveys had said that induction mostly covered things well,we noted that an in-house induction record for one person (two were viewed) was not being regularly completed and there was no record of this person doing fire training in induction. There was no record of fire training for another person. The manager said that he would address this in the next staff meeting in the following week and was trying to organise fire training. He also agreed to follow up about the persons induction. We have therefore not made a requirement. The records also showed that initial training or updating needed included 12 people in health and safety,10 for food hygiene ,18 for moving and handling ( booked for October 2009) and nine for medication. Most staff, in surveys said that they usually had the right support, experience and knowledge to meet the needs of people in the home. Those spoken with said that they had regular supervision and staff meetings and felt supported. 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 . Strong leadership in the home means that the people living there are increasingly consulted about the service they receive and their views and wishes are informing the service provided. They also benefit from improved routine monitoring of the service and systems within it,but, there are gaps in staff training putting staff at risk of not developing the skills that they need to meet the need of people living in the home. Evidence: Since the last inspection the organisation has recruited a new manager who was registered in March 2009. The manager has had several years experience of working with the company and is now working on his National Vocational Qualification and Registered Managers Award. He has had recent training on safeguarding,disciplinarys and risk assessments and has identified further training to do. Staff said they feel supported by the manager and that there are regular meetings but that he is approachable. Friendly staff /management relationships were noted during our visit. People living in the home when speaking about the manager gave examples of confidence in him following things up. The AQAA that the manager submitted was comprehensive and showed the managers commitment to improving the service and providing good outcomes for people, living in the home. Quality assurance questionnaires were sent out last August and these are held at the home . The manager showed us the business plan outlining the plans for the home which were identified in the AQAA .These include plans to for example - to increase contact with families and a BBQ was being planned with the residents. Also changes being made to increase the evening activities. We saw evidence of organisation in the Evidence: home to the benefit of the people living there.There are various checking systems in the home to ensure that work is completed. This includes a file used by the person in charge of the shift for monitoring work completed with people living in the home. Staff thought that the manager was aware of the contents as he was aware of events in the home. The monitoring of staff training in key areas such as induction and fire has identified gaps.This is referred to in the staff section with details of action the manager will take. We also noticed that there is a fire risk assessment, reviewed last December, and there are control measures that are identified as needing to be in place. Some of these are in place such as the fire checks but in discussion with the manager he agreed there needed to be a fire evacuation plan- signed by staff and evidence that staff had read the fire risk assessment. We noted that a fire drill had taken place in May this year. The manager agreed that he needed a system to ensure that all of the control mechanisms are in place. The manager said that this would be included in the next staff meeting we therefore have not made a requirement. Service checks are taking place.We also noted that generally fire checks in the home are regularly completed but for the week of the inspection were overdue by a day and the manager agreed to have them completed on the day of our visit. We also noted that the last gas safety check was recent and completed on 14/4/09. Are there any outstanding requirements from the last inspection? Yes  No  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 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 Description 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 Description 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 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. - 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!