Care Home: Tall Oaks

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What the care home does well The home make sure that they have written down all the things that people need and how they are going to help them. Staff help people who live in the home to decide about the things they do every day, like what they want to wear and eat, so that they have a say in their lives. The home write down how people can be kept as safe as possible while they are learning new things and doing things that they enjoy. The home works hard to help people to do the things they like to do during the day and in the evenings and weekends, so that they can enjoy their lives, as much as possible. People are helped to keep in touch with their families and friends and to make friends, if they want to. The home makes sure that it writes down how people like staff to help them with things, what they like and what they don`t like so that they can get help in the way they like best. The home help people to go to see Doctors and nurses so that they can stay as healthy as possible and be fit enough to do all the things they want to. The home have made sure that people know what to do and who to tell if they are unhappy about anything, so that it can be put right. What has improved since the last inspection? The staff treat people well and spend alot of time listening to what they say and helping them with things. The people who want to work in the home are checked to make sure that they are kind and honest and will not try to do any bad things to the people who live there. The home keep papers to show that they have been checked and that other people, where they have worked before, think they are O.K. Staff are told things (trained) to make sure that they know how to look after people in the best way. Someone who does not work in the home comes to visit it every month to make sure that everything is being done properly, he writes down what he sees and if anything needs to be looked at. What the care home could do better: The home has not been told to do anything (there are no requirements), but we talked about whether it would be good to write down when people should be given their medicine that the Doctor says they should take `when necessary`, so that everybody gets it, exactly, when theY need it. We also talked about how the manager might look at, if the home is giving the `best care it can` and write down what the people who live in the home think of that care. Key inspection report Care homes for adults (18-65 years) Name: Address: Tall Oaks 5 Pirbright Road Farnborough Hampshire GU14 7AB     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Kerry Kingston     Date: 0 8 0 2 2 0 1 0 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 28 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 28 Information about the care home Name of care home: Address: Tall Oaks 5 Pirbright Road Farnborough Hampshire GU14 7AB 01252378459 TBA pirbright@downingcarehomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Downing (Acacia House) Limited care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users to be accommodated is 6. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) Physical disability (PD) Date of last inspection Brief description of the care home Tall Oaks Care Home is a property situated in a residential area in Farnborough and is undistinguishable as a care home from other homes in the street. Downing (Acacia House) Limited oversees the service and the home is registered to accommodate six people under the age of 65 with a learning and possibly, associated physical disabilities. Each service user has a single bedroom with en-suite facilities. Communal space includes a lounge/ dining room and a kitchen. Most of the doors are wide enough to accommodate wheelchairs easily. Care Homes for Adults (18-65 years) Page 4 of 28 1 7 0 2 2 0 0 9 6 6 Over 65 0 0 Brief description of the care home The home has its own transport and is within walking distance of the town and other community facilities. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This is a report for the key inspection, which included a routine unannounced site visit to the service. This took place between 10.30 and and 3.00 pm on the the 8th February 2010. The information was collected from an Annual Quality Assurance Assessment, a document sent to the service from the Care Quality Commission and completed by the service manager and six surveys returned to us by staff of the service. Discussions with the manager, one other staff member and one person who lives in the home took place. Some people who use the service have difficulty communicating with people who do not know them so limited observations of people and their interactions with staff took place during the visit to the home. Reviewing records of the people who use the service and other records and procedures was also used to collect information on the day of the visit. All information received by the Commission since the last inspection, about this service Care Homes for Adults (18-65 years) Page 6 of 28 was also taken into account when producing this inspection report. Care Homes for Adults (18-65 years) Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: The home has not been told to do anything (there are no requirements), but we talked about whether it would be good to write down when people should be given their medicine that the Doctor says they should take when necessary, so that everybody gets it, exactly, when theY need it. Care Homes for Adults (18-65 years) Page 8 of 28 We also talked about how the manager might look at, if the home is giving the best care it can and write down what the people who live in the home think of that care. 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 28 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 28 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 ensures that people are properly assessed so that they know that they can meet their needs. Evidence: There have been no admissions since the last inspection. One person left the home in April 2009, as the home identified that it was unable to meet their specific needs. The home is registered for six , there are four people living in the home, currently. Building alterations are being carried out so that everyone, can have access to the first floor. Two bedrooms designed for people with physical needs aswelll as learning disabilities will, then, be available. There is a comprehensive admissions procedure in place, this will be used for any future admissions. The admissions procedure will include peoples compatibility with those already in residence. