Care Home: Summit Road, 1

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What the care home does well The home is providing good quality care and support to the current five residents who have a range of very complex needs, including physical disabilities and communication needs in addition to their learning disability. A community nurse manager from the local Learning Disability Partnership told us "Staff are doing well, they always engage positively with our team regarding people`s health". The new provider organisation is working hard to further develop the quality of care the home provides, including by recruiting to vacant staff posts, the introduction of a range of new policies and procedures and by the introduction of a new redecoration and refurbishment programme for the physical environment to the home. What has improved since the last inspection? The home was rated as 2 stars, good outcomes for people when it was managed by the previous registered provider. There were no outstanding requirements from that time. This is the first inspection of the service under the management of Outlook Care. What the care home could do better: One requirement is made at this inspection in relation to storage of controlled medication, this is to maximise protection to both residents and staff. Four good practice recommendations are also made to further reinforce the good quality care and support residents receive: for key workers to write monthly reports of the work they have undertaken; to consider the recruitment of suitably qualified volunteers; to request formal feedback from the consultant psychiatrist following residents appointments with him and to review staffing levels should a new prospective resident be referred to the service. Key inspection report Care homes for adults (18-65 years) Name: Address: Summit Road, 1 1 Summit Road London London E17 9LR     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: Peter Illes     Date: 0 2 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 31 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 31 Information about the care home Name of care home: Address: Summit Road, 1 1 Summit Road London London E17 9LR 02085205521 02085216466 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.outlookcare.org.uk Outlook Care Name of registered manager (if applicable) Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The registered person may provide the following category of service only: Care Home only - code 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 - Code LD The maximum number of service users who can be accommodated is: 6 Date of last inspection Brief description of the care home Summit Road was purpose built in the early 1990s as a registered care home for six people with a diagnosis of learning disability, following the closure of a local long stay learning disability hospital. However, the home was taken over by Outlook Care, a different provider organisation, in January 2009 and because of this the Commission rates the home as being newly registered and this is the first key inspection since then. Outlook Care is a not for profit company and successfully runs a number of other services for people with a learning disability and other vulnerable groups. The building Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 6 6 Brief description of the care home is fully accessible to people that use wheel chairs and accommodation is provided is on two floors, connected by a lift and staircase. The ground floor consists of: an entrance hall; two residents bedrooms, one unoccupied at the time; a kitchen, which has been refurbished; a large dining room/ lounge, that we were informed was due to be refurbished; the laundry; the managers office and a staff sleep in/ meeting room. The first floor contains four residents bedrooms. There are sufficient bath/ shower and toilet facilities on each floor, all of which are accessible and eqipped to meet the needs of people that use wheelchairs. The home has a large and pleasant enclosed rear garden that includes a sensory area and their is parking for two cars in the front of the building. A stated aim of the home is to support people to make their own choices and live their life the way they want to live. The London Boroughs of Waltham Forest & Redbridge Joint Learning Disability Partnership block purchases all the places in the home. The current weekly cost of a placement is between £1468 and £1550 p.w. The provider makes information available about the service, including inspection reports, to people living in the home and to other stakeholders. 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: This is the first key inspection undertaken since the home was registered in January 2009 with Outlook Care as the provider organisation. This key inspection took approximately seven hours and was undertaken by the lead inspector. However, terms such as we, our and us are used where appropriate within this report to indicate that the inspection activity was undertaken by the Commission. The registered manager post was vacant at the time although the deputy manager and a supporting registered manager from another of the provider organisations nearby services were available to assist throughout this inspection. There were five residents living in the home on the day and one vacancy. All the five current residents have lived at the home for over ten years. The inspection activity included: meeting and speaking to all of the residents present although this was very limited due to their communication needs; detailed discussion Care Homes for Adults (18-65 years) Page 6 of 31 with the supporting registered manager and the deputy manager; discussion with staff on duty, two of them independently; independent discussion by telephone with a speech and language therapist from the local Learning Disability Partnership and a community nurse manager from the same team; independent discussion with a visiting massage therapist and independent feedback from an independent advocate that supports residents living at the home. Further information was obtained from a tour of the building, documentation kept in the home and from an Annual Quality Assurance Assessment (AQAA) that the home sent us when we asked for it. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 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 9 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 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 range of accessible information available for prospective residents and their representatives to assist them to make informed choices about living at the home. People living in the home have their needs and preferences reviewed on a regular basis, with input from health and social care professionals and from an independent advocate as appropriate, to assist the home in meeting peoples changing needs and preferences. Evidence: The homes annual quality assurance assessment, AQAA, states, The service has produced a Statement of Purpose and Service Users Guide. This contains all relevant information for someone wanting to move into the home. We saw a copy of the statement of purpose, which was up to date and had been completely re-written to reflect the re-registration of the service by the new provider. A copy of this can be viewed on the provider organisations website. We were given a copy of the service user guide, which is in accessible pictorial format; this was detailed and, in our view, will be helpful for all stakeholders when a prospective resident is considering moving into the home. Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: The home has appropriate admission procedures that were seen. However, no new residents have been admitted to the home since 1996, with all the current residents having previously lived in Leytonstone House, a long stay hospital, that was closed around that time. The service is aware that the needs and preferences of any new prospective resident to the home will have to be carefully assessed. This is to ensure that they can be met appropriately within the home and also to ensure minimum disruption to the other people that have lived there for many years. The files of three of the five residents were inspected and showed a range of detailed assessment information that was up to date. This information covered the persons physical, social, and emotional needs and included up to date information compiled by both the home and by a range of external health and social care professionals. Evidence was seen that peoples needs and preferences are regularly reviewed and that an independent advocate as well as other appropriate stakeholders are invited and attend review meetings. Feedback to us from an independent advocate that we contacted indicated that residents are properly supported by the home. The home operates a key worker system and a key worker spoken to was knowledgeable about the needs and preferences of the person they were key worker for. The key worker confirmed that they coordinated their residents review and undertook regular one to one sessions with that person. However, key workers currently do not write monthly key worker reports. Such reports would be useful for helping to share up to date information on any changing needs or preferences that the person may have and may also contribute more detailed information to inform peoples review meetings. A good practice recommendation is made regarding this. Care Homes for Adults (18-65 years) Page 11 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs and preferences are properly recorded in their care plans to assist staff in meeting these. People are supported to maximise their independence by being encouraged to make as many decisions as possible for themselves, which they appreciate. People are also supported to take appropriate risks in their lives to assist them to safely achieve their aspirations. Evidence: The homes annual quality assurance assessment, AQAA, states, All the service users have in place Support Plans, Risk Assessments and Health Action Plans that are updated when required and also reviewed/ updated at least six monthly. These are set out in a clear manner outlining the individual needs of the service users and how they will be assisted in meeting these needs. The service users are encouraged to help with this, ensuring that their choices are respected. The files of three residents were inspected and each showed evidence of up to date and detailed care planning. The files showed evidence of person centred planning Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: and had sections including Things I am good at, What I want and What I dont like. The above information contributed to peoples care plans, called Personal Support Plans, that included pictures to help make the information more accessible. The plans were appropriately detailed to provide meaningful information to staff and other interested parties in how to support individuals who have a range of very complex needs, including the majority with specific communication needs. The plans seen contained detailed information on how personal care is to be provided and took account of peoples views on such areas as the gender of those providing personal care. The plans also covered peoples needs and preferences regarding their culture, religion and sexuality. It was noted that the plans are reviewed regularly and on some recent review meeting notes seen the responsible individual from the new provider