Care Home: St Anne`s

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What the care home does well The stimulating, sometimes unpredictable but never dull atmosphere at St Anne`s reflects the diverse personalities of the service users and the evident, understanding and close professional relationships that have developed between them and the dedicated staff team. Despite unsettled periods in the past, the current stability and commitment of the support workers clearly reflects the open and inclusive style of the established and very experienced manager. Staff are evidently valued and supported by the manager and she is clearly held in high regard not only by members of staff but service users and their relatives as well. The improved decor,furniture and furnishings in the home provide a safe and comfortable environment for people who live there. Effective systems are in place for the admission and ongoing care of service users. Individual care plans developed from comprehensive pre-admission assessments ensure that the often complex support needs of service users are met in a structured and consistent manner. Communication and consultation with service users` family members is effective and ongoing. Relatives have the opportunity to partake in individual assessment, care planning and reviewing processes. What has improved since the last inspection? Person centred care and suport plans have been developed and introduced for each service user. Daily household tasks have recently been incorporated into individual service users, opportunity plans. Environmental improvements made since thay previous inspection include service users` bedrooms, which have been decorated according to their chosen colour scheme. New flooring has been fitted in the bathroom. The large dining table has been replaced by two smaller ones and the lounge ceiling has been replastered and painted. Following regular consultation, including the very productive, weekly, key worker meetings, all personal care and support is now provided in the way service users prefer and require. What the care home could do better: It is important that service users` individual care plans, including staff guidance and risk assessments, be regularly reviewed and updated, to reflect any changing needs or circumstances.Also despite acknowledged difficulties during the long term sick leave and subsequent departure of the former deputy manager, it is essential that formal supervision for all support staff be reinstated, on a regular and structured basis. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: St Anne`s 4 St Anne`s Road Eastbourne East Sussex BN21 2DJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Nigel Thompson     Date: 2 9 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: St Anne`s 4 St Anne`s Road Eastbourne East Sussex BN21 2DJ 01323728349 01323728349 stanne4christine@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : The Complete Care Group care home 6 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 6 The maximum number of service users who can be accommodated is: 6 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 Date of last inspection Brief description of the care home St Annes is overseen by its parent company, The Complete Care Group, and is registered to provide care for six adults with Autistic Spectrum Disorders (ASD). St Annes is a large detached Victorian house within walking distance of Eastbourne town centre and railway station. Service users individual and collective social care needs are assessed and met. Community participation is promoted and service users are enabled and supported to access local amenities, including the cinema, college, theatre, swimming pool and restaurants. Activities within the home include aromatherapy, computer skills, board games, Care Homes for Adults (18-65 years) Page 4 of 31 Brief description of the care home karaoke and cooking. The dedicated staff team provide structured, yet flexible opportunity programmes to enable service users to develop social, emotional and independent living skills. There is spacious living accommodation with six bedrooms that have shower en-suite facilities. Adequate communal areas are provided to meet the individual and collective needs of the service users, including a sensory room and a light and spacious lounge at the front of the house. There is a dining room and kitchen to the rear of the home and a conservatory that leads into a large rear garden. Information about the service, including the Statement of Purpose, Service User?s Guide and CSCI reports is made available to prospective service users or their relatives, on request, as part of the admission process. The current range of fees at St Annes is £1513.8 - £1943.00 per week. Additional charges are made for hairdressing, holidays, toiletries and magazines. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced inspection took place over six hours, between 10.00 and 16.00, in July 2009. It found that all of the key National Minimum Standards that were assessed had been met or partially met and the overall quality of care provided was good. The purpose of this inspection was to assess compliance with the requirements of the previous inspection and to generally monitor care practices at the home. On the day of the inspection there were five service users living at the home. Care Homes for Adults (18-65 years) Page 6 of 31 The inspection process involved observation of working practices, examination of the homes records and discussion with two service users, two service users relatives, two members of staff, the manager and the Director. Communal areas throughout the home were seen and all service users bedrooms were viewed. Information about the service, contained in the recently completed Annual Quality Assurance Assessment (AQAA), has also been included in this report. The focus of the inspection was on the quality of life for people who live at the home. What the care home does well: What has improved since the last inspection? What they could do better: It is important that service users individual care plans, including staff guidance and risk assessments, be regularly reviewed and updated, to reflect any changing needs or circumstances. Care Homes for Adults (18-65 years) Page 8 of 31 Also despite acknowledged difficulties during the long term sick leave and subsequent departure of the former deputy manager, it is essential that formal supervision for all support staff be reinstated, on a regular and structured basis. 