Care Home: St George`s

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What the care home does well St Georges provides accommodation to a high standard.People have their own rooms, some with en suites and others close to bath or shower rooms.A person centred approach to care is in place and people said they are fully involved in monitoring and reviewing their care plans.People said they enjoy going out to work or doing voluntary work. Some said they like going to day centres and colleges.People were observed helping around the home, cooking, cleaning and doing their laundry. People said, "I like the company here", "I love living here" and "We do have nice food."Staff have the skills and knowledge needed to support people. They have access to training and have regular support from their manager. What has improved since the last inspection? The decor of the home has been maintained and people asked about their choice of colour schemes.People have been fully involved in proposed changes to their home. They have had access to advocates to support them through these changes. What the care home could do better: When new staff are appointed a full employment history must be provided. If there are any gaps in employment history these must be looked into. Key inspection report Care homes for adults (18-65 years) Name: Address: St George`s Wellclose House Lansdown Road Cheltenham GL50 2LH The quality rating for this care home is: Three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Lynne Bennett Date: 2 5 1 1 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. 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 Care Homes for Adults (18-65 years) Page 2 of 34 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: St George`s Wellclose House Lansdown Road Cheltenham GL50 2LH 01242511237 01242242627 enquiries@stgeorgesassociation.co.uk www.stgeorgesassociation.co.uk St George`s Association Ltd care home 10 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) : Number of places (if applicable): Under 65 Over 65 10 0 learning disability Additional conditions: Date of last inspection 1 4 0 3 2 0 0 7 A bit about the care home St Georges care home is based in a Regency Grade II listed building that provides residential accommodation for ten women with a learning Care Homes for Adults (18-65 years) Page 4 of 34 disability. The Well Close House is part of St Georges Association. Well Close House is one of several projects overseen by the charity. The home is set in its own attractive and extensive grounds in the front and a water garden to the rear of the building. The home is close to Cheltenham town centre a mile away from Montpellier and its facilities. Weekly fees are agreed during admisson to reflect individual need(s). Prospective admissions are given information about the home including copies of the Statement of Purpose and Service Users Guide which includes some information about what is covered by fees. Care Homes for Adults (18-65 years) Page 5 of 34 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 Care Homes for Adults (18-65 years) Page 6 of 34 How we did our inspection: This is what the inspector did when they were at the care home This inspection took place in November 2009 and included two visits to the home by one inspector. The registered manager was present at both visits. The registered manager completed an AQAA (Annual Quality Assurance Assessment) as part of the inspection, providing information about the service and plans for further improvement. It also provided numerical information about the service (DataSet). We talked to 3 people using the service, and asked staff about those peoples needs. We also looked at the care plans, medical records and daily notes for these 3 people. This is called case tracking. Care Homes for Adults (18-65 years) Page 7 of 34 We spent time talking to other people and also observing the care they receive. We were also invited to join people at their house meeting. We looked at a range of records including health and safety audits, quality assurance records, staff files and training information. We walked around the home with the registered manager and some people showed us their individual rooms. Care Homes for Adults (18-65 years) Page 8 of 34 What the care home does well St Georges provides accommodation to a high standard. People have their own rooms, some with en suites and others close to bath or shower rooms. A person centred approach to care is in place and people said they are fully involved in monitoring and reviewing their care plans. Care Homes for Adults (18-65 years) Page 9 of 34 People said they enjoy going out to work or doing voluntary work. Some said they like going to day centres and colleges. People were observed helping around the home, cooking, cleaning and doing their laundry. People said, I like the company here, I love living here and We do have nice food. Staff have the skills and knowledge needed to support people. They have access to training and have regular support from their manager. Care Homes for Adults (18-65 years) Page 10 of 34 What has got better from the last inspection The decor of the home has been maintained and people asked about their choice of colour schemes. People have been fully involved in proposed changes to their home. They have had access to advocates to support them through these changes. What the care home could do better Care Homes for Adults (18-65 years) Page 11 of 34 When new staff are appointed a full employment history must be provided. If there are any gaps in employment history these must be looked into. 