Care Home: The Anchorage

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What the care home does well People have told us that they visited and were "very happy" to live at the Anchorage. They were given a lot of information about what to expect.The team are very good at finding out about people and ensures that every person has a care plan.People say that they have "a lot of freedom" to do what they want to, when they want. There are a few house rules to make sure people are safe.They know who to speak to if they have any concerns, and know these will be dealt with.People understand their responsibilities and are encouraged to learn new skills like cooking.The activities, events and work that people do are tailored to their likes and dislikes. People said, "I like going to the colour cabin" and "I like cooking and dusting" and "We went to see a show in Barnstaple". Family and friends are made welcome. The Anchorage is a comfortable place to live. People see it as their own "home" and that it is always clean and nicely decorated.Staff are well supported. They do a lot of training so that they have the right skills and experience to care for people. What has improved since the last inspection? Important information like the staff roster is in easy words and pictures so everyone knows what is happening. What the care home could do better: People`s medicines are not always kept secure and at the right temperature. We have made legal requirements about this. The provider must improve this. Key inspection report Care homes for adults (18-65 years) Name: Address: The Anchorage 47 Abbotsham Road Bideford Devon EX39 3AF 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: Susan Taylor Date: 3 0 0 7 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 33 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 33 Information about the care home Name of care home: Address: The Anchorage 47 Abbotsham Road Bideford Devon EX39 3AF 01237421002 01237421002 jeddinternational@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Jedd International Ltd. Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 9 Number of places (if applicable): Under 65 Over 65 9 0 learning disability Additional conditions: On the termination of the placement of the named service user, the registered person will notify the Commission and the particulars and conditions of this registration will revert to those held on the 28 November 2005 The maximum number of placements including that of the named service user will remain at 9. This variation allows the admission of one named person, aged 16 years, in the category of Learning Disability (LD). Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 33 A bit about the care home The Anchorage is a large, older house that is close to Bideford. Up to 9 people with learning disability are able to live there. Everybody who lives at the home has their own bedroom. Nobody has to share a room. Copies of previous inspection reports are on the notice board just inside the home. The fees range from £316.88 to £469.68 per week. People also have to pay for toiletries, clothing, hair dressing and chiropody and any private day care. Care Homes for Adults (18-65 years) Page 5 of 33 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 6 of 33 How we did our inspection: This is what the inspector did when they were at the care home We talked to 6 people who live at the home. We looked at some of the policies and procedures in the office. Policies are rules about how to do things. Procedures tell people how to follow the rules. We sent surveys to people that live at the Anchorage. The comments from 6 people are in the report. We also sent surveys to staff and 6 were returned. The manager sent us a lot of information about the home. This said what was good and what needed to improve. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well People have told us that they visited and were very happy to live at the Anchorage. They were given a lot of information about what to expect. The team are very good at finding out about people and ensures that every person has a care plan. People say that they have a lot of freedom to do what they want to, when they want. There are a few house rules to make sure people are safe. Care Homes for Adults (18-65 years) Page 8 of 33 They know who to speak to if they have any concerns, and know these will be dealt with. People understand their responsibilities and are encouraged to learn new skills like cooking. The activities, events and work that people do are tailored to their likes and dislikes. People said, I like going to the colour cabin and I like cooking and dusting and We went to see a show in Barnstaple. Family and friends are made welcome. The Anchorage is a comfortable place to live. People see it as their own home and that it is always clean and nicely decorated. Care Homes for Adults (18-65 years) Page 9 of 33 Staff are well supported. They do a lot of training so that they have the right skills and experience to care for people. What has got better from the last inspection What the care home could do better Care Homes for Adults (18-65 years) Page 10 of 33 Peoples medicines are not always kept secure and at the right temperature. We have made legal requirements about this. The provider must improve this. 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 Susan Taylor CQC South West Citygate Gallowgate Newcastle upon Tyne NE1 4PA 03000 616161 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Adults (18-65 years) Page 11 of 33 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 12 of 33 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 13 of 33 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. Potential new people benefit from a good admission and assessment process, which ensures that the home can meet their needs. Evidence: The Statement of Purpose provided was clearly written with a good description of the service to be provided and was in a total communication format with pictures. 