organisation had attended the review meetings. We were told that this was for the responsible individual to further familiarise themself with the needs of the residents and how staff were supporting these needs being met. Evidence gathered through the inspection, including from records on peoples files and observation of staff interacting with residents, showed that staff are working hard to help residents make as many decisions for themselves as they can about their daily lives. This included involving the use of an Independent Mental Capacity Advocate (IMCA) for one resident and the involvement of an independent advocacy organisation to support all the residents. An independent advocate confirmed this and told us that they felt the home had made a number of improvements since the new provider organisation had taken over management of the home. The files inspected contained a section called infringement of Rights, which recorded where peoples rights had been curtailed. Examples of this included where one persons external music group had been cancelled and another being where the lift at the home had been out of action for a period before it was repaired and the persons ability to use all of the building was restricted. Staff were observed assisting people with their lunch on the day of the inspection and staff were seen to do this with good humour and suitable sensitivity to peoples needs. Soon after the meal started one person indicated to staff very clearly that they did not want the meal served but wanted a sandwich instead. This was dealt with in a relaxed and friendly way and the person was made a sandwich of their choice and was seen to enjoy it. Each file inspected contained detailed and good quality risk assessments relating to that person, these were current and subject to regular review. The risk assessments covered a wide range of potential risks that were relevant to that individual. They also gave guidance to staff on how to minimise the identified risks whilst at the same time promoting peoples independence. Risk assessments covered a range of areas including the risk of abuse, sexually inappropriate behaviour, moving and handling, Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: mobility, communication and specific issues relating to individual personal care. Care Homes for Adults (18-65 years) Page 14 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. People living at the home are encouraged and supported to participate in range of activities of their choice, including within the wider community. They also enjoy contact with relatives and friends to the extent that they wish. Peoples rights and responsibilities are respected and promoted within their daily lives. People are also supported to enjoy healthy and nutritious meals of their choice. Evidence: The homes annual quality assurance assessment, AQAA, states, All service users have both support and the opportunity to develop their skills both within the home and also outside the home. We help to monitor progress that is made (including) by documenting evidence on forms. The residents at the home have complex needs and staff are working hard to provide a range of stimulating activities for them to take part in. We saw evidence that individual residents take part in a range of external activities such as attending a music group, going for pub lunches and events such as the local Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: Mencap Friday disco. We were also told that the home was planning a trip for residents to see the show Mamma Mia. One resident is keen on wrestling and we saw evidence that this person had been supported to attend wrestling events, including at the 02 arena in Greenwich. Residents are also offered a summer holiday and we were told that the last holiday to Butlins was very much enjoyed by all. One resident told us enthusiastically that there had been a wrestling match as part of the entertainment at the holiday camp. However, although there is a minimum of three staff on duty during the day for the five residents much time is spent by the residents in the house each week because of their complex needs and the individual support they need. A good practice recommendation is made that the home explores the possibility of creatively using other resources such as suitably experienced volunteers to further assist residents in accessing community resources. Residents are supported to maintain contact with family members where appropriate and evidence was gathered from records seen and staff spoken to support this. Residents are also supported to develop and maintain friendships of there choice. The home promotes equality and diversity and peoples support plans evidenced this. The support plans seen included information about the persons cultural, sexual and religious needs and wishes. An example of this includes how one person is supported to attend their preferred place of worship, and other detailed recordings were seen of how people are supported in terms of their gender, sexuality and cultural needs and preferences. Residents have individual support plans about eating and drinking that were seen to be detailed and up to date. Where residents have specific needs regarding eating and drinking the involvement of specialist health professionals, including a speech and language therapist and community dietitian, is sought to advise staff. Residents are consulted each week regarding the menu for the following week and staff spoken to were very knowledgeable about peoples likes and dislikes. A number of people require their meals to be pureed and need individual assistance to eat it. Lunch was observed on the day of the inspection and was seen to be prepared and served in a relaxed and