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. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. The thorough admission policy and procedure ensures that service users are admitted only on the basis of a full needs assessment, undertaken by people competent to do so. Prospective service users know that the home is able to meet their individual care and support needs. Evidence: As part of St Annes admission policy and procedure, a detailed pre-admission assessment form has been developed and includes information relating to the individuals personal, medical, social and psychological care and support needs. It was noted that the assessment, currently undertaken by the manager or Director, also includes details of the service users autistic spectrum disorder, their communication, leisure interests and emotional wellbeing. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: Prospective service users and their relatives are encouraged to visit the home and have the opportunity to look around and meet with members of staff and existing residents. Having moved into the home, the manager confirmed that service users undergo a six week trial period, during which time their suitability and compatibility with existing service users are assessed and it is established whether their identified care and support needs are able to be met. A review of the placement is held after this time to establish their suitability and compatibility and decide whether or not their needs can be met within the home. Subsequent placement reviews are held on a six monthly basis and routinely involve the service user, a relative or representative where appropriate, the Care Manager and staff, including the individuals key-worker, from St Annes. It is evident that since the previous inspection there has been one service user admitted to St Annes. Documentation relating to the admission, including comprehensive assessments and details of the complex transition process, was examined and found to be thorough, up to date and well maintained. As part of the extensive correspondence relating to the transition, it was noted that a senior healthcare professional had described the need for an integrated multi disciplinary coordination of the treatment and management. Positive comments about their experience of the admission procedure were also received from relatives, spoken with as part of the inspection process: Paul (the Director) could not have been more helpful. He has kept us informed and involved at every stage and I think that without him ....... would not have moved into St Annes. She has settled in very well and despite the occasional outbursts, which have to be expected, she seems very happy there. Review reports that were examined were found to be full and comprehensive with updated details of the service users physical and emotional wellbeing, their social interaction and levels of communication and community participation. It was noted that these reports also include a detailed overview of the agreed goals and objectives. Care Homes for Adults (18-65 years) Page 12 of 31 Care Homes for Adults (18-65 years) Page 13 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The assessed support needs of service users are not always met in a structured and consistent manner due to shortfalls in the developing and reviewing of care plans. Systems for consultation and participation are effective and service users are treated with respect and encouraged and enabled to make decisions about their day to day living. Evidence: Person centrerd care plans have been developed for each service user, clearly linked to the individuals assessed needs. The care plan contains detailed guidelines on how to meet their identified needs, outlining any risks with accompanying risk assessments. Procedures for management of challenging behaviour are also included. The plan is evidently formulated by the key worker and manager and essentially with the direct Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: involvement of the service user, or family member as appropriate. The manager confirmed that service users care plans are formally reviewed annually to ensure that the individuals care and support needs continue to be met in a structured and consistent manner. However this was not supported in certain plans that were examined, where personal risk assessments and staff guidelines and interventions had evidently not been reviewed since March 2008 and in some cases not updated since May 2007. The individual care plan and other relevant documentation, including opportunity programmes, relating to a relatively new service user was found to be sparse and incomplete. Staff spoken to during the inspection confirmed that, despite the variable communication of some service users, effective and regular interaction and consultation takes place constantly throughout