100 percent of people responding in a survey verified that they received enough information about the home before they moved in. At the home, people had a guide about the home that was in total communication format. At the same time, people spoke about how they had been consulted at a meeting about a prospective resident. Information sent to us by the manager verified that shared care assessments are obtained from health and social care professionals before people are admitted to the home. We looked at 2 care files to establish whether the care delivered was based on detailed assessment of peoples needs. Assessments were person centred and contained a lot of information. This included the persons needs in terms of disability and medical Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: background. Additional information gathered included a persons preferences about routines and meals, significant relationships and social interests. Where appropriate the individuals advocate had also been involved in the process. Hazards had been identified for each person and the level of risk was clear with regard to issues such as behaviour, activities, door keys, medication, finances, scalding from hot water surfaces, water and laundry. Assessments had been regularly reviewed. We looked at the file of an individual with diabetes. Whilst information about diabetes had been obtained, there was insufficient guidance for staff about what to look out for should indicating that this person was becoming hypoglycaemic or hyperglycaemic. Additionally, there was no specific guidance for staff about the action that should be taken if the persons health suddenly deteriorated. We tracked the care of a person who told us that following a spell in hospital they had become sore and now had to sit on a pressure relieving cushion. Measures had been put in place to prevent pressure damage occuring. However, the level of risk for this person had not been assessed to ensure that the measures were right for the individual. We looked at a third care file for someone that has epilepsy. Records demonstrated that the person needs to be monitored closely to ensure that their safety is maintained during a seizure. Records demonstrated that an alarm is used to alert staff when the person is having a seizure during the night. Staff told us that they did not want to disturb the person unnecessarily at night. However, the persons safety is also paramount and they need to know when the individual is having a seizure so that they can immediately give care to them. The persons mental capacity had not been assessed to establish whether they have the ability to consent to using such equipment. Careful assessment and agreement from all stakeholders, including the individual and their advocate needs to be obtained so that all decisions are made in the persons best interests. Therefore, we have made a recommendation about this. Care Homes for Adults (18-65 years) Page 15 of 33 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. Overall, people living at the Anchorage are involved in planning their lives there. Evidence: We looked at 2 care plans to see how care is planned and delivered. Where possible people living at the home, their family and relevant professionals are involved in the development of care plans and reviews. The care plans set out individual needs, preferences and any associated risks. The care plans had specific headings to address health, personal and social care needs, including individual and diverse needs. Good information is available about peoples abilities, how they communicate, their preferences and emotional and psychological needs. Records seen demonstrated that the team had sought guidance from relevant health and social care professionals when planning or reviewing peoples care. Although information about peoples needs is detailed in care plans, one person who we case tracked did not have sufficient guidance in their care file about a change in their physical health that meant that they were potentially at risk of developing pressure sores. However, we observed that staff had ensured that the person was sitting on a pressure Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: relieving cushion and doing exercises as advised by other healthcare professionals. Similarly, the individual themselves knew that it was important for them to do this and why nurse specialists had advised them to sit on a pressure relieving cushion for example. 6 staff in surveys verified that they are always given up to date information about peoples needs. One person also wrote care plans and risk assessments are regularly updated. Staff we spoke to at the home told us, Care plans tell you exactly what you need to know about peoples abilities, communication needs etc. They are very useful. Surveys show that people living here are always able to make decisions about their daily life. However, 1 person living at the home is unable to express their wishes and choices verbally. The persons care plan contained information to guide staff about how to assist the individual to make decisions and choices. This includes information about peoples preferences, how to recognise non-verbal clues and objects of reference. The AQAA tell us that a number of people living at the home have been assisted to access advocacy services, which provides an independent support for people. Staff told us how some people let them know about their needs, and likes and dislikes through behaviour, facial expressions, noises and body language, which are reflected in the care plans for staff to understand and follow. Staff also told us they sometimes use objects of reference and choice indicators to help them communicate with people and ensure that individuals can make simple choices. We saw people making simple decisions about their daily lives, such as what activity they engaged with, where to spend their time and what they wanted to eat at mealtimes. Similarly, people we met told us that their views were always sought about the suitability of individuals attending