Care Home: The Byre

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What the care home does well Each of the people living in the home has a range of care plans in place that detail their needs across a range of areas and the steps staff must take to meet those needs. Guidelines provide sufficient detail to enable the acting manager and her team to review people`s needs and identify changes. People are being given more choice about what activities they complete and this is being reflected in people`s daily notes. Peoples quality of life has improved. A range of risk assessments are in place that identify potential risks and where possible these enable people to complete activities with risks being minimised. People are provided with a homely, comfortable environment that meets their current needs. Staff recruitment procedures minimise potential risks to people living in the home. People are supported by a team that have a range of skills and experience and this helps in providing people with a varied lifestyle. Staff training has improved with the whole staff team completing a range of training to meet peoples needs and maintain a safe environment in the home. What has improved since the last inspection? Since we completed the previous key inspection in December 2009 and a random inspection in March 2010 the owner and the acting manager have worked hard to address the shortfalls identified in the previous key inspection. A lot of the points identified above are areas that have improved since the last key inspection. What the care home could do better: Now each of the people in the home has detailed guidelines in place the acting manager must ensure that regular reviews are completed and documented providing evidence of people`s needs being reviewed. The provider must be mindful of always promoting choice to people and making use of different formats/methods that enable people to do this. The provider needs to implement a programme of redecoration as there are a number of areas around the home where the paintwork is looking worn. People living in the home should be involved in choosing the colours wherever possible. Key inspection report Care homes for adults (18-65 years) Name: Address: The Byre Allaston Court Farm The Byre Lydney Gloucester GL15 5SR     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: Paul Chapman     Date: 1 4 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 3 of 30 Information about the care home Name of care home: Address: The Byre Allaston Court Farm The Byre Lydney Gloucester GL15 5SR 01594844244 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Footsteps Medical Care Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who may be accommodated is 4. The registerd person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home The Byre was registered in July 2007 as a new service for adults with a learning disability. It is located in a residential area on the outskirts of Lydney. The property is a bungalow which has been fully redeveloped in order to meet the relevant National Minimum Standards. All bedrooms have en-suite facilities. There is also a spacious shared bathroom with adaptations, a lounge and a kitchen-dining area. Prospective residents and their representatives are provided with information about the home including the Service Users Guide. Fee levels are negotiated on an individual basis. Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 4 2 5 1 1 2 0 0 9 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: Before completing the inspection site visit to this service we (the CQC) received the outstanding AQAA (Annual Quality Assurance Assessment). This document asks a service provider/registered manager to rate the services performance against the National Minimum Standards (NMS). A service provider/registered manager will be asked to provide evidence of what the service does well, what has improved in the past 12 months and their planned improvements for the next 12 months. What the registered manager tells us in this document helps to form a hypothesis and focus on different areas depending on what the AQAA tells us. In addition to providing evidence about how the home meets the NMS it also provides us with a Dataset (information about staffing, health and safety, complaints, the environment, policies and procedures and the people living in the home). This inspection site visit was completed Tuesday 11th May 2010 and was unannounced. On arrival at the service we were greeted by the acting manager and Care Homes for Adults (18-65 years) Page 5 of 30 the owner of the service. All three people living in the home were present and they were being supported by two care staff. We completed a tour of the premises with the acting manager where we saw all of the communal areas, we did not see peoples individual bedrooms on this occasion. We spent time with the acting manager assessing the homes progress towards meeting the requirements of the previous two inspection reports and the homes ability to meet the National Minimum Standards. Whilst completing this visit we were able to observe the relationships between staff and people in the home. This showed staff were respectful and friendly and as we have identified in the body of the report the home is now noisy with the sound of laughter and activities, this has not always been the case when we have visited previously. Care Homes for Adults (18-65 years) Page 6 of 30 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our Care Homes for Adults (18-65 years) Page 7 of 30 order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has an admissions policy in place, this has not been used and therefore it is impossible to judge its effectiveness until it has been used. Each of the people currently living in the home has a statement of terms and conditions explaining what they can expect whilst living in the home. Evidence: No new people have been admitted to the service and the home currently has one vacancy. After the previous key inspection where the service was rated as poor the owner agreed to a voluntary embargo on new admissions. The acting manager has reviewed the Service Users Guide and included a section that gives a brief summary of the admissions process. It explains what staff will do and what information will be required. The admissions process has not been tested as yet as no one has been admitted to the service since the previous key inspection. A requirement of the previous key inspection report was that each person should have a statement of terms and conditions detailing what service they can expect whilst living in the home. This has now been achieved. Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: In the AQAA completed by the acting manager they state a planned development for the future is the creation of a DVD of information for prospective service users. Care Homes for Adults (18-65 years) Page 11 of 30 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. Each of the people in the home has a range of care plans in place that provide staff with guidelines to meet peoples needs. The amount of choices people have has increased in their day to day lives with the service now being led more by peoples needs. Risk assessments identify potential risks to people and where possible detail the steps that should be taken to minimise those risks. Evidence: At this key inspection we case-tracked the care of two people in the home (at the random inspection completed on 30/03/10 we case-tracked the care of the other person in the home). The key inspection completed in December 2009 raised serious concerns about the care plans as they did not contain sufficient detail about peoples needs, and had not been reviewed. As a result a requirement was made by us that this was addressed. At the random inspection we completed in March 2010 the acting manager had made progress with addressing this issue. Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: People living in this home have complex needs. Examining the care plans on this occasion showed that both people had detailed plans in place covering a wide range of needs.The acting manager explained that presently these plans are updated from day to day (and we saw some evidence of updates being done). The acting manager stated in future all care plans will be reviewed a minimum of three monthly. At the end of each shift staff write notes explaining what they have done and how people have been. This provided us with good evidence that peoples needs are being met. Speaking with staff during this site visit they understood the importance of care plans. When examining the care plans we felt that further development was still required and we spoke to the acting manager about adapting care plans with pictures to make them more understandable to people with communication disabilities. This becomes a recommendation of this report. Each person had a Person Centred Plan (PCP) in place. These had been updated by the manager since our previous inspection. Both of the PCPs we examined provided us with a good insight into what people liked and disliked but still had potential for further development. We had a discussion with the manager about how they may be developed in the future to include peoples hopes and dreams, identify goals and provide evidence of those goals being achieved. It becomes a recommendation of this report that the acting manager looks at developing PCPs in the future. At the previous key inspection we were concerned that people were not being empowered to make choices in their day to day lives. As a result we made a requirement of the provider to ensure that this was being done and that they would be able to provide evidence in the future. On this occasion we were able to see examples of choice being given to people in daily notes completed by the staff. When speaking to staff they gave us examples of some of the choices people are being given from day to day. These included what activities they completed and the food they ate. Staff stated, the service is led by the needs and choices of the people in the home. At the previous key inspection we had serious concerns about the serious risks present in the home due to there being limited risk assessments. At this inspection risk assessments were in place for both people whose care we examined. The assessments we sampled were detailed and where appropriate had been written with the support of other health professionals. In the AQAA the acting manager states that they are in the process of developing a snapshot form which will contain important information about what has happened to a person over the previous month. Care Homes for Adults (18-65 years) Page 13 of 30 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 now leading more active lifestyles that are led by their needs and choices and supported by staff as required. People living in the home have relationships outside the home with friends and family and staff support people to maintain these relationships as required. People are given a choice of what they would like to eat and they are being supported to be involved in the preparation of meals. Evidence: A significant change from our first two visits to this service was the atmosphere in the home when we arrived. At our previous visits the home has been quiet, but on this occasion it was noisy with staff supporting people with activities in house including playing musical instruments. Clearly both staff and people in the home were enjoying this judging by the laughter. A concern from the previous key inspection was that people