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People, who live in the home, know their assessed and changing needs and are involved in the regular review of their care plans. People are encouraged and supported to make as many decisions as possible about their lives and are helped to be as independent as they are able, as safely as possible. Evidence: Four plans of care were seen, they have all the necessary information and are reviewed regularly. A Care management review is held annually and staff review and write a summary, monthly, to ensure care plans remain current and appropriate. People who live in the home are as involved in the reviews and care planning process as they want to be. Plans of care are very person centred, they include a communication passport and action plans for each area, so that it easy to identify progress made or areas that need adjustment. One person spoken to knew what was in her care plan, she said that she attends her reviews and talks to her key worker, regularly, if she wants to make any changes. She said she always feels that she is Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: involved in making decisions about her life. Peoples sexuality, relationships, gender , physical and any other diversity needs are are included in the plans of care. One person has an advocate and attends an advocacy group, other people have families or friends who can and do advocate on their behalf. Resident meetings are held, approximately, every two months. Minutes are produced in pictures and symbols (widget) but this form of communication is not particularly relevant to most of the people who live in the home. The manager has just obtained a Dictaphone and she is planning to produce the minutes on a CD, that will be given to individuals. She feels this will afford them the best opportunity to fully understand the information that was given in the meeting and to remember what decisions were made. Risk assessments are very detailed, they cover all the necessary areas and are reviewed regularly. Because of the standard and detail of the risk assessments, they are an excellent tool for ensuring people can have opportunities to experience things and be more independent, whilst keeping people as safe as possible. Risk assessments are completed with individuals and are written in various ways, as is appropriate to the individual. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given opportunities to take part in interesting and rewarding activities that help them to meet some of their identified goals. They are supported to be part of, and use the facilities in the community, whatever their ability level. People are offered balanced and nutritional meals that they are fully involved in choosing and preparing. Evidence: People have daily activity programmes individualised according to their need. Programmes are included in plans of care and often help people to meet their identified goals. One person said she has plenty to do, is always busy and is always involved in setting up her daily activity programme. She, currently, has work experience which she is no longer enjoying and staff are helping her to look at alternatives. Another person has a completely different programme, to meet her needs, this includes two and a half days at a local day centre, hydrotherapy, visiting Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: parents and attending church, with staff, every Sunday. Another person participates in trampolining, swimming, arts and crafts, visits to family and involvement in developing domestic skills within the house. Records showed that people also go bowling, attend cinemas, go out for meals and attend social clubs in the evenings, if they want to. Staff make sure that people know what they are doing,on a daily and weekly basis, by various means, including providing large print/symbol and picture timetables for those who require it. Everyone has contact with family and/or friends, they visit them regularly, family members were visiting one person on the day of the inspection visit. The home work with a nearby service to hire facilities and do joint activities, such as arts and crafts in the local community hall. One person is engaged to someone she met at one of the social clubs she attends, she is is very aware of her own identity and staff appear to have worked hard with her to help her form a realistic view of her future plans, inclusive of her relationship. Menus are chosen by people who live in the home using a method of pictures produced on cards so that those less able to communicate can be equally involved in the choices. The cards are then stuck to the daily menu (Velcro) so that everyone knows what the meals will be that day. Several people are involved in shopping for, preparing and helping to cook a meal as part of their activities programme. Two people said that they help to choose meals and love the food they are given. Any nutritional needs are recorded and weight charts are kept, as appropriate, healthy eating and a healthy lifestyle are encouraged. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home meet the very diverse, personal care and health needs of the people who live there very well. They ensure that medication is administered as safely as possible but do not have individual guidelines for the use of medicine prescribed to be taken, as necessary. Evidence: Peoples plans of care are very detailed, they include how people like to be supported.There is a section called what I like and what I dont like, it is produced in pictures and symbols, with the full involvement of the people who use the service. It was noted that one person becomes anxious if certain weather conditions are mentioned, staff were observed working with her, as described in her care plan, very effectively reducing her level of anxiety when the weather conditions were mentioned, inadvertently. Each plan of care is very individual noting all peoples physical, emotional and health needs, which are very diverse. Everyone has a detailed health care plan which includes visits to specialists, the home try to imaginatively assist other professionals to ensure people get the best possible Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: health care. Health care plans include descriptions of peoples mobility and record six monthly physiotherapy reviews, behavioural needs and contacts with the behavioural team, chiropody, healthy eating plans, weight charts (if appropriate) and individuals mental capacity. They also include physiotherapy guidelines for walking exercise, visits to the wheelchair clinic and any visits