an interview for a staff position. Risks to people are identified and guidelines for reducing and managing risks associated with behaviour, situations or the environment are available to staff. This ensures staff have the information they require to keep people safe. Risk assessments enable people living at the home to be involved in activities they enjoy such as swimming or outings to place of interest. Care Homes for Adults (18-65 years) Page 17 of 33 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 enjoy regular and varied activities and links with family, friends and the local community are good. Evidence: The AQAA tells us that people are very much part of the local community taking part in events, outings. People have had access to education, training and work placements and further opportunities have been made available in the last 12 months. Records showed that people visit local shops, cafes, clubs, beaches and other facilities. People told us (via surveys), I listen to music a lot and I like playing on my computer or listening to music. Similarly, when we met people at the home we were told I like going to clubs and I go to work. During our visit we saw people engaged in a variety of activities. We saw one person appearing to enjoy banging and shaking an instrument. Two other people were watching daytime TV, one person was listening to music in their room and another was polishing their bedroom furniture. A group of people arrived home late afternoon having been out to work placements or doing arts and crafts. We were told that visitors were welcome. One person we spoke to said that they often go away for the weekend to spend Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: time with their family. Care plans contain information about peoples preferred routine and staff told us, where possible, peoples preferences are met. There was a relaxed atmosphere within the home. People in the home invited us to join them for lunch. People said they liked the food. It was a relaxed atmosphere. Staff preparing the meal said that they knew peoples likes and dislikes because this information is written down in their care files. We observed individual preferences being catered for. For example, we saw that all 4 people that were at home chose something different for their lunch. Another person, chose not to have their lunch until later and this was respected by staff. Additionally, we observed people making tea and coffee for themselves and other people with discreet support from staff. The staff told us about a project they are doing with people that will ensure there is better access to menus in a total communication format. A member of staff is collating photographs of different foods for this purpose. Staff said that they would be able to use this to support people better in meal choice, shopping and preparation of food. We observed this being put into practice with the individuals concerned over the course of the inspection. Care Homes for Adults (18-65 years) Page 19 of 33 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. Peoples health and social needs are planned and consistently followed by staff. People cannot be assured that best practice is always followed with regard to the management of the medicines. Evidence: Protocols within care plans provide good guidelines on how to manage complex health needs. Care plans described individuals health care needs and showed their needs were monitored and specialist health professionals are regularly consulted. Staff have received a range of training on health issues relevant to the people they care for, such as epilepsy. Records show that peoples weights are monitored two or three times a year and that three of the four looked at had a stable weight. We tracked the care of a person that had been prescribed insulin. Staff we spoke to told us that District Nurses had provided training about giving insulin. The individual themselves told us that staff help them to take this medicine every day by setting the device and letting them inject themselves. Records show that people receive additional specialist support from physiotherapists, occupational therapists and speech and language therapists to ensure their individual needs are met. Guidelines from various health specialists were included in care plans. The home uses a monitored dosage system. Senior staff said that they are responsible for stock taking and giving out medicines. Records of ordered drugs and a register of Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: controlled drugs were seen, although none had been prescribed for the people living in the home. The system was easy to audit and we tracked medication given to 2 people. Records accurately reflected medication having been given as prescribed by the GP. We also observed that safe practice was followed by staff when giving out medicines prescribed for people at lunchtime. All medication is kept in a locked built in cupboard; however the facilities for controlled drugs, ordinary medicines and medicines requiring refrigeration do not meet the current legal requirements (information about the changes is available on our website). We discussed this with the acting manager who said that they would take further advice from the pharmacist that supplies medicines about upgrading the storage facilities. Medicines requiring refrigeration at a certain temperature, for example stocks of insulin, eyedrops or antibiotics was kept in an unlocked domestic fridge with other food. We spoke to staff about temperature checks and were shown records demonstrating this had been done. Therefore, the provider can be sure that medicines are being stored within the safe temperature range recommended by the manufacturer. However, the arrangements mean that that people cannot be confident that their medicines are stored securely enough. Certificates seen in files verified that all of the staff that gives out medicines has had training to do this. Care Homes for Adults (18-65 years) Page 21 of 33 