were not leading active Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: lifestyles leading to poor outcomes for people. We made it a requirement that this was addressed. At this site visit we spoke to four of the staff on duty and examined daily records for two people. Staff commented that they thought people had active lifestyles now, and that this had improved significantly since our key inspection last year. Staff comments and daily records showed the following activities being completed over the past two months; swimming, shopping, watching TV, washing cars, attending a local social club, eating meals out, painting, walking, golf, playing cards, helping with chores around the home, going out for drives in the homes car, attending hydrotherapy and playing musical instruments. Importantly we also saw some examples of staff recording peoples choices, i.e. if they have been offered an activity and refused it. We asked whether holidays had been arranged for people yet? Staff explained they are planning to support people individually to holiday in chalets/bungalows in Dorset. Promoting choice for two people in the home can be difficult due to communication difficulties and the acting manager must remain focused on different methods to ensure people have choices. The acting manager should consider using photos or objects of reference to help people make choices where this is appropriate. This becomes a recommendation of this report. All of the people living in the home have contact with their families and staff support them to maintain these relationships where it is required. We saw a number of examples of people being visited by their family, or going to visit them at their homes. The home are about to implement a new menu for people. Speaking with staff they were in agreement that people now get more choice about what they eat. Examples of this include staff supporting one person to look through recipe books and choose what they want to eat, another person has a PEG and staff are supporting them to have tasters of other meals/foods. Another method that is being introduced to promote choice of meals is the use of photos to help people choose what they wish to eat. Where possible staff are supporting people to help prepare food, this may mean helping cook meals or bake cakes, staff said baking is a new practice and spoke about how much fun it was for people. We spoke to the staff member who has taken the lead in developing the new system of menus. They recently completed a short course in food and nutrition and this has helped them in developing the new menus. The new menu showed a good range of foods being offered with two choices available for lunch and dinner, and if people did not want either of these they could choose something else. As we have identified one person has a PEG for feeding, the acting manager stated the Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: majority of staff have completed training in this and they have arranged for the local community nurse to provide training for other members of staff in the future. Care Homes for Adults (18-65 years) Page 16 of 30 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 personal care needs are identified and guidelines provide sufficient detail to enable staff to meet peoples needs consistently and identify peoples changing needs. People are supported to use health care professionals to meet specific needs when required. Evidence: At the previous key inspection guidelines for peoples personal care were poor and raised concerns that peoples needs were not being met. Both of the people whose care we case tracked had detailed guidelines in place to address their needs around personal care. These guidelines provided the reader with sufficient detail to meet the persons needs consistently and assess whether peoples needs are changing. As we identified earlier the acting manager stated that currently these plans are reviewed constantly but in future there will be a maximum period of three months between reviews. As with the other care plans we examined the acting manager should consider how these documents can be made user friendly for people (e.g. use of pictures and large print where appropriate). At the previous key inspection we found it difficult to judge whether peoples helath Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: needs were being met appropriately. The acting manager has implemented a new system for recording appointments with other health professionals. As a result it is more simple to see when people have attended appointments and what the outcome was. Health action plans/assessments were being completed for both of the people we were case tracking. The manager explained this process was taking some time as they were involving peoples families in a number of areas. A concern identified at the previous key inspection was around moving and handling, plans for staff to follow were poor and staff had not completed training. Case tracking has shown that where one person needs support to mobilise plans are in place and staff have received the appropriate training. At the previous key inspection we identified occasions where the CQC should have been informed of incidents under Regulation 37, but had not. Since the acting manager has been in post we have received an appropriate notification. Training records made available to us showed that all staff have now completed training in medication administration. On the whole medication administration is managed more effectively but we were unable to find evidence that the requirement we made had been addressed. We made a requirement that the hand written medication sheets are checked by another staff member. This was brought to the attention of the acting manager. They stated it would be addressed. This is clearly an oversight by the acting manager and from other evidence gathered as part of this site visit we are satisfied it will be addressed. Care plans/guidelines are being created to identify peoples wishes in respect of increased mental and physical frailty. We were able to examine a completed plan for one person in the home that had been developed with a relatives input. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints procedure to ensure that if people wish to make a complaint it is dealt with efficiently. Guidelines are in place for staff to follow when people become anxious or agitated, these guidelines are supported by training and this helps to minimise the potential risks to both people in the home and staff. Where people are unable to manage their own finances these are kept securely by the home and records of income and expenditure are detailed. Evidence: The home has a complaints procedure that ensures where people are unhappy about any aspect of their care they can make a complaint. We spoke to the acting manager about complaints, they stated that there have not been any complaints since our previous random inspection completed on 30/03/2010. In addition to the home having a complaints procedure there is also a whistle-blowing policy for the staff. Staff have completed safeguarding adults training. A concern we identified at the previous key inspection was guidelines to support people when they became anxious or agitated were poor. Both of the people whose care we examined have care plans in place that detail behaviours that may be exhibited and the steps that staff should take. Staff have completed training in behaviour management and breakaway to enable them to work more safely with people in the home. We spoke to staff about this training and the guidelines in place Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: asking them how they feel it has benefitted them. Staff responded that they felt it was easier working with people when they become anxious or agitated. People in the home are unable to manage their finances and as a result monies are managed by the staff. The acting manager explained how finances are managed and showed us the records of income and expenditure for both people. The records we examined were accurate and wherever possible staff obtain receipts to support expenditure. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is comfortable, homely and clean that meets their current needs. Evidence: We completed a tour of the premises with the acting manager. The property is a single storey bungalow situated in a good-sized plot of land. Outside there are parking and lawned areas. At the time of this visit the grass was in need of cutting. The property provides people with a range of communal areas including a kitchen/diner, a music/activity room and a lounge. In addition to the communal areas there is also an assisted bathroom, toilet and each person has their own bedroom. We did not see peoples bedrooms on this occasion. Looking around the home it provides people with a range of furniture and equipment that they need in their day to day lives. Speaking with the acting manager and the owner it was agreed that some re-decoration was required in the communal areas as parts are looking a little tired. This becomes a recommendation of this report. The home has an overhead tracking system fitted which enables staff to move people as they wish. Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: The home was clean and tidy and there were no offensive odours. Care Homes for Adults (18-65 years) Page 22 of 30 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 recruitment process for new staff minimises potential risks to people living in the home. Staff induction minimises the risk of staff not understanding peoples needs and the procedures that must be followed to maintain a safe environment in the home. The home has a training programme that covers a range of mandatory training to maintain peoples safety and other more specific training to meet peoples needs. Evidence: The acting manager stated that since we completed the random inspection of this service on 30/03/10 two staff have been employed. We examined the employment records for both staff which showed the acting manager and provider had taken the necessary steps to minimise potential risks and meet the criteria of these regulations. We spoke to the two new staff about their induction training. Both said they felt it was really good and explained that they had been assigned a mentor and were additional staff on shifts. We saw records that showed the acting manager, mentor and the new staff meet to discuss the induction process, sign off good practices witnessed, training and confirm that procedures are understood. A concern identified in the key inspection from December 2009 was the skill/experience mix of the staff team. The owner and the acting manager have gone Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: some way to addressing this with the staff employed since December 2009. Speaking to staff there now appears to be a better mix of skills. Staff training was examined at the previous random inspection site visit. Speaking with the acting manager they explained that the training programme is ongoing and that all staff will complete training in Deprivation of Liberty Safeguards and the Mental Capacity Act (2005)and fire safety in June. In addition to this the acting manager stated that two staff are due to start a National Vocational Qualification (NVQ) level two in Health and Social care, whilst the other staff who already have a level two will be starting level three qualifications in care. Team meetings take place each month and we saw minutes for the recent meetings. Staff confirmed they receive supervision