Care Home: The Ashurst

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What the care home does well The home feels very comfortable and homely. Residents were chatty with staff and with us and took pride in their rooms. The owners are continuing to upgrade the environment, and there is a good relationship between residents, the manager and the administrator/director. Residents are monitored for changes in their health, especially those who are beginning to suffer from the illnesses of older people. It is clear that the residents are well cared for and express their happiness at living in the home. Visiting professionals also praise the home for its speedy response to residents` needs. The residents have a choice over many activities in their daily lives, including where to live, finding work, planning outings or following a hobby. They have a real influence over what goes on in their home. What has improved since the last inspection? Residents` meetings are now a significant route for them to express what they want to happen in the home and in their lives. The home has also encouraged some more able residents to help with household tasks such as food shopping, and keeping their rooms clean and tidy. The range of activities has been widened to include some more physical activities and sports, and supporting those wishing to find a job. The home has supported a resident to apply for, and be allocated, a supported living house. What the care home could do better: No requirements or recommendations have been made as a result of this inspection. However the manager told us about improvements they wish to action. Their principal aim is to give residents more opportunities to run their own home with support, and to give them a sense of ownership of their home and lifestyle. More independent trips into the community will be encouraged after suitable risk assessment. The manager wishes to promote with staffan understanding of the responsibility to avoid taking unnecessary control of residents` lives in keeping with the Mental Capacity Act. The home would like to expand its own day service if funding can be found, and the next staff vacancy will be used to try to attract male applicants. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Ashurst 1 Kirkley Cliff Lowestoft Suffolk NR33 0BY The quality rating for this care home is: three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: John Goodship Date: 0 3 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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 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 Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 31 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: The Ashurst 1 Kirkley Cliff Lowestoft Suffolk NR33 0BY 01502519222 01502537406 ashurstcarehome@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr A T Wight,Mrs Joanna Louise Jay,Mr Martin Edward Jay care home 19 Number of places (if applicable): Under 65 Over 65 19 7 learning disability Additional conditions: 1 Five persons, over the age of 65, whose names were made known to the Commission for Social Care Inspection in November 2004. Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 31 A bit about the care home The Ashurst is a residential care home for 19 people with learning disabilities. The home is located in a residential area of Kirkley south of the coastal town of Lowestoft and is close to the beach, pier, marina, local shops, churches and amenities. The accommodation spans three floors served by a shaft lift. There is one double bedroom, the remaining are single. All bedrooms have a wash hand basin and eight bedrooms have ensuite facilities. The front windows of the home on the first and second floors offer excellent views of the North Sea. The home offers three communal rooms on the ground floor where service users meet friends and relatives, participate in crafts, hobbies or board games or watch television. There is also a small room for private meetings. The fees at the time of inspection ranged from £362.00 to £469.00 per week. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 31 How we did our inspection: This is what the inspector did when they were at the care home We visited the home in order to do a key unannounced inspection. The last one was in June 2007. There was an annual service review by us last year. We spent five hours at the home, focussing on the outcomes for the residents. The manager and one of the owners who acts as the administrator were there throughout, together with six residents plus others who came and went during our visit. We spoke to two residents about their views of the home, and to a member of staff. We inspected care plans for two residents, and one staff record, plus maintenance and safety records. This report includes evidence gathered during the visit together with information already held by the Commission. In addition, a questionnaire survey was sent out by the Commission to residents, staff and health and social care professionals. Ten residents responded, five staff and three professionals. Their answers to the questions and any additional comments have been included in the appropriate sections of this report. The manager was also required to complete an Annual Quality Assurance Assessment which was returned on time, and was full of helpful information about how the home had progressed during the year and what plans there were for more improvements. The information in this assessment has Care Homes for Adults (18-65 years) Page 7 of 31 also been used in the report. What the care home does well The home feels very comfortable and homely. Residents were chatty with staff and with us and took pride in their rooms. The owners are continuing to upgrade the environment, and there is a good relationship between residents, the manager and the administrator/director. Residents are monitored for changes in their health, especially those who are beginning to suffer from the illnesses of older people. It is clear that the residents are well cared for and