Care Home: St Teresa`s Cheshire Home

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What the care home does well The registered providers are a registered charity and have extensive experience in the provision and management of care homes. Mrs Proctor is a qualified nurse, and has worked at the home for approximately 25 years. The home ensures assessment documentation is received from external agencies. Care plans are in place for all residents. Staff were seen to interact very well with residents in a kind and relaxed way. The people using the service were seen to make decisions on their own lifestyle and are involved in directing their own care. Activities take place in the home, and the residents go out on trips and into town and so on. The home`s vehicles enable residents to get out into the local community. Residents have contact with their family and friends, and the visitors book showed that people visit regularly. The residents said that meals were good and confirmed they could request an alternative. Special equipment, including special wheelchairs, is provided as needed and the home employs a physiotherapist. Specialist healthcare professionals including doctors, dentists, nurses and speech therapists, are accessed when required. Generally prescribed medicines are managed safely. Appropriate arrangements are in place to protect residents from abuse and to deal with residents` complaints or concerns. The home offers a warm, comfortable, homely environment that is clean, well furbished and free from odours. Residents can easily access all parts of the building and the large garden, which is well maintained and equipped with garden furniture. The registered providers employ two maintenance people. 27 out of 37 care staff have achieved at least NVQ level 2 qualification. Sufficient numbers of staff are on duty each day and night. A nurse is on duty at all times. What has improved since the last inspection? The registered manager has addressed the two requirements made at the previous inspection. A consistently high level of individualised care continues to be provided, with the registered manager and staff demonstrating an in-depth understanding of people`s capabilities and care needs. The people that live there confirmed that they are happy with the care received and the manner in which it is delivered. What the care home could do better: The home could do more to provide information to people with sensory deficits. The organisation of care documentation could be improved, and risk assessments could be reviewed more frequently. More could be done to show people are actively offered a choice at meals. A summary of th e findings from quality assurance questionnaires could be published in a format meaninful to the reader. Policies and procedures should be reviewed and kept up to date. Key inspection report Care homes for adults (18-65 years) Name: Address: St Teresa`s Cheshire Home Long Rock Penzance Cornwall TR20 9BJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Alan Pitts     Date: 3 0 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 30 Information about the care home Name of care home: Address: St Teresa`s Cheshire Home Long Rock Penzance Cornwall TR20 9BJ 01736710336 01736710549 chris.proctor@lc-uk.org www.lcdisability.org Leonard Cheshire Disability care home 27 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 physical disability Additional conditions: Service users to include up 27 adults with a physical disability (PD), 15 of whom may have nursing needs Date of last inspection Brief description of the care home The care home is situated on the outskirts of Marazion and overlooks St Michaels Mount bay on one side. The town of Penzance is within easy reach and therefore there is a wide range of amenities available. St Teresas provides a home for up to 27 younger adults who experience disabilities and are registered to provide nursing and residential care. The Home comprises of a new purpose built setting that was opened in 2000 and an established building that has acted as a care home for many years. The two settings are interconnected. Internally the accommodation is maintained to a high standard and residents have personalised and furnished their own rooms. St. Teresas is organised on the basis of three self-contained units of nine residents. Each unit has dedicated staff allocated and a Care Coordinator to facilitate efficient and smooth functioning. Each service user is allocated a key worker who takes a key role in ensuring the individuals needs are met in a manner that is acceptable to the individual Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 27 Brief description of the care home concerned. Qualified nursing staff are on duty 24 hours a day to meet the nursing needs of residents. The service offers care and accommodation on a long-term basis and for short-term care. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We visited St Teresas Cheshire Home on the 30th June 2009 and spent approximately 6.5 hours at the home. This was a key inspection and an unannounced visit. The purpose of the inspection was to ensure that the needs of the people using the service are properly met, in accordance with good care practices and the laws regulating care homes. The focus was on ensuring that placements in the home result in good outcomes for people. It was also to gain an update on the progress with requirements identified in the last inspection report. The CQC Annual Quality Assurance Assessment (AQAA) document completed by the provider has also been considered to support this inspection. All of the key standards were inspected. On the day of inspection 26 people were living in the home. The methods used to undertake the inspection were to meet with a number of residents, staff and the registered provider to gain their views on the service. Records, policies and procedures were examined and the inspector toured the building. This report summarises the Care Homes for Adults (18-65 years) Page 6 of 30 findings of this inspection. The registered providers have continued to maintain the premises and the continuity of care provision for people using the service. Residents expressed satisfaction with the care and services provided at the home. Overall the home is providing a good quality of care to the residents placed there. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The home could do more to provide information to people with sensory deficits. Care Homes for Adults (18-65 years) Page 8 of 30 The organisation of care documentation could be improved, and risk assessments could be reviewed more frequently. More could be done to show people are actively offered a choice at meals. A summary of th e findings from quality assurance questionnaires could be published in a format meaninful to the reader. Policies and procedures should be reviewed and kept up to date. