Care Home: Tarn House

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What the care home does well The care needs assessment process is very thorough providing staff with detailed personal information helping them to make sure the service they provide is both personalised and consistent. The majority of admissions are on a planned basis enabling people to make an informed decision about moving in to the home. Person centred care plans are agreed with each person, which provide a valuable insight for staff about what is important to the person and their preferences about how they want to live their lives. Information about people`scommunication needs are well documented so that staff understand and can support people to make their needs known and lead an independent lifestyle. People are relaxed and comfortable in their home environment and get good support to access the local community to pursue their interests and hobbies. They also value the opportunity to take an annual holiday of their choice with support from staff. A good range of activities are available to people with staff supporting people both in the home and in the local community. Staff liaise with other professionals to make sure personal and health care needs are assessed and responded to appropriately. All health interventions are recorded enabling staff to monitor people`s changing needs.The home benefits from having a full compliment of staff who have developed a good understanding with the people living in the home making sure they receive a personalised service. The home has a stable management and supervisory team who support staff in providing a consistent and reliable service. What has improved since the last inspection? The statement of purpose and service user guide has been reviewed to make sure all the information is up to date and accurate and is provided to people in an easy read format.Care needs assessments are being kept under review and appropriate action taken if people`s needs change, to make sure the home is suitable and people`s needs can be safely managed in the home.People are more involved in the day to day running of the home with monthly house meetings taking place enabling them to share their views and concerns.Quality questionnaires are being used to evaluate the night time support for people using the respite service to make sure it is meeting their needs.COSHH substances were securely stored throughout the home to prevent people from harm. Staff have received refresher training in the safe handling of COSHH substances to ensure they understand their responsibilities.All staff now receive fire instructions at appropriate intervals to make sure they know how to respond in an emergency situation. The fire procedures and fire risk assessment file have been reviewed to make sure all documents are up to date, relevant and in line with fire regulations and a Fire Service visit is planned. What the care home could do better: The manger should make sure all the people living in the home agree and sign a contract of terms and conditions that explains the fees to be charged, the services provided and the terms and conditions of residence. The contents of the general risk assessment file should be audited to make sure only accurate and up to date risk assessments are held and they are clearly sectioned in the file making them easy to refer to.The manager should liaise with the other agency`s involved in the decision to restrict one person`s visitors to the home to make sure Deprivation Of Liberty safeguards are being followed. The personal hygiene policy and procedure was displayed on the wall in the bathroom which is not appropriate and should be removed.An alternative solution for protecting people from the hot water pipes and radiators should be sought as the grey insulating foam and metal radiator guards are unsightly and inappropriate in a homely setting.Individual training records need to be updated to make sure an accurate record is maintained of all the staff training taking place. Key inspection report Care homes for adults (18-65 years) Name: Address: Tarn House Mill Lane Walney Barrow in Furness Cumbria LA14 3XX 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: Ray Mowat Date: 1 2 0 5 2 0 1 0 Care Homes for Adults (18-65 years) Page PAGE of NUMPAGES This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 3 of 41 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 4 of 41 Information about the care home Name of care home: Address: Tarn House Mill Lane Walney Barrow in Furness Cumbria LA14 3XX 01229471798 01229470125 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.cumbriacare.org.uk Cumbria Care Name of registered manager (if applicable) Mrs Bernadette Eileen Calldine Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 14 3 0 0 care home 14 learning disability physical disability Additional conditions: The maximum number of service users who can be accommodated is: 14 The registered person may provide the following category/ies 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 (maximum number of places: 14) Physical disability - Code PD (maximum number of places: 3) Date of last inspection 0 2 0 6 2 0 0 9 Care Homes for Adults (18-65 years) Page 5 of 41 A bit about the care home Tarn House is a care home providing personal care and accommodation for fourteen adults with learning and or physical disabilities. The home is owned by Cumbria County Council and managed by Cumbria Care, an independent business unit of the County Council. It is situated in a residential area of Walney Island and is close to local amenities