pleasant manner, the pureed food was presented in an attractive manner and residents appeared to enjoy their meal. One resident decided when their meal was served that they did not fancy the meal after all and indicated rather loudly that they wanted a sandwich instead. Staff dealt with this request in a welcoming way and the resident enjoyed their sandwich. Care Homes for Adults (18-65 years) Page 16 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. People living in the home are well supported with their personal care needs. Their health care needs are also well met including through referrals to a range of community based health professionals. People living at the home are protected by robust medication policies and procedures although an identified improvement in the storage of controlled medication will help maximise this protection. Evidence: All of the residents living at the home need considerable support by staff to meet their personal care needs. There needs, preferences and guidance for staff in assisting with this was clearly laid out in the support plans seen. Staff were observed supporting residents sensitively during this inspection and staff spoken to were very knowledgeable about different residents needs in this area. We noted a written compliment dated April 2009 from a community nurse about the care of a PEG site for one resident. Residents also have a range of significant health care needs that were well documented. Each person had an up to date health action plan that had been drawn up with the assistance of relevant healthcare professionals and evidence seen that Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: these are reviewed on a regular basis. The files inspected showed that each resident is registered with a GP and evidence seen that they were able to access a range of specialist healthcare professionals. This included with a dentist, community dietitian, the continence advisory service and a range of learning disability professionals from the multi-disciplinary Learning Disability Partnership. We spoke independently to a private massage therapist who visited the home during the inspection and whose sessions were funded by residents. She told us that she has visited the home up to twice a week for a number of years. she went on to say that staff are very cooperative and that she had no concerns about the care of residents. We spoke independently by telephone to a speech and language therapist for the local Learning Disability Partnership. He told us he had had significant contact with the deputy manager who was very thorough and took on board any recommendations he had made regarding residents and felt that one resident in particular has made some recent progress. We also spoke independently by telephone to a Community Nurse manager from the Partnership who gave us positive feedback from the home, including telling us that Staff are doing well, they always engage positively with our team regarding peoples health. It was noted that residents regularly saw the consultant psychiatrist at the learning disability service and notes taken by staff of the outcomes of these appointments were seen. There was also a record on some files of the outcome of the appointment through a letter sent from the consultant to the persons GP with a copy being sent to the home. However, this was not the case for all appointments and a good practice recommendation is made that the home requests a copy of such a record of appointments with the consultant to further assist the home in being clear about any recommendations made from such appointments. The home has a satisfactory medication policy and procedure, issued by the new provider organisation, that were clear and up to date. These were supported by an individual medication care plan and medication risk assessment that were also seen on the files inspected. We were told that the home was in the process of changing the dispensing pharmacist used by the home and that the new pharmacist had undertaken a pharmacy inspection in May of this year. Up to date records of medication entering the home and being disposed of by the home were seen. Arrangements for storing medication in the home were generally satisfactory and the medication and medication administration record (MAR) charts for two people were inspected and were satisfactory. These indicated that people were receiving their medication properly and the record of administration of each dose of medication was signed by two staff members, one administering and one observing it was administered correctly. However, it was noted that one person was prescribed an identified controlled drug Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: and we were told that the home had ordered a controlled drug cupboard to accommodate this following the new dispensing chemists visit in May 2009. As the regulations on storing controlled medication in care homes changed last year a requirement is made to reinforce the need for a separate controlled drugs cupboard and controlled drugs register. Care Homes for Adults (18-65 years) Page 19 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. People living in the home are supported to express their views and concerns and have these properly addressed. People living in the home are also protected by up to date safeguarding adult policies and procedures, which staff are aware of. Evidence: The homes annual quality assurance assessment, AQAA, states, There is a clear, concise complaints procedure in place. This is also provided in an easy read format. We encourage the service users to attend advocacy forums, so that they may speak about any concerns that they have outside of the home. We saw the homes complaints procedure that was clear and up