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 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 30 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. Assessment documentation and care plans are received from external agencies. All prospective residents are assessed by a competent person from the home prior to admission, with records maintained. The people who are thinking about a move to Caritate are provided with good information to help inform them about their choice of home. Evidence: Evidence was provided in the form of records, talking with staff and the registered provider. All residents and prospective residents are provided with a copy of the homes Service User Guide. The Statement of Purpose and Service User Guide was seen to be up-todate. The registered accepted that more could be done to meet the needs of people with a sensory loss (e.g. audio/visual). The file of a prospective resident was inspected and this contained relevant and appropriate assessment documentation completed by the registered provider or a Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: nurse from the home. The home also obtains multi-disciplinary assessments as appropriate. Prospective clients are invited to visit to meet the staff and familiarise themselves with the environment. Appropriate equipment and professional opinions are sought as needed. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of residents, who are involved to the best of their capabilities in decision-making and self-determination. Evidence: The registered manager and team leaders spoken with demonstrated a detailed understanding of the complex range of needs that are presented by residents and the records inspected detailed how the relevant support is provided. The registered manager is involved daily with the running of the home, and is available to residents and their families at all times. Residents each have an individual service plan (ISP), which sets out the goals of their placements in the home so that they maintain and develop their independence and are able to enjoy a good quality of life in a homely, community setting. They are encouraged to make decisions for themselves about things that are important to them, such as how to spend their money and what to wear. They are supported to take managed risks so that they develop their confidence and skills. Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: Care plans are regularly reviewed with, where possible, the involvement of the person concerned. The format of the individual files means that the information required by the reader may not be in the ISP, but included elsewhere in a personal profile or in an intervention plan. The individual files also contain archive material. The information provided is detailed and does provide clear direction to staff as to the individuals personal preferences and how to best meet their care needs. Residents spoken with said that the staff and care provided was good, and they had no concerns. The service has achieved Beacon status within the Gold Standard Framework. This is a framework to help deliver a Gold Standard of care for all people as they near the end of their lives. Advance Care Planning is used to best meet the needs of people and their families. It is a multi disciplinary team approach working closely with GPs Nurses and the palliative care team. The service obtained the Beacon status due to the way they adapted the care planning process to meet the needs of service users in their particular type of service. Policies and procedures have been put in place to safeguard the people using the service. It is clear that staff care for residents and risks are managed though their knowledge and skills. Written risk assessments are in place, though some were seen to be a few years old, and care should be taken to ensure they cover both environment, individual, and the two combined (e.g. client using kitchen). Any form of restraint such as bed rails must be risk assessed; consent should also be obtained, and the decision should include all relevant people. The people that live there are involved in the running of the home, for example, being included on interview panels for new staff. The people using the service were seen to make decisions on how they spend their time and they decide when to get up and go to bed and so on. One resident was assisted to attend a hospital appointment. Staff receive training including the Mental Capacity Act and Deprivation of Liberties training, and demonstrated a keen awareness of peoples rights. The staff work closely with other relevant agencies (college, care managers, advocates). Confidentiality is included in staff induction training. Care Homes for Adults (18-65 years) Page 14 of 30 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. A range of social and recreational opportunity is available in keeping with known preferences and capabilities. Residents engage with the local community, and all have appropriate contact with people important to them. Residents rights and capacity as adults is recognised. A balanced diet is provided. Evidence: Evidence was provided in the form of documentation, records, observation, talking with the people using the service, staff and registered provider. Activities take place in the home, entertainers visit and the residents go out on trips and into town and so on. Residents are involved in planning of daily life and activities. Social activities in the home include: painting, games, music sessions, baking; the involvement of outside agents such as hairdresser, aromatherapy. Residents are involved in a range of appropriate leisure/work activities and maintain contact with Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: people important to them. There are 4 suitable adapted vehicles available to assist with clients whishing to go out. There is a voluntary IT assistant and the home is trying to establish the equipment and software needed to help people stay in touch with distant family and friends. People are able to lock their rooms, and staff were seen to knock before entering rooms. Staff use the individuals preferred form of address. The registered provider and staff have no involvement with the management of individuals finances. The kitchen was seen to be clean and orderly. Residents confirmed that there is an alternative available if they wish, but people are not actively asked for a choice prior to meals. The people spoken with said that the food was good and in plentiful amounts. The menu has been developed by the parent organisation. Care Homes for Adults (18-65 years) Page 16 of 30 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. Personal support is given to residents according to their needs, ensuring their individual preference is respected. Residents have access to health care services as necessary to ensure their physical and emotional needs are met. There is a suitable system in place for dealing with