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 Lynne Bennett CQC South West Citygate Gallowgate Newcastle NE1 4PA Tel:03000 616161 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Adults (18-65 years) Page 12 of 34 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 13 of 34 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 14 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with information in accessible formats and fully consulted about changes to the service being provided to ensure that it will continue to meet their changing needs. Evidence: The home has a Statement of Purpose in place which is regularly reviewed. Each person has been given a personal copy of the new Service User Guide which has been produced in a format appropriate to their needs using plain English and illustrated with photographs and pictures. There have been no new admissions to the home since the last inspection. The home has a comprehensive admissions procedure in place which would include obtaining a full assessment of need from the placing authority and completing their own assessment. Visits to the home are encouraged. Each person had a copy of St Georges terms and conditions as well as a copy of the contracts from their placing authority. The needs of some people are changing due to the ageing process. They are being supported sensitively through this to make sure that the service they receive reflects their changing needs. Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: People have been involved in a consultation about a change to the provision of their service. St Georges will be deregistering the registered care home and after considerable refurbishment providing three self contained flats with communal facilities which people currently living in the home will share. Each person will have a tenancy and will be provided a service reflecting their individual needs from St Georges Home care and Support. People discussed the process with us and were really excited about the proposed changes. They have had access to an advocate during this consultation and information and records have been produced in accessible formats. Great time and effort has been put into this consultation to ensure that people have been able to explore the implications of these changes to them personally and to involve them in the plans for the refurbishment of their home. The registered manager and staff are to be commended for the role they have played in this transition. Care Homes for Adults (18-65 years) Page 16 of 34 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. A person centred approach to care planning provides the opportunity for people to take control of their lives. Peoples needs are being assessed and they are being supported to makes decisions about their lifestyles. Risks are being managed safeguarding them from possible harm. Evidence: A person centred approach to care planning is promoted within the home focusing on each individuals personal wishes and aspirations. The AQAA confirmed that care plans are person centred and regularly monitored and reviewed. There was evidence that people were being fully involved in this process from an assessment of their need, to developing care plans and risk assessments and their annual reviews. People spoke positively about their relationships with their key workers. People had signed many of the records on their personal files. We casetracked the care of three people. One person had recently been diagnosed with Dementia and the others had specific health care or specialist nutritional needs. A holistic Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: assessment provided an analysis of their physical, intellectual, social and emotional needs. From this care plans had been developed producing specific objectives for each person. For instance for one person with Diabetes staff were to support them to plan their diet and to create the opportunity to prepare their own meals. Staff described to us how they were planning to implement this. Care plans were being reviewed every 6 months and annually at peoples reviews. Staff spoken with had a good understanding of peoples needs and were observed supporting people in line with their identified needs. An example of this was supporting one person to maintain their fitness and staff were observed encouraging them to join in with a running club and to go swimming. A range of monitoring forms were being used including behaviour observation charts (ABC), personal care and activity logs and contact sheets. Some keyworkers were maintaining monthly key working records summarising the persons appointments, activities and wellbeing. The registered manager confirmed that people had access to an advocate from a local advocacy group. We discussed whether one person should have access to a personal advocate to support them through changes they were currently experiencing. The registered manager said she would arrange this. People were observed being supported to make choices and decisions about their day to day lives such as choosing activities, how to spend their time and meals. As mentioned people were being supported through major changes in the provision of their care and accommodation. The registered manager and staff were fully involving them in all aspects of this. People were supported to manage their personal finances where needed. All people had access to secure facilities to keep their money. A review of the procedures for supporting people had resulted in cash cards being removed and new procedures put in place to ensure people were safeguarded from possible financial abuse. Each person had a care plan detailing how they were supported to manage their personal finances. At the time of this inspection there were no restrictions or limitations to freedom in place. A selection of risk assessments had been developed to support people to take risks as safely as possible. These were being regularly reviewed. After examining accident and incident records we noted that