and a local bus route that services the island and the nearby town of Barrow-in-Furness. The Home is on two storeys and is divided into four distinct units. These are called Hill View, Sea View, Greenland and Beachwood. Three of the rooms are used for shortterm respite care. Each of the units has a lounge and a separate kitchen with dining area. All the bedrooms are Care Homes for Adults (18-65 years) Page 6 of 41 single occupancy, some of which are fully accessible for people with physical disabilities. To the rear of the building are two fenced garden areas with seating. To the front of the building are open plan garden areas and a large car park, which is shared with the adjoining day service. The scale of charges for the home varies according to persons assessed needs and are agreed on admission, with additional charges agreed on an individual basis for personal sundry expenses. The home makes relevant information available to residents in an accessible format including the statement of purpose and service user guide. The previous inspection report is displayed in the home and is accessible to people on request. Care Homes for Adults (18-65 years) Page 7 of 41 Care Homes for Adults (18-65 years) Page 8 of 41 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 Care Homes for Adults (18-65 years) Page 9 of 41 How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. During the visit we, The Care Quality Commission (CQC), met with people living in the home and spent time with the Registered Manager Mrs Bernie Calldine. We also met with supervisory staff and care staff individually and talked to them as they went about their duties. Care Homes for Adults (18-65 years) Page 10 of 41 The Registered Manager completed a self assessment questionnaire called an Annual Quality Assurance Assessment, AQAA and sent it to us before the inspection visit. This provided us with information about how the home is run and the manager’s views on what the home does well, where they have improved and plans for the future. There is also information about the people who live in the home and the staff working there. Surveys were sent out as part of this inspection to people living in the home, staff and other professionals with their views being used to formulate the judgements in this report. Care Homes for Adults (18-65 years) Page 11 of 41 We also examined records relating to the running of the home that are required by legislation, which included care plan files that guide staff in supporting people to achieve their goals and lead independent lives. We examined staff files and records relating to the maintenance and safety of the home. Care Homes for Adults (18-65 years) Page 12 of 41 What the care home does well The care needs assessment process is very thorough providing staff with detailed personal information helping them to make sure the service they provide is both personalised and consistent. The majority of admissions are on a planned basis enabling people to make an informed decision about moving in to the home. Person centred care plans are agreed with each person, which provide a valuable insight for staff about what is important to the person and their preferences about how they want to live their lives. Information about peoples Care Homes for Adults (18-65 years) Page 13 of 41 communication needs are well documented so that staff understand and can support people to make their needs known and lead an independent lifestyle. People are relaxed and comfortable in their home environment and get good support to access the local community to pursue their interests and hobbies. They also value the opportunity to take an annual holiday of their choice with support from staff. A good range of activities are available to people with staff supporting people both in the home and in the local community. Staff liaise with other professionals to make sure personal and health care needs are assessed and responded to appropriately. All health interventions are recorded enabling staff to monitor peoples changing needs. Care Homes for Adults (18-65 years) Page 14 of 41 The home benefits from having a full compliment of staff who have developed a good understanding with the people living in the home making sure they receive a personalised service. The home has a stable management and supervisory team who support staff in providing a consistent and reliable service. What has got better from the last inspection The statement of purpose and service user guide has been reviewed to make sure all the information is up to date and accurate and is provided to people in an easy read format. Care Homes for Adults (18-65 years) Page 15 of 41 Care needs assessments are being kept under review and appropriate action taken if peoples needs change, to make sure the home is suitable and peoples needs can be safely managed in the home. People are more involved in the day to day running of the home with monthly house meetings taking place enabling them to share their views and concerns. Quality questionnaires are being used to evaluate the night time support for people using the respite service to make sure it is meeting their needs. Care Homes for Adults (18-65 years) Page 16 of 41 COSHH substances were securely stored throughout the home to prevent people from harm. Staff have received refresher training in the safe handling of COSHH substances to ensure they understand their responsibilities. All staff now receive fire instructions at appropriate intervals to make sure they know how to respond in an emergency situation. The fire procedures and fire risk assessment file have