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 at the Anchorage are protected and able to voice their concerns, safe in the knowledge that these will be acted upon. Evidence: People responding with surveys said they know who to speak to should they have any concerns. Most of the people living at the Anchorage are able to tell someone if they were unhappy about any aspect of their life their. However, information about the complaint procedure has been produced in a total communication format making it accessible to everyone living there. We saw a copy of this displayed in the entrance hall and people told us they knew who to go to if they were unhappy about something. Surveys indicated that family members and key workers would advocate on behalf of individuals if they felt they were unhappy about something. Information sent to us verified that no safeguarding or POVA referrals had been made since the last inspection. However, the Commission received concerns in June 2009 and made a referral that was dealt with under the safeguarding process. The registered provider has worked closely with other professionals and demonstrated good partnership working and a willingness to ensure that people living at the Anchorage are protected. We saw a copy of the Alerters guide, the updated version of which, had been obtained from Devon County Council. The home also had a whistle blowing policy, which all of the staff we spoke to understand. Staff told us that they have had training about how to recognise and report abuse. Kind and caring interactions were observed throughout the day between staff and people living in the home. Staff engaged positively with people Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: who had dementia and demonstrated genuine warmth when engaging those individuals. Information sent by the provider told us that 55 percent of the staff holds an NVQ in Learning Disabilities, part of which is about safeguarding people. Staff told us that policies and procedures are discussed with them. We looked at training records and saw that Safeguarding Adults training had been provided for staff. Therefore, people are cared for by well trained staff in a culture that does not tolerate any form of abuse. We observed that people are treated with respect and encouraged to see the Anchorage as their home. Care Homes for Adults (18-65 years) Page 23 of 33 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 comfortable home that is clean, well maintained and meets their needs. Evidence: The AQAA tells us the home has a redecoration and replacement schedule. Overall the home was well maintained and decorated. Four people showed us their bedrooms, which had been decorated and personalised to reflect individual tastes and interests. One person said that they had chosen the colour of the room when it was decorated. The personal aids and equipment people need to maximise their independence and comfort are available. People told us in surveys that the home was always clean and fresh. Similarly, staff responding in surveys made comments like a homely atmosphere is created. There is a separate laundry room with domestic equipment. Staff told us that they support people to do the washing. Infection control measures, such as hand washing facilities are good, and staff have protective equipment such as gloves and aprons to promote good practice. The AQAA shows that all staff have received training in prevention and control of infection. The acting manager was aware of the Department of Health guidance about dealing with a potential outbreak of swine flu and was considering what measures would need to be put in place if people living in the home or staff were affected. Care Homes for Adults (18-65 years) Page 24 of 33 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment practices at the Anchorage are robust and inclusive and therefore protect the people living there. The training and development programme ensures that competent and knowledgeable staff cares for people. Evidence: In a survey 100 percent of people tell us that staff are always available when they need them. Similarly, all the staff responding in a survey verified that there is always enough staff to meet the individual needs of people who use the service. We examined duty rosters for four weeks up to the week of the inspection. On the day of the inspection there were 2 carers during the day till 4pm looking after 5 people that were at home. We examined the files of 2 of the newest staff. Two satisfactory written references had been obtained for all of the staff prior to employment. Independent Safeguarding Authority checks had been undertaken and Criminal Records Bureau certificates had been obtained also before employment commenced. The home had a written procedure about recruitment and retention of staff and it was clear that these had been followed to protect the people living in the home. Two people said that they regularly took part in the recruitment process and that everyone living at the Anchorage is asked their opinion about individuals attending interviews for a staff position. Information that the manager had sent us verified that a wide range of training had been Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: provided over the last 12 months. Records demonstrated that 55 percent of the care staff had achieved the NVQ level 2 specifically covering learning disability. We saw individual training files, which contained further evidence of numberous specialist training having been provided e.g. total communication, disability equality and epilepsy. Induction records seen demonstrated that training meets the appropriate standards set out by the Skills for Care. We spoke to staff about their experience and training opportunities in the home and people verified that this was regularly offered to them. The training and development plan for the home contained information for the period 2009-10 and reflected the needs of people currently living in the home so would ensure that staff has the knowledge and understanding to