to date, written by the new provider organisation and we saw a pictorial summary that was displayed in the home. The homes complaints log showed one complaint that had been dealt with appropriately in accordance with the homes complaints procedure. No complaints have been made to the Commission since the homes registration by the new provider organisation. The home had a copy of the provider organisations safeguarding adults policy that was clear and up to date. Staff spoken to were also clear about the L.B. of Waltham Forests safeguarding adults policy and procedure and had a copy of the relevant forms should they need to make a safeguarding referral to Waltham Forest, the local authority the home is situated in. The home has made one safeguarding referral to Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: L.B. of Waltham Forest since registration by the new provider organisation. The Commission was informed of this as required by regulation and evidence seen that this was being satisfactorily investigated, including that an independent advocate was being used to assist in the process. Staff spoken to were aware of the actions that they should take if an allegation or disclosure of abuse is made to them and evidence seen that staff receive regular training in this area. No other allegations of abuse have been made to the home or the Commission since registration by the new provider organisation. Care Homes for Adults (18-65 years) Page 21 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. People live in a home that is properly adapted for use by people in wheelchairs. It is comfortable, well decorated and meets the current residents needs. The home was clean and tidy throughout creating a pleasant environment for all. Evidence: The home was purpose built in the 1990s following the closure of a long stay learning disability hospital. The building is fully accessible to people that use wheel chairs and accommodation provided is on two floors, connected by a lift and staircase.The ground floor consists of: an entrance hall; two residents bedrooms, one unoccupied at the time; a kitchen, which has been refurbished; a large dining room/ lounge, that we were informed was due to be re-furbished; the laundry; an office and a staff sleep in/ meeting room. The first floor contains four residents bedrooms. Although bedrooms do not contain en-suite facilities there are sufficient bath/ shower and toilet facilities on each floor, all of which are suitable equipped and accessible to people that use wheelchairs. The home has a large and pleasant enclosed rear garden that includes a sensory area and their is parking for two cars in the front of the building. It was clear during the inspection that the new provider organisation has substantially improved the maintenance and renewal of the fabric of the building including refurbishment plans and new carpets. The building provides a pleasant home for Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: residents that meet their needs. We saw a number of residents bedrooms that had clearly been personalised to suit the person that lived in them. We were told that much work goes on to obtain individuals preferences with regard to colour schemes and choice of furnishings etc. The furniture and equipment in the bedrooms are suitable for people using wheelchairs. The bath and shower rooms are properly equipped, including with adjustable fittings and hoists, to safely support staff assist residents with their personal care. one of the shower rooms has just been converted into a wet room to further assist residents receive personal care In a comfortable and dignified way. The home had an appropriately equipped laundry room and sluicing facilities that were clean and hygienic. There are a range of environmental risk assessments in place and evidence that regular health and safety checks are undertaken on the physical environment of the home. The home has satisfactory infection control policies and procedures that staff were aware of. The home was clean and appropriately tidy throughout the inspection. Care Homes for Adults (18-65 years) Page 23 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. The home has a staff team with a range of qualifications and competencies and in sufficient numbers to support people living in the home. The homes recruitment policy assists in protecting people living in the home. People are also supported by staff who have access to appropriate training and formal supervision to assist in further meeting the needs of people living in the home and in the staffs own development. Evidence: At the time of this inspection the managers post was vacant but the home was being supported by a registered manager from a nearby registered home belonging to the provider organisation. A permanent deputy manager was in post along with three permanent support workers. Three other support worker posts have been covered by long term agency workers and also more recently by other permanent staff from the provider organisations other services. We were pleased to learn that the registered manager and the three vacant support worker posts were all in the process of being recruited to on a permanent basis by the new provider organisation. Given the complex needs of the existing five residents it is important that the home keeps its staffing under review, especially if any prospective resident is referred to the vacant place at the home. A good practice recommendation is made regarding this. The permanent deputy has achieved the national vocational qualification (NVQ) level 3 Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: in care and one permanent support worker has also achieve NVQ level 3 in care and a second support worker NVQ level 