been reviewed to make sure all documents are up to date, relevant and in line with fire regulations and a Fire Service visit is planned. Care Homes for Adults (18-65 years) Page 17 of 41 What the care home could do better The manger should make sure all the people living in the home agree and sign a contract of terms and conditions that explains the fees to be charged, the services provided and the terms and conditions of residence. The contents of the general risk assessment file should be audited to make sure only accurate and up to date risk assessments are held and they are clearly sectioned in the file making them easy to refer to. Care Homes for Adults (18-65 years) Page 18 of 41 The manager should liaise with the other agencys involved in the decision to restrict one persons visitors to the home to make sure Deprivation Of Liberty safeguards are being followed. The personal hygiene policy and procedure was displayed on the wall in the bathroom which is not appropriate and should be removed. An alternative solution for protecting people from the hot water pipes and radiators should be sought as the grey insulating foam and metal radiator guards are unsightly and inappropriate in a homely setting. Care Homes for Adults (18-65 years) Page 19 of 41 Individual training records need to be updated to make sure an accurate record is maintained of all the staff training taking place. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Ray Mowat CQC Northwest Citygate Gallowgate Care Homes for Adults (18-65 years) Page 20 of 41 Newcastle upon Tyne NE1 4PA Telephone 03000616161 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 21 of 41 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 22 of 41 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. Good systems are in place to make sure peoples needs are fully assessed and informed decisions can be made about the suitability of the home. Evidence: Since the last inspection visit the statement of purpose and service user guide has been reviewed and all the information updated. The documents are provided to people considering a move in to the home, giving them a clear understanding about all aspects of the service provided and their rights and responsibilities. We examined three care plan files in detail including one person who had recently moved in to the home enabling us to evaluate the admission procedures. Two of the people were planned admissions and one person was an emergency admission. All the files contained detailed care needs assessments including specialist assessments by other professionals. The assessments were very detailed and person centred, giving staff a good insight and understanding about how to support and care for the individuals. The assessment process included the person and significant people in their lives giving staff enough information to develop detailed person centred care plans for each person. The person who had been admitted on an emergency placement also had a thorough care needs assessment Care Homes for Adults (18-65 years) Page 23 of 41 Evidence: completed but risk assessments were not in place. The manager explained that the homes staff were now working closely with the community health team to develop a care plan including a risk profile. The detailed assessments and care plans support and guide staff in providing a personalised service that meets peoples assessed needs. The home has a well trained and experienced management and staff team, who have the skills and experience to provide a safe and consistent service. Even when emergency admissions are requested the assessment process ensures an informed judgement is made about the suitability of the home and its ability to meet peoples needs in the short term. The majority of people moving in to the home is on a planned basis and as a result of social work or multi disciplinary assessments. In one of the files we examined there was a good example of this. The social worker involved had met with the person and the home and agreed a programme of planned visits and overnight and weekend stays to enable both the person and the home to make an informed decision about the suitability of the home. It also provides staff with an opportunity to get to know the person and assess their compatibility with people already living there. Although there were letters from the manager held on care plan files regarding the level of fees to be charged each year and the service user guide contained service information, there were no agreed, up to date contracts of terms and conditions. The manger should make sure all the people living in the home agree and sign a contract of terms and conditions that explains the fees to be charged, the services provided and the terms and conditions of residence. A copy should then be held on file and a copy issued to the person or their Representative. Care Homes for Adults (18-65 years) Page 24 of 41 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. Detailed care plans support and guide staff in providing a personalised service that promotes choice and independence. Evidence: The home develop comprehensive person centred care plans for each person living in the home. The files we examined were informative and provided staff with a good insight to an individuals personal care and health care support needs. There was evidence they are kept under review to make sure they are up to date and accurate, reflecting peoples changing needs and personal preferences about how they like to live their lives. The plans were very detailed giving staff a good understanding about a persons