residents medicines. Evidence: Evidence was provided in the form of records, observation, talking with the people using the service, staff and registered provider. The registered manager and staff said they ensure that appropriate personal support, care and encouragement are provided in such a way as to respect residents privacy and dignity. People said they were happy with the care and support they receive from the staff. It is evident that positive and trusting relationships have been established between the staff and the people that live there. People spoken with confirmed they are treated in a respectful and dignified manner at all times. The care records, observation, and discussion with the registered manager and staff show that the residents waking day is flexible. The residents are free to determine their own lifestyle. Personal preferences are known, including gender preferences for the staff Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: providing care and their wishes if care needs or circumstances change. Residents health needs are well met and medical services are promptly accessed when required. A qualified nurse is also on duty each day and night and other health professionals are in regular contact with residents. People spoken with said that they felt there were no barriers to raising any issues or concerns with the staff or manager of the home. Special equipment including special wheelchairs is provided as needed and the home employs a physiotherapist. All residents are registered with a GP and specialist health care workers are consulted as necessary, for example speech therapists, occupational therapists, dentists, and doctors. A key worker system is used, meaning that residents know they each have a member of staff responsible for overseeing their care needs. A monitored dose system is in use. Medication fridge temperature check is done daily. Medicines received are entered on the charts and the disposal records are satisfactory. Any hand written instructions on the medicine charts are witnessed and signed by two people. Medicines are stored safely and securely. The system for managing controlled drugs is appropriate. Appropriate medication training is provided for staff, though nurses administer medicines. People are enabled to self-administer medicines following assessment. Care should be taken to ensure that medicines are ordered in time to ensure people do not have to do without. Care Homes for Adults (18-65 years) Page 18 of 30 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. The home has a suitable complaints procedure. Residents were seen to interact with staff in a relaxed manner. The registered manager has a clear understanding of Adult Protection issues and procedures that will protect residents from abuse. Evidence: Evidence was provided in the form of documentation, observation, and talking to the registered provider. The people that live at the home are enabled to maintain existing contacts with relatives and friends, and external agencies. The homes complaints procedure is available to residents in the Service User Guide. The home has an appropriate policy and procedure regarding complaints and concerns. The Commission has not received any complaints since the last inspection. There is a system at the home for recording and complaints received. People said that they would feel able to express any concerns should they have any, and they said they had confidence in the registered manager and staff. The registered manager and staff have received training on protecting vulnerable adults from abuse. The home has copies of the local authority procedures for safeguarding vulnerable adults in addition to its own internal procedures. A satisfactory policy and procedure is in place and any concerns or allegations about abuse are reported to the statutory authorities for investigation. There is a flow chart Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: for staff to follow in the event of an allegation of abuse (this would benefit from the inclusion of relevant contact information). The people that live there have access to resources outside of the home so they are not isolated there. People are protected by the homes recruitment procedures. There is no money held on behalf of residents. The registered manager does not act as appointee for any resident. Care Homes for Adults (18-65 years) Page 20 of 30 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. The registered providers have improved the environment for residents and they are determined to offer accommodation that exceeds the minimum standards. The home is clean and free from offensive odours making it a pleasant place to live in. Evidence: Evidence was provided in the form of a tour of the building, observation, AQAA and discussion with the registered provider. The care home is a detached single storey facility that is maintained to a high standard. Wherever possible the fixtures and fittings and furniture are domestic in nature and help to ensure a homely atmosphere is provided. Corridors and doors into bedrooms are wide to assist easy access. Floors are level throughout. The building is well lit, and this is helped by having windows on all sides. The people that live there describe the home as comfortable and had no significant concerns about their safety. There are accessible gardens around the care home and ample car parking facilities at the entrance to the home. Gardens are wheelchair friendly, and include a herb garden. Each unit is decorated in the preferred manner of the people who reside there and it is evident that residents have personalised their own bedrooms. Bedrooms are furnished Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: to a high standard and the resident is able to choose their own colour scheme. If they wish they can provide their own furniture, furnishings and fittings. In addition the rooms are set up to enable the occupant to maximise their independence. Each of the units also has its own communal space that comprises of a sitting room, dining area and kitchen. In addition there are other communal rooms at the home that people are able to utilise if they wish. Many of the bedrooms have en-suite facilities, though there are also a number of shared bathroom and toilet facilities distributed throughout the care home. A wide range of disability equipment is evident at the home and this includes hoists, specialist baths and mobility equipment. Where required each resident has a specialist assessment to determine the equipment or adaptations they require to met their needs and promote their independence. The home is clean and a good standard of hygiene is maintained on a daily basis. People said they were very satisfied with the facilities and equipment provided and the standard of cleanliness throughout the home. A regular programme of maintenance, replacement and redecoration is in place and two maintenance