the home. This was evident from direct observation of staff supporting service users in a professional, sensitive and respectful manner. As previously documented, a weekly one to one meeting continues to take place between individual service users and their key worker. This regular discussion and structured recording format provides an opportunity for choice and decision making. It is also clearly an effective system of monitoring changes in emotional and personal support needs and demonstrates good practice. The manager confirmed that service users continue to be consulted regarding many aspects of their day-to-day living, including menu planning, recreational and leisure activities and holidays. Care Homes for Adults (18-65 years) Page 15 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users are enabled and supported to maintain contact with family and friends as they wish and effective links with the community enrich their social and educational opportunities. Service users benefit from appropriate recreational and leisure activities and menus that are balanced and nutritious, reflecting their individual likes and preferences. Evidence: The recreational and leisure interests of service users are identified and recorded in their individual care plan and they continue to be supported to access activities and facilities, reflecting their individual needs, preferences and abilities. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: It was evident from direct observation and through discussions with members of staff that the comprehensive Opportunity Plans, in place for each service user, continue to provide a structured programme of daily activities, reflecting individual interests and preferences. Opportunity plans that were examined included activities as diverse as: music; videos; karaoke; walk in the park and free time. Community participation has always been a focus for the home, with service users regularly accessing local amenities icluding shops, restaurants, cinemas and swiming pools. The manager confirmed that as part of their individual opportunity programmes it is becoming a more significant part of the lives of many service users. Staff support for service users outside the home is evidently an integral part of their role and responsibility. This was reinforced by service users relatives: She does so much more than she did before and goes out every day. Three service users continue to attend the local college and are evidently looking forward to the new term starting in September. Courses in which they have chosen to partake include art, cookery and flower arranging. The manager confirmed that visiting during is unrestricted. Service users family links continue to be supported, where appropriate, with variable contact with relatives being maintained in the majority of cases. Service users relatives, spoken with as part of the inspection process, were able to suport this: Whenever I visit I am always made very welcome. A four week rolling menu is in place, providing service users with a balanced, varied and nutritious diet, which reflects individual choice and preference. An alternative to the main meal is always available. Service users have access to fruit, hot and cold drinks and healthy snacks throughout the day. The menu has been made accessible to all service users by the effective use of symbols and pictures. The manager confirmed that staff and service users routinely sit together for the evening meal. It was noted that since the last inspection the dining Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: room has been improved significantly. There are now curtains up at the large windows. Two comforatble chairs help soften the appearnace of the room and the large dining table has recently been replaced by two smaller tables. Service users weight and dietary needs are monitored regularly. Menus and individual dietary needs are discussed during regular staff and service users meetings. Referrals to the dietician are made as necessary to assess any specific nutritional needs and seek advice on promoting healthy eating. Care Homes for Adults (18-65 years) Page 18 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Staff have developed close and positive relationships with service users and demonstrate an awareness and sound understanding of their individual care and support needs. Service users are protected by improved, clear and comprehensive policies and procedures in place for the control and safe administration of medication. Evidence: In accordance with their personal care plan, service users continue to be fully supported and enabled, as far as practicable, to exercise control over their lives and maintain maximum levels of independence and individuality. During the inspection, service users were observed being supported in a sensitive, professional and respectful manner by members of staff. This was further evidenced through positive comments from service users and their relatives: Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: She loves her independence but obviously needs the structure and support that she gets here. I think the staff have done wonders with her, she has improved so much. Even if I won the lottery I wouldnt leave St Annes. Documentary evidence was in place to demonstrate that the health and emotional care needs of service users continue to be met within the home. Service users are given support regarding personal hygiene in a sensitive and appropriate manner according to agreed guidelines in their individual care plan. Personal support is provided appropriately to maximise privacy, dignity and independence. All service users are registered with local GPs and have