daily routines and what is important to them in their lives. The person and their relatives or Representatives are involved in developing and agreeing the plans ensuring they reflect their views and wishes. Communication needs are well documented, which is essential to staff so they know how a person makes their needs known. There was also evidence the care plans have been developed and reviewed with input from other professionals who have liaised with the homes staff on an ongoing basis to develop specific strategies and guidance to help staff support peoples specialist needs. Care Homes for Adults (18-65 years) Page 25 of 41 Evidence: How people who live in the home make choices in their lives and any personal preferences they have expressed are well documented. Staff are aware of promoting peoples independence and choice about how they live their lives from small day to day choices to more major life decisions. Based on our discussions and observations staff take on an enabling role prompting and supporting people to achieve their personal goals. After the recent Quality Assurance survey any issues people had raised have been addressed individually with staff agreeing an action plan with the person stating what the action is, who is responsible and when it will be achieved. This ensures peoples views are respected and responded to in a timely manner. Due to some restrictions on visitors to the home recorded in one persons care plan, it is recommended the manager liaises with the other agencys involved in this decision, to make sure Deprivation Of Liberty safeguards are being followed. Another new development that gives people the opportunity to have their views heard is the monthly house meetings. Dates of meetings are planned for the year and an agenda posted on the notice board. Key workers support people in preparing for the meeting and recording any concerns or issues they raise. This is proving a very effective way of empowering people living in the home and including them in the running of the home and being involved in the decision making process. Individual risk assessments were in place on peoples care plan files where specific hazards were assessed. In addition a general risk assessment file is maintained that included more generic activities such as group trips or other potentially hazardous activities. The risk assessment file was not well ordered and contained old information that was no longer relevant making it difficult to find the relevant and current information. The contents of this file should be audited to make sure only accurate and up to date risk assessments are held and they are clearly sectioned in the file. All personal and confidential information is securely stored in line with Data protection guidelines. Staff we met were aware of the importance of maintaining confidentiality at all times and they have suitable policies and procedures to guide their practice. Care Homes for Adults (18-65 years) Page 26 of 41 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 are enjoying a fulfilling and independent lifestyle that meets their individual needs. Evidence: The majority of people living in the home attend a local day service Monday to Friday each week. This provides them with a good range of both educational and vocational activities. The homes staff work closely with day service staff to make sure a good continuity of care is maintained and relevant information is shared to help and support people to achieve their goals. Key workers are appointed for each person who take a lead role in supporting the person to develop their person centred plan ensuring it reflects their personal interests and preferences about how they like to live their lives. This includes useful information such as likes and dislikes and what is a good day for them and what is a bad day. The care plans we examined reflected a good range of activities being provided both in the home and in the local community. People are using local amenities such as shops, the Post Office, the local college, leisure facilities and pubs. It was evident from our discussions and observations that people were being supported to Care Homes for Adults (18-65 years) Page 27 of 41 Evidence: lead a more independent lifestyle with unobtrusive staff support. Personal relationships and family contact are well documented in the care plans with a record of the significant relationships in peoples lives. Staff support people to maintain contact with friends and family through both visits and phone contact. They liaise with other professionals for advice and guidance when concerns are identified to make sure people are supported and safeguarded. Restrictions on one persons care plan were recorded that should be reviewed using the Deprivation of Liberty safeguards good practice guidance. Meals and mealtimes are very flexible with each of the distinct units agreeing a weekly menu and shopping for their provisions independently. People are given a choice at each mealtime with alternatives provided if required. Diet and nutrition are monitored through the care plan review process with specialist advice sought when needs arise. Care Homes for Adults (18-65 years) Page 28 of 41 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal and healthcare needs are well documented enabling staff to monitor needs and provide a sensitive, personalised support that meets peoples individual needs. Evidence: As part of the person centred plan health action plans are maintained recording peoples health care needs and preferences in detail. Daily routines including the support required