express their happiness at living in the home. Visiting professionals also praise the home for its speedy response to residents needs. The residents have a choice over many activities in their daily lives, including where to live, finding work, planning outings or following a hobby. They have a real influence over what goes on in their home. Care Homes for Adults (18-65 years) Page 8 of 31 What has got better from the last inspection What the care home could do better No requirements or recommendations have been made as a result of this inspection. However the manager told us about improvements they wish to action. Their principal aim is to give residents more opportunities to run their own home with support, and to give them a sense of ownership of their home and lifestyle. More independent trips into the community will be encouraged after suitable risk assessment. The manager wishes to promote with staff Care Homes for Adults (18-65 years) Page 9 of 31 an understanding of the responsibility to avoid taking unnecessary control of residents lives in keeping with the Mental Capacity Act. The home would like to expand its own day service if funding can be found, and the next staff vacancy will be used to try to attract male applicants. 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 John Goodship 33 Greycoat Street London SW1P 2QF 02079792000 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 10 of 31 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 11 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 12 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Prospective residents can be assured that they will have sufficient information to decide if this home is where they wish to live. The home will also collect information to assure the person that the staff are able and competent to meet their needs. Evidence: The Statement of Purpose and the Service User Guide had been updated and completed fully. They now provided all the information required by the regulations in a large text format. The AQAA told us that the home will be providing mor accessible information about the home which could be taergeted more easily to an individual. Included now were the terms and conditions of residence, and the fees payable. There was a letter in one residents file from Suffolk County Council to their relative detailing the residents contribution to the care fees. All the residents who completed our survey form said that they were asked if they wished to move into the home, and that they received sufficient information about the home so that they could decide if it was the right place for them. There were eighteen people living at the home at the time of our visit. We heard about Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: one person who had been admitted last year with severe autism. We saw their preadmission assessment, and the care plan for supporting them. The person had visited the home,and the day service to meet their key worker with regular weekly visits to gradually get to know them. The clinical psychologist had also given staff training in behaviour management. The manager told us that she believed the staff were improving this persons behaviour and quality of life, but after a six month review, the placing authority decided to transfer them to a more specialist unit in another county. We saw a letter from a social worker for an earlier review which said: The behaviour management strategies used to divert X are very good. The Ashurst staff know X better than anyone. I am sure they will be creative in continuing to address Xs aggressive behaviour. This resident had moved out in March 2009. The AQAA told us about another resident who had moved into the home ifrom another care home. The owner and manager had met this person and discussed the proposed admission and looked at the homes service user guide with them. Since admission, the care plan showed that the home had worked with the clinical psychologist and the community nurse to provide a stable environment for them. This person told us that I like living here. The AQAA told us about the efforts made by the home to enable one resident to decide to move into supported living. The process took a long time and the manager had to advocate on the residents behalf to ensure that they were not let down. A date for this move had finally been agreed for July 2009. The home now had several residents who were over 65 years of age. The homes registration had originally been changed to recognise this, but the Commission does not now impose an age limit on care homes unless specifically stated. Therefore no further application will be required as residents get older. Care Homes for Adults (18-65 years) Page 14 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents can be assured that they will be given every opportunity to decide how to live their lives, supported by staff to ensure their safety. Evidence: The AQAA told us: Our home remains person-centred and we do all that we can to enable each individual to be in control of their life and lifestyle. We spoke to residents and to staff to confirm this statement. We heard of examples of a resident wishing to move to supported living and the support given to them by the home. We were told about one resident who could become aggressive and swear at staff when their attempt to befriend a female resident was rejected. A record of these instances was kept by staff on a form agreed with the resident to help them control this behaviour. The manager told us about one resident who had refused medical treatment for a time due to certain fears. The staff had worked with medical staff to build up their trust and confidence. Eventually this person made the decision to have the treatment. Other examples of residents taking decisions about their lives were: going out to Norwich for the day on their own, choosing not to go to their day activity, choosing what clothes to Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: wear each day. We looked at two care plans and spoke to and