one person had several falls. Their Health Action Plan indicated that at times they could be unsteady but there were no corresponding care plans or risk assessments in place. We discussed this with the registered manager who said that this would be put in place. (See also Personal and Healthcare support). Staff spoken with were aware of the risk of falls and described the strategies in place to prevent falls around the home or in the community. Each person had a missing persons profile in place with a copy of a current photograph. Page 18 of 34 Care Homes for Adults (18-65 years) 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home make choices about their lifestyle, and are supported to develop life skills. They have the opportunity to take part in social, educational and recreational activities and keep in touch with family and friends. People have a nutritional diet and their diverse needs are catered for. Evidence: People living in the home have drawn up activities schedules which reflect the way in which they would like to spend their time. For those people who wish to follow their religious beliefs this is respected and people attend a variety of local churches. During our visit people were planning to celebrate Christmas and were discussing which carol concert they would like to attend. People chatted about their work opportunities and voluntary work they were involved in. Some people also attended day centres and colleges on a regular basis. During our visit one person was going to a social club and others went swimming. Activities were also being arranged at home and people participated in a Bingo session during one of our Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: visits. We were also invited to join them for a house meeting one evening during which they discussed activities and told us about holidays they had taken this year. They also discussed taking part in a running club, completing the Race for Life and were thinking about another run on Boxing Day. People said they also going to the gym and enjoyed Riding for the Disabled. Some people liked to go to football matches and to the theatre. People planned to go for a walk locally and said they do this regularly. Surveys indicated that one person would like to go out more at weekends but another person said they went out for drives and a cup of tea at weekends. Staff commented that they enable people to engage in activities in the community. People said their family and friends could visit them whenever they wished. They were planning a Christmas celebration and inviting family and friends to join them. People are also supported to visit and keep in touch via telephone. People had responsibility for chores and household tasks. We observed them helping with the cleaning of communal areas, doing their laundry, setting tables for meals and helping to prepare lunch and dinner. Staff surveys indicated that they enable clients to make decisions and to be independent. People were observed using keys to open their rooms and staff sought their permission to enter their rooms. People take it in turns to care for the homes cat. At their house meeting people discussed the menus for the next week providing the opportunity for people to express whether they wished an alternative to the main meal offered. People take it in turn to help prepare the evening meal. Considerable thought has been given to the nutritional content of meals. A member of staff had completed a Healthy eating course and had held sessions within the home. One person was supported to attend a Weightwatchers club. Several people had support from a Dietician and their recommendations were being implemented. Staff said some guidelines were in the kitchen but they needed to produce more guidance for people with diabetes and on a wheat free diet. One person was a Vegetarian and they choose their own meals. Fruit was seen to be available in the dining room and people were observed helping themselves to drinks throughout our visits. One person had drink making facilities in their room. Care Homes for Adults (18-65 years) Page 20 of 34 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. Personal care support is offered in a way that responds to peoples needs and preferences, promoting peoples dignity. Medication processes are in place that should safeguard people from possible harm. Peoples wishes in respect of ageing and death are being discussed. Evidence: Peoples likes and dislikes were recorded in a format using pictures and photographs to illustrate the text. Conversations with people confirmed that these represented their views. They had signed these records. Staff were observed treating people with sensitivity, respect and dignity. Staff surveys confirmed that they treat each person individually, they get the care they need, when they need it and delivered in the way they want. They also said, we care very well for the clients. People spoke positively about their relationships with their key workers. Each person had a Health Action Plan in place which was being reviewed annually. Some people had also had an annual health care check with their Doctor. Robust records were being kept for peoples appointments with a range of social and healthcare professionals providing evidence of regular appointments with their Doctor, Dentist, Optician, Dietician and Continence Nurse. People were also being referred to the Community Learning Disability Team. We discussed concerns about the number of falls for one person and Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: staff said they thought this could be due to an ongoing ear problem. They said further investigation with the Doctor would be arranged immediately. The systems for administration of medication were examined and found to be satisfactory. The