with various personal care tasks is clearly recorded enabling staff to take on an enabling role that promotes the individuals Independence with the personal care task. There was evidence staff respect peoples dignity when supporting personal care with tasks being carried out in private with the persons consent. Specific aids and adaptations are in place as a result of specialist assessments by other professionals, which help people to maintain their independence. Key workers take a lead role in liaising with other agencies and professionals to make sure individual and specialist needs are responded to safely and consistently. All routine and one off appointments and interventions by health and other professionals are recorded. With some people having specific multi agency strategies in place to guide staff. Medication requirements are recorded including specific procedures to guide staff when administering PRN(as and when required) medications. The home has recently reviewed their medication procedures to make them easier for staff to follow and avoid Care Homes for Adults (18-65 years) Page 29 of 41 Evidence: confusion. The systems were working effectively ensuring people were receiving their prescribed medication in a safe and consistent manner. Records examined were up to date and accurate ensuring all medication was accounted for. Care Homes for Adults (18-65 years) Page 30 of 41 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. Good policies and procedures are in place that ensure people are protected and their views are heard. Evidence: No complaints have been received since the last inspection. The organisation has produced a suitable complaints policy and procedure that was recently reviewed and updated. This can be produced in alternative formats such as braille or audio versions and also in another language on request. It clearly sets out the procedure to be followed explaining how the concern or complaint will be handled and the timescale for responding to it. Compliments are also recorded. People we met and received survey responses from confirmed they were aware of how to raise a concern or complaint and who to talk to. The staff working in the home are provided with suitable safeguarding training to make sure they are aware of how to identify and report potential or actual abuse. There was evidence the home has made appropriate referrals to the relevant agency ensure people are protected from harm when concerns have been raised. Suitable policies and procedures are in place which are issued to staff that guide and support good practice. Care Homes for Adults (18-65 years) Page 31 of 41 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some aspects of the home environment need improving to make sure it meets peoples needs in a comfortable and homely way and is decorated to an appropriate domestic standard. Evidence: Despite being raised with the manager previously some rooms still have grey insulating foam, held on with industrial black tape, protecting water pipes. Although this protects people it looks unsightly and is totally inappropriate for a small domestic situation. In addition metal radiator guards are in place throughout the home and strip lighting, which might be practical but are more suited to an institution and do not give a homely feel. The manager must now address these issues making sure all areas of the home are suitably maintained and meet peoples needs in a comfortable and homely way, being decorated to an appropriate domestic standard, as stated in their own statement of purpose and service user guide. We toured the building and grounds during this visit including peoples bedrooms and the communal areas of the home. Improvements had been made around the home including an accessible shower room on the first floor. Individuals rooms were decorated to their own personal taste with their own belongings such as photographs, furniture and fittings of their choice. Some of the rooms have the original built in cupboards, which although dated are functional. Domestic staff maintain the cleanliness of the home in addition to Care Homes for Adults (18-65 years) Page 32 of 41 Evidence: people being involved in cleaning their own rooms. The gardens to the rear of the home have accessible patios and seating areas where people can relax and socialise in the summer months. There are suitable aids and adaptations around the home that promote peoples independence with bathrooms and toilets being accessible and fitted with suitable equipment to promote independence and maintain peoples dignity. In the upstairs flat a personal hygiene policy and procedure was displayed on the wall in the bathroom which is not appropriate and should be removed. The fire escape to the rear of the home is rusting badly and although it is structurally sound it is unsightly and in need of refurbishment and painting. Care Homes for Adults (18-65 years) Page 33 of 41 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 full compliment of staff who provide a personalised and consistent level of care based on individuals needs. Evidence: The staffing situation in the home has continued to improve with no relief staff being used on a regular basis. Any staff absences are covered by regular permanent or relief staff which gives a good continuity of care to people. Feedback from staff we met and who returned surveys was very positive, with staff feeling valued and part of the team. Staff are issued with suitable job descriptions and complete an appropriate induction training programme including the Learning Disability Qualification (LDQ). The