access to other health care professionals, including district nurses,the sexual health clinic, dieticians and dentists, as required. It was noted, in care plans that were examined, that all appointments with, or visits by, health care professionals are recorded. Improved policies and procedures relating to the control, storage, administration and recording of medication are in place. Medicines are stored and recorded appropriately. A senior support worker confirmed that all staff who have responsibility for administering medication have received appropriate training and are individually assessed and authorised to do so. This was confirmed through discussions with staff and supported by training records examined. Care Homes for Adults (18-65 years) Page 20 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The open and inclusive atmosphere within the home enables service users, staff and visitors to feel able to express any concerns, confident that they will be listened to and acted upon. Service users are safeguarded from abuse through relevant staff training and robust policies and procedures. Evidence: Close working relationships, effective and ongoing communication and consultation with service users provide adequate opportunity for any concerns to be raised and discussed, before they become complaints. Each week the opportunity is given for all service users to attend a house meeting to air their views. As previously documented, service users also have the opportunity to meet with their keyworker in a weekly one to one session, to raise any concerns or issues they may have. It is also evident that the manager operates an open door approach, enabling service users and staff to discuss any isues freely. The manager confirmed that all service users are made aware of the complaints procedure on admission and are given details on how to contact the CQC if they wish. Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: The information is printed in an easy to read format and is on the service users noticeboard. Records are kept of concerns and complaints. Service users and members of staff, spoken with during the inspection, confirmed that they would have no hesitation in speaking to the manager or making a complaint if necessary and each person was confident that they would be listened to. The organisation has produced detailed policies and procedures relating to safeguarding vulnerable adults, including a whistle blowing policy. Safeguarding vulnerable adult alerts are appropriately recorded and reported, as per protocol. The manager confirmed that staff have undertaken specific training, in accordance with the multi agency guidelines relating to safeguarding vulnerable adults, including recognising signs and symptoms of abuse, reporting and recording abuse and whistleblowing. This was supported through discussions with members of staff during the inspection and evidenced through individual training records. It is evident from observation and through discussions with the manager, staff and service users relatives that physical and verbal aggression by service users is recognised and understood by staff as an associated aspect of the service users condition and is responded to sensitively and appropriately. All staff are trained in NAPPI (Non abusive psychological and physical interventions) to ensure there is a consistent, planned response to incidents of challenging behaviour. NAPPI principles form part of the daily handover. All incidents of challenging behaviour and staff responses to these are accurately recorded. Care Homes for Adults (18-65 years) Page 22 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The service is accessible, safe and clean and remains clearly suitable for its stated purpose. Service users benefit from pleasant accommodation that is comfortable, well maintained and decorated to a satisfactory standard. Evidence: There have clearly been some improvements in the physical environment of the home since the last inspection and standards were found to be generally satisfactory throughout. Of note was the redecoration of some service users rooms and refurbishment of several communal areas, including the lounge and dining room, which, as previously stated has new curtains fitted and replacement chairs and settee. The large dining table has been replaced with two smaller tables. It is evident that the well maintained decor and adequate furniture and furnishings Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: continue to provide a comfortable and pleasant environment for the service users. The manager confirmed that, where appropriate and following risk assessments, adaptations have been made to take into account the autistic characteristics of the service users. Independence and individuality continue to be promoted within the home as evidenced from the personalising of service users individual rooms, which clearly reflects individual tastes and interests. Outside there is a large rear garden with swing chair and on ground swimming pool in the summer months. The garden also has flowerbeds, a lawn area, a vegetable and herb patch and a small fish pond. Much of this was the work of the previous Deputy Manager, who evidently was a keen gardener. The garden is a large area with a lot going on. It is therefore important that work continues on the upkeep or, as discussed with both the manager and maintenance man, it could literally and very quickly grow out of control. On the day of the inspection, levels of cleanliness and hygiene throughout the home were found to be generally satisfactory. Care Homes for Adults (18-65 years) Page 24 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users are protected