to other health professionals. There is a booklet describing peoples health, personal care and communication needs, for people to take with them if they ever have to be admitted to hospital. A serious medical problem with one person was recognised, recorded and very efficiently and effectively dealt with, during the last year. The AQAA noted and the manager confirmed that they have very good relationships with the local G.P surgery and other local health providers. Notes are of a very good standard so that the home has an overview of peoples health needs and how they are being met. The home use a monitored dosage system for administering medication. Records seen on the day of the inspection were accurate. A medication error noted earlier in the year was robustly responded to by discussion at staff meetings, retraining and a temporary system of putting peoples photographs on all their medication (not in a dossett boxes), the manager said that she is constantly reviewing medication administration to ensure it is as safe as possible. Staff do not administer medication, unless they are trained to do so and two people sign that the medication has been given correctly. The home do not have individual guidelines for the administration of medication prescribed to be taken as necessary.This was discussed and the manager agreed to consider whether they would be beneficial, especially for those people with more limited communication skills. Care Homes for Adults (18-65 years) Page 17 of 28 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 comprehensive complaints procedure, which is tailored to peoples individual needs. They listen to people if they have complaints or concerns. Staff know how and are able to protect people from all forms of abuse. Evidence: The home has a comprehensive complaints procedure, this has been personalised for the individual, that is, it is produced in the format that they are most likely to understand. It also notes what support they need to enable them to complain, effectively. The AQAA noted and the manager confirmed that they have received no complaints since the last inspection. The safeguarding referrals noted on the AQAA were not accepted as safeguarding issues by the local authority and were dealt with appropriately by the home. Staff are trained in the safeguarding of adults and action taken after notified incidents evidence that people know the appropriate action to take. One staff member was very confident of what she would do if abuse occurred or was suspected and one person said that she feels very safe, she could tell the staff or the manager if she ever felt unsafe. The Commission has received no information with regard to complaints or safeguarding issues, since the last inspection, about this home. The home do not use restraint of any kind. They have behavioural guidelines and excellent detail of how to Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: minimise the risk of self harm or other dangerous behaviours. The home is helped with behaviour guidelines by the behaviour team of the local Community Team for those with Learning Disabilities. It was discussed with the manager that they should show more clearly if plans are current, and who has sanctioned them. There was evidence in peoples records that peoples behaviour is becoming more positive, excellent notes are kept of any incidents , how they have been dealt with and what action needs to be taken. People have only personal allowances kept in the home, the manager and staff have no access to peoples finances other than the cash that they hold for them. Cash is dealt with in a safe way, with receipts and records of all expenditure, being kept. The manager is in the process of compiling a financial file to ensure that their financial position is clear. The manager is able to check peoples overall financial position to ensure they are receiving the correct benefits and their money is safe, even though she has no access to it. Care Homes for Adults (18-65 years) Page 19 of 28 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 house is comfortable and homely and has a good standard of hygiene. Specialist equipment and adaptations are provided to meet the current, group and individual, needs of the people who live there. Evidence: The home as pleasant communal space and four ground floor bedrooms. There are currently only four people living in the home, all have physical disabilities. The first floor of the home is not used for residents, as it is not accessible to those people who have physical disabilities. It is being re-designed to include two large en-suite bedrooms accessed by a lift that travels up the outside of the building (the entrance is via the sitting room). When work is completed, everyone will have access to all areas of the house and it will be suitable to offer a home to other people with physical disabilities. The rest of the house will be redecorated and any other changes made when the main building work is done. Whilst suitable for wheelchairs, careful consideration will need to be given to how to comfortably accommodate six people with wheelchairs and staff in the limited downstairs space. Everyone has specialist equipment and aids, to ensure they are as safe and as independent as possible. They have six monthly reviews from physiotherapists to ensure all their current needs are met. One person showed me her room and Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: bathroom which met all her needs. She is very proud of her personal space, she said she had chosen the colour and all the things in it. She had her own entertainment systems which included music, T.V. and laptop. The Kitchen has a low work surface and kettle on a special stand so that people can use it as safely as possible. The Utility room is a bit small for wheelchairs but the home manage to ensure peoples involvement in their clothes care even though they do not have ideal space. The home was clean and hygienic, the kitchen , utility room and bathrooms are kept to a high standard. Care Homes for Adults (18-65 years) Page 21 of 28 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 properly qualified staff team, in sufficient numbers to meet the needs of the people who live there. Staff are safely recruited and all the necessary checks are completed prior to them beginning work. All staff have received appropriate training to ensure they are able to meet the needs of the people who live in the home. Evidence: There are 11 full and one part time staff member, they work in shifts from 7.30 am to 3.00 pm and from 2.30 pm to 10 pm, with a waking night shift. There are