organisation is also committed to providing NVQ training to all levels of staff, with supervisory staff completing the NVQ level 3. The manager has completed a training needs analysis for all the staff to identify their training and development needs. A programme of training has been planned from this identifying the numbers of staff who require specialist training or refresher courses in the coming year. This information is shared with the organisations central training department who make sure suitable courses are provided. If the training plan is implemented as planned this will ensure all staff have the relevant skills and knowledge for their roles. Individual training records need to be updated to make sure an accurate record is maintained of all the staff training taking place. The manager described how staff will be responsible for maintaining Care Homes for Adults (18-65 years) Page 34 of 41 Evidence: continuing professional development files at supervision and team meetings, recording all their training and development activities. We examined a selection of staff files and found these to be in order, with relevant checks and references recorded. One of the supervisory team was undertaking an audit of security checks as some of them were due for renewal, which is good practice. There was evidence of regular formal supervision meetings between staff and one of the management or supervisory team enabling them to reflect on their practice and plan training and development targets. Care Homes for Adults (18-65 years) Page 35 of 41 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 manager and supervisory team make sure the home is operating effectively and in the best interests of the people living there. Evidence: The manager is still working toward her registered managers award. She is suitably experienced working for many years in Learning Disability services and more recently in a management role. The manager formally supervises six supervisory staff making sure the home meets its stated purpose, aims and objectives. Through regular supervision and team meetings the management team create an open and positive atmosphere and make sure a good continuity of care is maintained and important information is shared. In addition monthly house meetings are taking place enabling the people living in the home to be involved in the day to day running of the home and decision making. Staff we met confirmed that these meetings have been an effective way of sharing information and empowering the people living in the home. Regular consultation is taking place with people with annual quality assurance questionnaires being one of the ways used to get feedback from people living in the home. The results from this are recorded on individual action plans identifying agreed Care Homes for Adults (18-65 years) Page 36 of 41 Evidence: actions, who is responsible and when they will be achieved. More informal consultation is also taking place on a daily basis with key workers and care staff working closely with the person and their families or representitives to make sure the home is operating in their best interests. The organisation makes sure there is a good range of policies and procedures in place in line with current legislation and good practice guidelines. Staff are aware of the key policies and procedures and receive suitable training to guide their practice. All the records we examined were securely stored but were accessible to the person and the staff supporting them. All routine health and safety checks and servicing of equipment were taking place as required making sure the home environment is safe. Fire drills and a record of tests were now taking place and the fire risk assessment has been updated, with the fire service due to complete an inspection visit in the near future. Specific manual handling risk assessments and a range of other risk assessments are ensuring both the people living in the home and the staff supporting them are safe at all times. Care Homes for Adults (18-65 years) Page 37 of 41 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 38 of 41 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 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 5 The manger should make sure all the people living in the home agree and sign a contract of terms and conditions that explains the fees to be charged, the services provided and the terms and conditions of residence. The manager should liaise with the other agencys involved in the decision to restrict one persons visitors to the home to make sure Deprivation Of Liberty safeguards are being followed. The contents of the general risk assessment file should be audited to make sure only accurate and up to date risk assessments are held and they are clearly sectioned in the file. The fire escape to the rear of the home is in need of refurbishment and painting. An alternative solution for protecting people from the hot Page 39 of 41 2 7 3 9 4 5 24 24 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 water pipes and radiators should be sought as the grey insulating foam and metal radiator guards are unsightly and inappropriate in a homely setting. 6 27 The personal hygiene policy and procedure was displayed on the wall in the bathroom which is not appropriate and should be removed. Individual training records need to be updated to make sure an accurate record is maintained of all the staff training taking place. 7 35 Care Homes for Adults (18-65 years) Page 40 of 41 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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