registered manager described the procedure for administering medication to people which reflected good practice. We were concerned about a tray with peoples names written where containers would be placed and she assured us that this was only used to transfer one persons medication at a time. Staff said that most people preferred to come to the medication room for their drugs. The medication administration record (MAR) was being completed correctly apart from some handwritten entries which had not been signed or countersigned as being correct. Stock control was in place for medication in blister packs and in boxes. Homely remedies had been authorised by the Doctor. A list of staff administering medication was in place indicating they had received training. A copy of their signature or initials also needs to be provided. There was evidence that end of life plans were being discussed with people. The AQAA confirmed that My Life My Wishes booklets were being put in place. A questionaire concerning support during ageing and illness was examined for one person. Records indicated that another person was being supported to explore writing a will. Care Homes for Adults (18-65 years) Page 22 of 34 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. Systems are in place to enable people to express their concerns and they are confident that they will be listened to. People should be safeguarded from possible harm or abuse. Evidence: Surveys from people living in the home indicated that everyone knew how to make a complaint. Some people told us that they would talk to their key worker or the registered manager if they had concerns. It was also evident during the house meeting that people would express any issues they had in this forum. The complaints procedure was accessible to people although our details need amending to reflect the CQC and our contact details at the National Contact Centre. Training records confirmed that staff had completed training in the safeguarding of adults. Each member of staff had a personal copy of the homes main policies and procedures including whistle blowing, the protection of vulnerable adults and abuse. The DataSet indicated that the home had received two complaints. We examined the complaints folder which provided a full record of the complaints and their outcomes. We had been notified by the home about safeguarding concerns. They had followed their procedures in a timely fashion and had liaised with the local Adult Protection Team. There was a copy of the local adult protection procedures in the home and staff talked to us about No Secrets. Incidents and accidents were being fully recorded. The registered manager discussed some incidents with us and reflected at what point they would involve the local team. Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: Staff had completed training in the management of challenging behaviour. They supported people in a non aversive manner encouraging people to find space and become calm when upset. Changes had been made to the management of peoples personal finances to protect them from possible financial abuse. There was a heightened awareness within the team about enabling people to remain independent but also safe. Care Homes for Adults (18-65 years) Page 24 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is safe, clean and well maintained which recognises their diverse needs creating an environment that matches their personal requirements. Specialist equipment is provided to those people who need it. Evidence: St Georges is a listed building and is maintained to a high standard. A maintenance plan was in place for day to day repairs and long term refurbishment. We examined the plans for the refurbishment of the home into self contained flats. In the meantime there was evidence that any issues were being actioned and the home kept in a good state of repair. Communal areas were pleasantly decorated with good quality carpets or washable flooring. People said the decor of their rooms reflected their choice of colour scheme. Where specialist adaptations were needed these had been provided after consultation with an Occupational Therapist. One person had a room on the ground floor with an ensuite wet room. Handrails had been provided by steps to this room. Bathrooms were of a good quality and any concerns about condensation were being dealt with. Other concerns about water damage to the rear of the property were also being investigated. The laundry area is compact and was tidy and organised at the time of our visit. This area was also be used by people to do their personal laundry. Personal protective equipment was provided for staff should it be needed. Communal hand wash basins were supplied Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: with paper towels and liquid soap. Staff had completed infection control training. Arrangements were in place for the appropriate disposal of soiled waste. Hazardous products were being stored securely. Care Homes for Adults (18-65 years) Page 26 of 34 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. Peoples needs are met by a competent staff team who have access to a comprehensive training programme that provides staff with the opportunity to gain knowledge about the diverse needs of people living at the home. Recruitment and selection processes need to be more robust to make sure people are safeguarded from possible harm. Evidence: People said they had positive relationships with staff and their key workers. Staff were observed supporting people with sensitivity and respect enabling them to make choices and decisions about their day to day lives. New staff had completed an induction, Basic Skills, reflecting the Skills for Care Common Induction Standards and the Learning Disability Qualification. A new member of staff confirmed they had completed this and was looking forward to starting their National Vocational Qualification (NVQ) Award. Copies of this induction programme were available for inspection and certificates of completion were seen. The DataSet indicated that sixty six per cent of staff had a NVQ Award. Rotas confirmed that sufficient staff were on duty to meet the needs of people living in the home. Surveys indicated that the staff team are strong and will step in if someone is off ill or on holiday. Although one survey stated, staffing could be better organised. The registered manager said there were two 20 hour vacancies which would allow for staff to provide additional cover when needed. Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: Recruitment and selection files were examined for three new members of staff. Each had completed an application form and provided evidence of former employment. However on two applications there were gaps in employment history which had not been investigated. The registered manager must make sure that she obtains this information. References had been obtained for staff prior to employment and had requested the reason why they had left former employment. Each person had a satisfactory Criminal Records Bureau (CRB) check in place. These can now be destroyed in line with our guidelines. Evidence that proof of identity had been provided was on each file. Each member of staff had a training profile in place confirming courses completed and any training needs identified either in their regular supervision sessions or annual appraisal. A training matrix was also in place providing an overview of training needs for the staff team. Staff had completed mandatory training in addition to specialist training relating to peoples individual needs such as epilepsy, diabetes, dementia and podiatry. Staff who had delegated responsibility for key tasks around the home such as healthy eating and health and safety confirmed that they had completed the necessary training. Care Homes for Adults (18-65 years) Page 28 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on openness and respect. There are effective quality assurance systems which involve people who live at the home. Systems are in place to maintain and monitor the health, safety and welfare of people. Evidence: The registered manager has considerable experience supporting people with a learning disability. She has the Registered Managers Award and NVQ Level 4 and is a NVQ Assessor. People spoke positively about her and staff confirmed that she was a lead practitioner and always supportive to them in their roles. She stated in the AQAA, I prefer to empower the staff team by delegating areas of responsibility to them over and above the care and support of the service users. She said, They report back to me in supervision and the work they do enhances the running of the home and the lives of the service users. She had provided a copy of the AQAA to us before the deadline providing information about the home and developmental plans. Staff and management had received training in the Mental Capacity Act. The registered manager had completed training in the Deprivation of Liberty Safeguards and information about this was provided in the home. As mentioned there was evidence that advocates Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: were being involved with people where appropriate. No one in the home was subject to a Deprivation of Liberty Safeguard at the time of the inspection. Robust quality assurance processes were in place. The home had the Investors in People Award confirmed again this year and were also awarded the ISO9001 and ISO1400 this year. People were being involved in regular house meetings and the monthly Regulation 26 visits required by us. Copies of the latter reports were seen and included statements from people about the service they received. Systems monitoring health and safety were in place. Certificates and records sampled confirmed evidence provided in the DataSet that systems and utilities were being regularly serviced and monitored. A fire risk assessment was in place and due to be reviewed. Regular fire drills and training were taking place also including people living in the home. Staff were maintaining fridge, freezer, water and hot food temperatures. Good infection control measures were seen to be in place. The home had received four stars from an Environmental Health inspection. Environmental risk assessments were in place and had been reviewed. Health and safety audits were being completed and it was evident that actions identified were being completed. Care Homes for Adults (18-65 years) Page 30 of 34 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 Care Homes for Adults (18-65 years) Page 31 of 34 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 1 34 19 The registered person must make sure that any gaps in employment history are investigated and evidence provided of a full employment history. 31/12/2009 This is to safeguard people from possible harm. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 Risk assessments should reflect practice which is in place to prevent a person from falling either in the home or in the community. Nutritional guidance should be readily available for staff supporting people on wheat free diets or with diabetes. Handwritten entries on the medication administration record should be signed and countersigned as correct. 2 3 17 20 Care Homes for Adults (18-65 years) Page 32 of 34 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 4 5 20 22 A specimen of staff signatures or initials should be provided. The complaints procedure should reflect our current contact details. Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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