with the acting manager. Care Homes for Adults (18-65 years) Page 24 of 30 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 acting manager has addressed the majority of the requirements and recommendations of the previous two inspection reports, as a result potential risks have decreased and peoples quality of life has increased. Training and procedures in place help to minimise potential risks to the health and safety of people in the home. Evidence: A requirement of the previous report was for the provider to employ a manager to become registered with the CQC. Speaking with the acting manager they explained they had received their CRB (Criminal Records Bureau) disclosure in the week before this site visit and would be submitting her completed application form to the CQC in the days following this site visit. The requirement to apply for registration will remain in place as the CQC has not yet received the application. The acting manager explained to us that they are in the process of going through the new Health and Social Care Act (2008) Regulations and outcomes and linking them to the current National Minimum Standards. They explained the aim is that by October they will have a clear understanding where there may be shortfalls and she can address them quickly. This is seen as good practice. Since being employed at this home it is clear Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: that the manager has completed a substantial amount of work to address the large number of requirements and recommendations made at the key inspection in December 2009. The acting manager has completed a NVQ level 4 in management. We asked what plans they had for further personal development, the acting manager stated they are interested in completing a NVQ level 5 in management and looking into starting this at the moment. Speaking with staff it is clear there is an open door policy to the management of the home. Speaking with staff who have worked at the home for a significant period of time it is clear that since the acting manager has started there have been significant improvements to staff working practices which has led to better lifestyles for people living in the home. When speaking to staff we received more than one comment of, it is a joy to come to work, its a really nice place to work. We also received comments similar to this at the previous random inspection completed 6 weeks ago. The owner of the home completes Regulation 26 visits each month, we saw a sample of recent reports completed by the owner. All of the homes policies have been reviewed since the previous key inspection, and staff have been asked to read the policies and sign to confirm they understand them. The previous inspection report made requirements that the provider must implement quality assurance. The acting manager explained that she has sent questionnaires to professionals and families but has only had a small number returned. As a result the acting manager has implemented a small tick box questionnaire that people are asked to complete when they visit the home. We recommended that the acting manager writes a summary of the findings from the quality assurance questionnaires. We recommend that the acting manager continues to use questionnaires to other professionals and families at regular intervals to gather opinions. Other methods that need further development to provide evidence of quality assurance is the reviewing of care plans/PCPs/risk assessments and daily notes. These should provide evidence of peoples needs being met. The home has a COSHH file that provides staff with data sheets detailing what actions should be taken if chemicals are spilt. Other health and safety procedures include staff completing monthly health and safety checks around the home, hot water outlets being monitored monthly and cooked food temperatures being recorded. Training records showed that all staff have completed health and safety training in the past twelve months. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 37 8 The registered provider must ensure that the CQC receive a completed application from the acting manager to become registered with the CQC. The registration of managers with the CQC helps to minimises the risk of people without the appropriate skills and knowledge managing care services. 11/06/2010 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 6 The provider should ensure that peoples care plans are continued to be developed with the use of pictures and other formats that may help people with communication difficulties to understand them easily. Wherever possible people living in the home should be involved in creating their care plans. The provider should look to develop peoples PCPs over the coming months to reflect peoples needs/wishes/dreams Page 28 of 30 2 6 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 and identify the steps the taken by the staff to meet them where appropriate. 3 12 The provider should ensure that different methods to promote peoples choices are tried by the acting manager and the staff team. The provider should redecorate areas of the home where the paint has been chipped/scuffed/dirty. Where possible the provider should empower people living in the home to choose what colours they would like the communal areas painted. The provider should continue to send quality assurance questionnaires to families and other professionals. People should be given the opportunity to comment on the service. The provider should ensure a summary of the latest quality assurance questionnaires is completed to provide evidence of the feedback being examined and corrective action being taken as necessary. 4 24 5 39 6 39 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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