staff are employed. Protective clothing and suitable hand-washing facilities are provided for infection control purposes. The home is clean and hygienic, and staff receive infection control training. Care Homes for Adults (18-65 years) Page 22 of 30 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. The staff team is effective in supporting service users. Recruitment practice protects the rights and interests of the people that stay there. Staff complete appropriate training to meet the needs of service users. Evidence: Evidence was provided in the form of documentation, records, observation, talking with the people using the service, staff and registered provider. Many of the care staff have worked at the home for a considerable time. Staff were seen to interact well with residents and spend time talking with them. There are 37 care staff, of which 27 have achieved NVQ Level 2 or above (or equivalent). The duty rota showed that a qualified nurse is on duty at all times. Each unit has a core group of staff and the numbers of staff on duty are determined by the needs of the residents. The three units differ slightly in shift patterns and staffing numbers, but there is always a minimum of 3 staff on duty on each unit during the day and this is normally higher on some units. Each unit has a tea leader who coordinates the care provided and named nurses assist with their duties and responsibilities. A reliable out of hours on call arrangement is in place for any emergencies that arise. Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: People were very positive about the manner in which the staff undertake their duties and provide the care and support required. It is clearly evident the staff build and maintain positive relationships with residents and have a good understanding of residents support needs and capabilities. The team leaders have established regular opportunities for staff to be formally supervised about their work and each staff member has an annual appraisal. The providers use a recruitment system with an equal opportunities policy. Two staff files were inspected and these contained the records required by legislation. The registered manager confirmed that contracts of employment are given to staff. There were interview records, induction records, and health declarations on file. All the files had a photograph of the employee and confirmation of identity. New staff undertake an National Training Organisation compliant induction programme. The registered manager confirmed that all staff receive a copy of the General Social Care Council handbook and a staff handbook. Training is monitored to identify training needs. A training matrix identifies training completed, and where training needs are evident. A sample of staff supervision records was seen at the time of the inspection, and these demonstrate that appropriate asupervision is being provided and recorded at regular and frequent intervals. Care Homes for Adults (18-65 years) Page 24 of 30 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. The registered manager is competent and experienced and people benefit from a well run home. The home is run in the best interest of the people that live there. The registered manager promotes the safety of the residents, residents and visitors to the home. Evidence: Evidence was provided in the form of documentation, records, talking with the people using the service, staff and registered provider. It is evident the home is well run and well managed. The registered manager is a qualified nurse, has considerable experience of care provision and holds the Registered Managers Award. Staff and residents were positive about the manner in which the home is run and organised and commented they found the registered manager and staff to be approachable and responsive to any concerns or suggestions they raise. The providers have established a range of methods to review the quality of the Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: services and facilities provided each year. The arrangements include consulting with residents and staff, monthly reviews of the facilities and regular visits by staff who are not directly employed at the care home. This includes the monthly regulation 26 visits undertaken at the home. Annual surveys are sent out and the results summarised, but in a numerical way that could be improved to be more meaningful for public consumption. Discussion took place with the registered manager how best to publish a summary of the findings, including any action taken as a result of the findings (e.g. in the Service User Guide). The record keeping arrangements at the home meet the standard required. Suitable policies and procedures are in place to promote safe working practises and provide a safe environment for residents and staff, though a number have not been reviewed as expected. The equipment and services at the home are regularly serviced and maintained. Fire safety officers were inspecting the premises on the same day as this inspection. The registered manager assists residents to manage their personal allowances or to identify a suitable third party to do so where necessary. Small amounts of money, supported by records of transactions, may be kept for people. There are no concerns regarding the financial viability of the home and an appropriate Insurance Policy is in place. The registration and Insurance certificates are publicly displayed in the reception area. Care Homes for Adults (18-65 years) Page 26 of 30 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 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 1 6 The registered manager should make alternative formats available for clients with sensory deficits. Archive material should be separated from current documentation, and care should be taken to ensure that the ISP contains all the relevant information necessary to direct staff in providing effective care. Care should be taken to ensure risk-assessments cover both environment, individual, and the two combined (e.g. clients using kitchen) and they should be reviewed annually, or sooner if necessary. The registered manager should ensure that the alternatives available at meals are shown on the menu and made known to the people that live there. A record of food provided should be kept that demonstrates the choices available and decisions made for meals. The registered manager should consider how best to publish a summary of the quality assurance findings, including any action taken as a result of the findings (e.g. in the Service User Guide). 3 9 4 17 5 39 Care Homes for Adults (18-65 years) Page 28 of 30 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 6 40 The registered manager should ensure that the homes policies and procedures are reviewed to ensure they are all current and accurate. Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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