a minimum of two staff per shift, with additional staff available for activities and any special occasions. Some staff do long shifts, over fourteen hours, on occasion but do not do more than one consecutively. The manager is very aware of performance and staff well being issues. The home has used very few agency staff since the last inspection, any shortfalls are covered by staff working extra hours. All staff except one have been working in the home for over a year. Interviews are conducted by the operational manager and the registered manager or by the manager of the home and a manager from a different home. All staff have detailed job descriptions and codes of conduct. The AQAA noted a requirement from the last inspection with regard to, staff being properly vetted, and the records kept, to ensure Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: they are suitable to work with vulnerable people, this was met in June 2009. The records for the two newest staff were seen, they contained all the necessary information. They also include records of interview questions and answers and interview rating forms. The manager confirmed that staff do not work directly with people who use the service until they have full CRB clearance. Staff complete a three month probationary period, at the end of which they receive a written review which includes any training needs. Staff have a full induction which adheres to the common induction standards, they have to produce written responses to ensure their understanding of the issues covered. Protection of vulnerable adults (safeguarding) training is included in the induction process and further training is provided by the local authority. All staff complete the core training which includes health and safety issues, fire, first aid,lifting handling and others that are necessary knowledge for working with the individuals in the home such as autism, mental Capacity act, safety in the minibus and food hygiene. Records showed and the manager confirmed that training is up-dated as necessary. The home have excellent training records and have met the requirement made at the last inspection. Seven of eleven staff have NVQ 2 or above, or are about to complete their NVQ3, four staff are pursuing an NVQ qualification. The home have regular staff meetings and people are supervised regularly, some supervision is not up-to-date, the manager is aware of this. Staff morale appears to be high staff comments received on returned surveys included, the home provides excellent care to service users and adequate support. We have a great staff team and low staff turnover. Service users are happy and it is a good environment to live in,Good staff team, supports staff and residents well,Good relationships with all residents, good staff team, good quality of care,staff team are fantastic and I have alot of support and alot of training,I enjoy working at Tall Oaks, a wonderful home. Staff, observed on the day of the inspection, were interacting very positively with people. The people who live in the home,were communicating confidently and appeared to be very comfortable in the comapany of the staff. Staff used humour and their obvious knowledge of the indivuidals and their needs to create a very pleasant, supportive and enabling atmosphere. Care Homes for Adults (18-65 years) Page 23 of 28 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 home is being well managed by an acting manager who is experienced and qualified and is to apply to the Commission for registration, imminently. It is managed in the best interests of the people who live there. The home has ways of looking at the quality of care it offers, including regulation 26 visits, but some aspects of the quality assurance process is not formalised. The home take their Health and Safety duties very seriously and keep people who live there, as safe as possible. Evidence: The manager has been in the role of acting manager since the last manager left. She combines some of the duties of the operational manager with managing the home, on a daily basis. She has many years experience and many qualifications in a management role, she is currently completing an NVQ 4 in care. She is applying for registration with the Commission as soon as her checks are completed. People who use the service said that they liked the manager, could talk to her and felt she was a good manager. Staff surveys were very positive about the management of the home and the support given. Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: Quality assurance systems include regular regulation 26 visits, reports of the visits are kept in the home (meeting the requirement from the last inspection). Resident meetings, staff meetings, key worker meetings where people get to talk to their key workers on a 1:1 basis, regular reviews of care plans and a communication book inform the manager of the views and thoughts of the people who live in the home and the staff team. She keeps her own records of peoples views and ideas and incorporates them into any developments to be made. She records all individual meetings with people and residents for later reference. There is a survey that can be sent to families and other interested parties but this has not been sent recently, as families and friends are in contact with the home very frequently. It was discussed that the Quality Assurance system should be formalised and an annual development plan produced showing the relationship, particularly of residents views and ideas, to the development of the home. The home is currently developing the house to be more suitable for the work theyre doing for instance, making the upstairs accessible to everyone. The AQAA noted and the manager confirmed that all health and safety maintenance records are up-to-date and all testing is done in a timely manner. The home has recently had a Health and safety training day where they reviewed all their COSHH assessments. Health and safety is a standing item on the staff meeting agenda. Accident and incident forms are, completed as necessary, incident forms contain excellent detail, accident forms could include how the home intends to minimise the risk of recurrence. An environmental health visit resulted in a 4 star commended, rating. Care Homes for Adults (18-65 years) Page 25 of 28 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 26 of 28 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 Care Homes for Adults (18-65 years) Page 27 of 28 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). 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. 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