meet these needs. Care Homes for Adults (18-65 years) Page 26 of 33 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. Interim management arrangements are ensuring that people live in a well run home, where their views count and improvements are made. Health and safety is promoted and ensures that people living and working in the home are protected. Evidence: The Registered Manager has left since the last inspection. Interim management arrangements were put in place in June 2009 and the provider is actively recruiting a new manager. The acting manager and team leader assisted us with the inspection. We found that they both had a clear understanding of their role in meeting the stated aims and objectives of the home. The Commission was sent a lot of information in a document entitled AQAA (Annual Quality Assurance Assessment). In it the provider outlined what the home could do better to improve the quality of life of people living there and how it would be done, in addition to explaining what had improved. Our main concern at the inspection was the security of medication, and therefore people cannot be assured that their tablets are kept safe. However, we are confident that this will have been addressed as the acting manager said that they would contact the pharmacist for further advice about upgrading the storage facilities so that they meet current legislation requirements. Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: We observed that there are clear lines of accountability within the home. People told us that the registered provider makes them feel valued. We observed people being asked for feedback about lunch, their care and activities during the inspection. There is an open door policy that also allows people living there, visitors and staff to speak with the acting manager whenever they wish to do so. Similarly, people said that they have meetings to talk about issues and their plans for the future covering trips out, activities and changes in the home for example. We toured the premises and saw that the certificate of registration was displayed in a prominent position where people living in the home and visitors could see it. Evidence was seen of systems to monitor the quality of the service provided. This included questionnaires and audits of health and safety for example. For people that are unable to look after their own money, the Anchorage holds a small float of money for people. The money is kept in secure facilities. People we spoke to verified this and told us that either they managed their own money or relatives did this for them. We saw records that the home kept and checked balances which were correct. Appraisal records were seen in the staff files we looked at. Staff told us that the manager and provider were always approachable. We looked at 2 records and both staff had had a 1:1 with the manager in the last 12 months. Information sent to the Commission also verified that the manager works alongside staff every day. This ensures that best practice is followed and staffs also have the opportunity to reflect and identify any gaps in their knowledge and experience. Comprehensive Health and Safety policies and procedures were seen, including a poster stating who was responsible for implementing and reviewing these. In information sent to the Commission, the manager verified that risk assessments are carried out. We saw various examples of this with regard to audits done, which included hot surfaces, fire safety and first aid equipment. As we toured the building we observed cleaning materials were stored securely and used with by staff wearing gloves. Data sheets were in place and staff spoken to understand the risks and strategies to minimise those risks from chemicals used in the building mainly for cleaning and infection control purposes. Records of accidents were kept and showed that appropriate action had been taken. The fire log was examined and demonstrated that fire drills, had taken place regularly. Similarly, the fire alarm had also been regularly checked. The fire safety officer had written to the Commission to tell us that the home is fully compliant with fire safety legislation. People living in the home, and staff told us that the alarm was regularly. A certificate verified that an engineer had checked the fire equipment. First aid equipment was clearly labelled. Nearly all of the staff on duty held a current first aid qualification. Risk assessments for the environment had been reviewed since the last inspection. Maintenance certificates were seen for the heating and fire alarm systems. The manager had verified in information sent to the Commission that portable electrical appliance Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: checks had been done and we were told by people living there that an electrician had looked at their appliances. Therefore, the health and safety of people living, working and visiting the home is assured. Care Homes for Adults (18-65 years) Page 29 of 33 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 30 of 33 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 20 13 16/10/2009 The provider must ensure that controlled medicines are stored securely in accordance with the regulations. This is so that people can be assured that their medicines are kept secure. 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 There should be a clear plan detailing how and who is responsible for making decisions for people that are assessed as lacking capacity. This will ensure that decisions are made in the best interests of individuals concerned. People that have conditions like diabetes and epilepsy should have clearly written emergency treatment plans. Page 31 of 33 2 2 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 This will ensure that staff have guidance about how the condition affects the person, what indicates that their health is deteriorating and the action that should be taken. Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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