2 in care. New staff are enrolled on the Learning Disability Award Framework (LDAF). In addition the new provider organisation has also introduced an additional 30 hour p.w. housekeeper post who was spoken to and stated that she was enjoying her new job. The homes staff rota showed a minimum of three support workers on duty on both the early and late shifts and one waking and one sleeping-in support worker on duty at night. The managers post is additional to the rota. Staff on duty during the inspection matched those recorded on the rota. Evidence was also seen on the rota that the home operates a designated shift leader system to assist coordination of work on each shift. Staff spoken to confirmed that this worked well and that the provider organisation operates an on call management system that also works well. The new provider organisation operates a robust recruitment procedure. Evidence that existing permanent staff were properly recruited included: evidence of a criminal records bureau (CRB) clearance and protection of vulnerable adults (POVA) check obtained by the provider organisation prior to the staff member starting work, a clear application form, two references, proof of identity with a photograph and evidence of entitlement to work where appropriate. Staff confirmed that they were offered regular training, including refresher training. A staff training record was seen that listed all the core training undertaken by staff, including dates to help managers plan refresher training. Evidence was seen that recent training undertaken by staff included health and safety, moving and handling, safeguarding adults and fire safety, staff spoken to confirmed that this was helpful. We were informed that all staff were supervised every six to eight weeks and both documents sampled and staff spoken to evidenced this. Care Homes for Adults (18-65 years) Page 25 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. People living in the home and staff benefit from good quality management support. They also benefit from the home involving them and external health and social care professionals in quality assurance monitoring that contributes to identifying how the service can continue to improve. The home has effective health and safety procedures in place to protect people living there and others that work or visit the home. Evidence: The previous registered manager has moved on from the service and we were informed that recruitment to the post by the new provider organisation was in progress. A registered manager from a nearby care home run by the provider organisation was providing support to the home in the interim. The home also has an experienced deputy manager who had filled out a detailed and good quality annual quality assurance assessment, AQAA, when we asked for it. Both the manager from the nearby service and the deputy manager were spoken to throughout this inspection and presented as being knowledgeable, competent and committed to further develop the service under the new provider organisation. Feedback from permanent staff, an independent advocate and a health professional spoken to was positive about the Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: current management of the home, which was pleasing to here considering the recent significant changes that have taken place over the past few months. The home has a variety of ways of monitoring the quality of the service it provides. This included feedback questionnaires from residents, filled out with the help of an independent advocate; from staff and from a range of healthcare professionals involved with the home. These were sampled and seen to provide positive and constructive feedback. From these questionnaires a development plan has been produced for the the year April 2009 to March 2010. Quality of the service is also monitored by the key worker system and by regular unannounced visits to the home by the responsible individual. A range of satisfactory health and safety documentation was seen. This included; a gas safety certificate, portable appliance test certificate, an electrical installation certificate and evidence of action being undertaken to minimise the risk of legionella. The homes fire log was inspected and contained satisfactory evidence of a fire risk assessment, fire fighting equipment being serviced and fire drills being undertaken. Care Homes for Adults (18-65 years) Page 27 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 28 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 20 13 The registered person must 07/08/2009 ensure that suitable arrangements are in place for the recording, handling, safekeeping and safe administration of medication received into the home. This must include the storage and recording of controlled medication in accordance with current regulations. This requirement is made to maximise protection for residents and staff with regard to dealing with medication. 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 Key workers should write monthly key worker reports to assist share information about any changing needs and preferences a person may have and to also to be able to use these to contribute to peoples review meetings. Page 29 of 31 Care Homes for Adults (18-65 years) 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 2 13 The home should explore the possibility of creatively using other resources, such as suitably experienced and competent volunteers, to further assist residents in accessing community resources. The home should keep the homes staffing ratios under review, especially when considering any new referral from a prospective new resident. 3 33 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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