from the homes thorough recruitment policy and procedures and benefit from sufficient trained, competent and supervised staff on duty at all times to meet their assessed care and support needs. Evidence: In addition to the comprehensive induction programme undertaken by all newly appointed staff, the manager confirmed that appropriate core skills training is provided, including first aid, food hygiene and fire safety. This was confirmed through discussions with staff and supported by individual training records examined. To address the acknowledged, unpredictable and frequently stressful nature of working at St Annes, the manager continues to provide all necessary support for staff. In discussion with members of staff during the inspection, it was evident that, without exception, they feel valued and supported by the manager: Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: Shes brilliant, the best manager Ive had. Always ready to listen. However,having had her deputy on long term sick leave shortly before he left St Annes, the manager readily concedes that it has been a difficult time and, because the service users always come first, the provision of formal staff supervision every month has slipped. The manager is clearly aware of the need for thorough and robust recruitment procedures, to ensure the protection of service users. Individual files that were examined, relating to recently appointed members of staff, were found to be well maintained, containing all relevant and necessary information, including two satisfactory references, proof of identity and satisfactory Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) disclosures. The recruitment process evidently allows the opportunity for service users to meet with prospective employees prior to the interview. A core team of bank staff ensure that they know the service and the service users well to reduce the need for unfamiliar agency staff. Agency staff are only used to cover night shifts when there is minimal contact with the service users. A six month probationary period is in place linked with a comprehensive induction programme which must be successfully completed. An appraisal takes place after successful probation period. The Director confirmed that the home is currently looking to recruit another Deputy Manager and two support workers, one to replace a member of staff recently promoted to a senior. Care Homes for Adults (18-65 years) Page 26 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users benefit from a well managed home, effective quality monitoring systems, thorough health and safety checks and guidelines and efficient record keeping. Evidence: The dedicated and experienced Registered Manager continues to work hard to maintain a safe, supportive and stimulating environment within the home. She has successfully completed the Registered Managers Award (RMA) and is a NVQ Assessor D32/33. Since the previous inspection she has achieved a Certificate in Autism. Staff and service users, spoken with during the inspection, confirmed how approachable and supportive the manager is. Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: Comments from service users relatives, spoken with as part of the inspection process, indicated a high regard for the manager: I liked the manager from the first time that I met her. She always keeps me invovled and informed of any issues. I have complete confidence in her. As previously documented, since the last inspection, the long serving deputy manager has left St Annes to take up a managers position elsewhere. It is clear from discussions with service users and colleagues that he will be missed. The home continues to operate effective quality monitoring systems, including six monthly satisfaction questionnaires for both service users and their relatives. The service is involved in the Autism Accreditation Programme to review how well the service meets the autism specific needs of the service. The manager confirmed that the health, safety and welfare of service users and staff remains of paramount importance within the home. Staff training is provided in many aspects of safe working practices, including food hygiene; fire safety and first aid. All staff training is recorded. There is a maintenance schedule in place to ensure boilers, central heating system, water temperatures, gas appliances, fire alarms, emergency lights and extinguishers, electrical systems and equipment etc. are serviced and maintained as required. A Weekly health and safety walk through assessment takes place to ensure faults are promptly recorded and repaired. An annual in depth health and safety audit is also carried out, to ensure compliance with standards. COSHH assessments and guidelines are in place. Regular fire drills are undertaken and recorded and fire safety systems within the home, including alarms and emergency lighting are tested on a regular basis. Temperature regulators are fitted to all hot water outlets, accessible to service users. All accidents, incidents and injuries are recorded and reported, as required. Care Homes for Adults (18-65 years) Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 It is required, for each service user, that a plan of care be developed, implemented and regulalry reviewed. To ensure that all current and changing care and support needs are met in a structured and consistent manner. 31/08/2009 2 36 18 It is required that formal, recorded supervision be provided for all care staff on a regular basis. To ensure that staff receive the support and supervision they require to carry out their jobs. 31/08/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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