observed those residents. The plans covered all appropriate areas of daily living including day activities, preferences, health care, interests, personal safety and a personal hygiene record. There were guidelines for staff on helping one person with their self-control, and there was a good description of what triggered episodes of aggressive behaviour and how to avoid the situations arising, or how to de-escalate the situation when it happened. There were other risk assessments in care plans covering internal and outside situations. Recent assessments included safely using the minibus, and being in the kitchen. One of the residents told us: I like it here. I am happy here. Other comments from the survey were: I like living here and I want to stay here. If I go out for the day, I tell staff where I am going. We saw that the care plans were reviewed by the manager and the key worker with the resident on a six monthly basis. There were update sheets in the front of the plans for quick access by staff to information on changes. The manager told us that some residents were also reviewed annually by Social Service staff. Buffet style breakfasts allowed residents to choose what they ate and to serve themselves as much as they were able. Residents meetings were held regularly, and were increasingly run by, and minuted by, residents. We saw the record of the most recent one in May 2009. Ten residents were present. A housemate of the month was chosen, and upcoming birthdays were listed. Some ideas for future activities were discussed. The AQAA told us that these meetings had become vibrant and productive, and provided a useful opportunity to troubleshoot and defuse conflict and clashes of personality. Care Homes for Adults (18-65 years) Page 16 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents can expect to choose how they spend their time and be supported in their choice. They can be assured that their wishes will be respected and kept confidential. Evidence: The home had developed its own day service called Accord, in conjunction with Lowestoft Community Church, which took place every Thursday. This was for residents who were not able to use the local authority day centres. The AQAA told us that it provided opportunities in craft, music, and in sport. On Wednesdays, one of the senior staff supported three residents on an Out and About day which was planned and organised by the residents. Three residents attended community clubs. Each resident was supported to keep up a Lifestyle book. We saw two examples of these which were completed with the help of the persons key worker. The contents included About me, my family, my room, what I do, holidays, likes and dislikes, Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: looking after myself, keeping me safe, and communication. Although this information was in the care plan, these books put it in a more personalised and resident-friendly format. A resident who was dissatisfied with their day service had accessed a voluntary job in the sewing room of the local hospital. The manager told us, and later the person confirmed, that they found this job very satisfying. We noted that they had needed a Criminal Records Bureau check before being accepted for the job. This person had also taken responsibility for running the homes laundry on one day a week under supervision. They told us that the laundry was too small. The AQAA and the staff gave us numerous examples of the activities which residents either together or on their own had chosen to take part in, both inside the home and outside, covering holidays, sports, gardening, watching DVDs, food shopping, parties, outings in the minibus, looking after their room and helping to look after the home, and visiting former residents who had moved on either to a nursing home or to supported living. Most residents had bus passes, and one resident travelled by themselves to Norwich and Yarmouth regularly. In the survey, all the respondents said that they always or sometimes made decisions about what they did each day, and nearly all of them said they could do what they wanted to do during the day, in the evenings and at weekends. Relatives have told us in the past that they were made to feel welcome whenever they visited. The manager gave us an example where the wishes of the resident were different to those of the relative, and explained to us how it was resolved. The home had in the past experienced a close friendship between a male and female resident.The home had a policy on sexual relationships which emphasised respect, privacy and dignity for those involved. In this case, the manager had discussed it with the nearest relative of one of the residents, and with the GP. Staff had been given guidance on maintaining confidentiality. A health professional wrote in their survey that the staff give due respect to the residents at all times. The AQAA told us that breakfast was buffet style and people could help themselves. Everyone could make tea or coffee, or have juice, when they wanted. During the week, the main meal was taken in the evening. A resident told us: I have no complaints about the food. The menu showed that there was always a choice of main course and desserts for the evening meal. The home kept a food diary which recorded what each person chose. The AQAA told us that residents made their own packed lunches for their day centres and some were baking cakes with staff support. Staff encouraged residents to eat healthily. However, in the end the staff told us that it was the residents choice what they ate. Care Homes for Adults (18-65 years) Page 18 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents can expect their health needs to be monitored and action taken with professional advice. Residents can be assured that they are protected by the homes medication policies and procedures. Evidence: Health professionals told us in their survey forms that residents health care needs were always monitored, and advice sought where needed. The home responds well to support and advice offered. A doctor said: They flag up issues at an early stage. Care plans recorded contacts with NHS services. The community nurse, clinical psychologist, diabetic nurse, stoma care nurse and continence adviser had all been used for different residents. The manager described the support that staff were giving to several residents with particular health problems around dietary and continence issues. Care plans detailed each persons dietary needs. One resident had now become bedfast. They were cared for in a special bed, with an airwave mattress to prevent pressure areas. Their room was set up with a TV, and audio/visual sensory equipment. Another resident had been provided with an orthopaedic bed and a self-propelling wheelchair. Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: The AQAA told us, and the health professionals survey confirmed, that the staff took residents for health checks, medication reviews, blood tests and hospital appointments. One resident told us that they had been for a blood test that morning. One resident with a surgical problem had needed to attend hospital daily for a period. They were accompanied by a member of staff each time. Although this put a strain on resources, the manager told us that it evolved into a very fulfilling and touching experience for carers and the resident. The treatment had been successful and had given the resident confidence if any further treatments were needed. The manager was aware that the changes in some residents health needs, partly as a result of ageing, required more formal staff training in moving and handling, continence and nutrition. None of the residents had charge of their own medication. A check of the Medication Administration Record (MAR) sheets showed that all administrations had been signed for. All lotions and creams were identified to a resident. Stock levels of a sample of drugs tallied with the amount dispensed since the last delivery. The manager told us that she carried out spot checks of the MAR sheets to ensure procedures were being followed. The home had been able to care for an elderly resident during their last days without the need for them to remain in hospital. The manager told us that she had spoken to the parents of a resident whose health was giving concern to ensure that end of life wishes were known and followed. Care Homes for Adults (18-65 years) Page 20 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents can be assured that their views will be listened to, and acted upon. There is a proper policy, procedure and training programme for staff in place to give residents confidence that they are protected from abuse. Evidence: Although the home had a formal complaint recording book, no complaints had been received in the previous twelve months. None had been received by the Commission. All the residents who replied to the questionnaire said that they knew who to speak to if they were not happy. All the staff replies confirmed that they were aware of the homes complaints procedure. The manager told us, and the minutes confirmed, that issues of concern were raised at the residents meetings when quick action could be taken. The AQAA told us that staff were regularly guided at staff meetings and in individual supervisions in ways to diffuse conflict and avoid physical aggression. One resident had had their bed fitted with bed rails after a risk assessment and with the agreement of the resident, the parents, the community nurse and the social worker. The policy on the protection of vulnerable adults had been updated to include the latest Suffolk County Council procedure. The training of staff in this area was done by the manager through staff meetings. Minutes of these meetings, and discussion with Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: staff confirmed this. All staff who completed the survey said that they were aware of the homes complaints policy, and had received training in the homes abuse policy. Staff were e of the homes whistle blowing policy and the access to Customer First. The manager told us that she intends to ensure that all staff receive training in the implications of the Mental Capacity Act and the Deprivation of Liberty Regulations. All staff appointments were subject to checks with the POVA list and the Criminal Records Bureau for the protection of residents. Care Homes for Adults (18-65 years) Page 22 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents can be assured that they live in a safe and well-maintained home, and that they will be encouraged to personalise their rooms as much as they wish. Evidence: The AQAA told us that the home had a continuous redecoration programme. Each room was being redecorated in turn in colours and carpets chosen by the occupant. Three residents with mobility problems had ground floor rooms. There were eleven rooms with ensuite facilities. One resident had grab rails and a shower seat in their ensuite, and another had a bath lift. The home employed a permanent maintenance man who undertook the redecorations. The communal areas were now in three parts; one large lounge for noisier activities, one for quieter ones, and a third for private meetings with relatives or other visitors or for residents to use on their own. The carpet in the main lounge was marked and looked ready for replacement. There were a variety of tubs outside where some residents were growing plants and tomatoes. This originated from a request from a resident. The manager told us that this had led to more residents choosing to sit in the back garden. Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: Residents told us in their surveys that the home was fresh and clean. One told us: I dust my bedroom and put my clothes away. The AQAA told us that specific staff shifts were allocated to deep cleaning, and residents were supported to regularly keep their rooms orderly and attractive. The home had appointed a senior carer as its infection control link person. They were advised by the infection control nurse from the hospital and attended three-monthly link meetings there. At this persons recommendation, hand gel dispensers had been installed, and hand washing training had been given to staff and residents. Hot water temperatures were checked each week and recorded. We were told that an external contractor was used to test water quality. Care Homes for Adults (18-65 years) Page 24 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents can be assured that their needs will be met by sufficient and competent staff, and that they will be protected by the homes recruitment procedures. Evidence: The AQAA told us that were fourteen full and part time care staff employed. There were no vacancies at the date of our inspection. Only one person had left the staff in the previous year, upon their retirement. This vacancy had been filled by one of the part time staff becoming full time. This stability made residents comfortable with the staff, as we saw, and made the staff well aware of the needs and preferences of the residents. Staff cover varied during the day depending on what residents were doing that day. Staff surveys told us that there were always or usually enough staff on duty to meet the needs of residents. The AQAA told us that the home did not use agency staff. The manager recognised that there were no male carers on the staff, although half of the residents were male. A male volunteer visited the home as a befriender, and we were told that some of the male residents particularly enjoy his company. Twelve staff had achieved NVQ Level 2 and two others were undertaking it. Five staff had Level 3 with one person studying for it. The assistant manager had started Level 4. Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: We saw the records for the most recently appointed member of staff. Recruitment information was complete, and the identity and criminal record checks had been done before the person started work. The file held the details of the persons internal induction and the external induction course to meet the Common Induction Standards. The two monthly supervision record was also on file. The manager told us that all staff had had their annual appraisal in May 2009. Staff we interviewed were able to confirm the training they had received recently, and any courses that they were booked to attend. The staff surveys told us that they received appropriate and sufficient training to do their job competently. One carer was able to describe to us their role as a key worker for two residents, covering knowledge of their care needs, spending time with the person, and ensuring that their records were up to date and regularly reviewed. Care Homes for Adults (18-65 years) Page 26 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents can expect that their best interests will be safeguarded, and their views will be listened to and acted upon. Evidence: The AQAA told us that the registered manager was responsible for the management of care, staffing and recreation supported by one of the owners who undertook administrative, maintenance and budgeting responsibilities, and by an assistant manager. The home had a full-time maintenance person. Staff responding to the questionnaires all agreed that it was a well run home. It is a friendly place. I have worked here for seven years and feel that it is like my second home. There are a lot of genuine caring people here and I am proud to be part of it. The manager told us that she worked closely with the owners, and was totally aware and involved in the future direction of the home. Regular residents meetings were held, increasingly run by the residents with one of them taking notes. The manager told us that the meetings had become very popular. While we were there, a resident asked the manager when the next one was going to be held. The manager felt that that those present felt empowered to organise and Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: steer their lives. We saw from the minutes of the last meeting that topics covered discussion of what had happened in the home, plans for outings, and a request for a new light in a bedroom. It was clear from the above that the ethos of the home was open and transparent. Comments to us by staff, and the easy relationship between the residents and the manager showed that that the views of residents and staff were listened to, and valued. The AQAA contained excellent information about the importance of equality and diversity. It described how relationships between residents were supported, and how the two most physically disabled residents had been taken on holiday for the first time. The manager was aware that there were no male carers on the staff yet. This would be tackled when the next vacancy occurred. The manager described other methods by which she and the owners assured the quality of the service. These included staff supervision and appraisal, staff meetings and training, regular updating of care plans with the resident and external professionals, discussions with residents on specific topics such as a new resident, Christmas activities, and changes to the house. We saw that the care plans were kept up-to-date with each residents participation if they wished. All personal records of residents and staff were securely locked away. Maintenance and fire log records were examined. These were up to date, including fire alarm testing, equipment checking, hot water temperatures and portable appliance testing. The fire risk assessment had been due to be reviewed in February. The owner told us that the consultant used by the provider was booked to do this in June 2009. The appropriate Registration and insurance certificates were displayed in the home. Care Homes for Adults (18-65 years) Page 28 of 31 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 29 of 31 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation 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 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone : 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. 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