Care Home: The Cedars

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What the care home does well At the time of this visit the home provided a friendly, welcoming and happy atmosphere. Good interaction was observed between people and staff who were observed to be caring, respectful and attentive. Staff were observed to have a good understanding of people`s communication needs. The service is making good progress with the implementation of person centred care plans and supporting people to make decisions and choices about their lives. People are being supported to participate in a range of meaningful activities . During this visit a person said, "I go shopping" and I have been on holiday to France". The service provided a homely and comfortable environment and people`s bedrooms were personalised to their preference. What has improved since the last inspection? No requirements were made at the last key inspection that took place 27th March 2007 Since the previous key inspection an unannounced visit had been taken place in respect of medication administration practises in the service . This was assessed by one of the Commission`s specialist pharmacist inspectors. Although no requirements resulted from this visit the service was advised that medication handling procedures must give staff clear guidance and direct them to use only documents that the home currently uses, so that staff work consistently across the service. This has been completed. What the care home could do better: A manager must be appointed who must make an application to register with the Commission. Key inspection report Care homes for adults (18-65 years) Name: Address: The Cedars The Cedars (2 - 4) The Old Grove Surrey GU26 6BW     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: Lisa Johnson     Date: 1 8 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: The Cedars The Cedars (2 - 4) The Old Grove Surrey GU26 6BW 01428609374 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: cedars@robinia.co.uk Solor Care Group Limited care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users who can be accommodated is: 14 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD Physical disability - PD Date of last inspection Brief description of the care home The Cedars consist of three bungalows, numbered 2, 3 and 4, that provide care and accommodation for fourteen adults with a learning disability and physical disability. Each of the bungalows provides single service user bedrooms and offers a communal lounge, two bathrooms or shower rooms, a large kitchen. Bungalow 2 provides accommodation for four service users, and also accommodates the office facility for the service. Bungalows 3 and 4 each provide accommodation for five service users. All bungalows are suitably equipped for wheelchair users. Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 0 14 14 Brief description of the care home The laundry/utility room has been situated in the grounds of the home and the laundry is undertaken by the staff, from the three bungalows at different times of the day. The garden area has been landscaped and surrounds the three bungalows. A fence surrounds the garden area and this provides a safe environment for service users. The fees range from £1,300-£1,552.10 Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: This unannounced site visit was part of a key inspection and was carried out by two inspectors.We arrived at 10.20am and left at 3.20pm. Information was provided to us by the service prior to this visit in the Annual Quality Assurance Assessment (AQAA ). This is a self assessment that focuses on how well outcomes are being met for people using the service. We received the AQAA by the expected date,which was clear, detailed and gave us all the information we asked for. Reference is made to this assessment throughout this report. During this visit we were introduced to people that live in the service and discussion took place with one of the organisations (Robinia) operational manager, manager and some members of staff. We received surveys from five people who live in the service who had been supported Care Homes for Adults (18-65 years) Page 6 of 28 to complete them. We also received some feedback surveys from relatives , social and health care professionals and from a member of staff. Comments received have been included in this report. During this visit we spent time some time observing activities and staff interaction. We sampled staff recruitment and training records, care plans, risk assessments, menus, complaint, accident/incident records, quality assurance systems, medication administration practises, health and safety records and policies and procedures. We also reviewed other information that we have received since our previous including notifications. Care Homes for Adults (18-65 years) Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with information that they need to know about the home and their needs are assessed prior to admission ensuring that the service is able to meet them. Evidence: During this visit we looked at the information provided to people who use the service to see whether it is able to supply detailed information about everything that they or their representatives need to know about the service. There is a statement of purpose and service guide, which we were informed, can be produced in an accessible formats. The service provides a welcome pack, which details the last inspection report,statement of purpose and details of the staff team. Information seen provided clear and detailed information about the service and what they are able to provide. The service has an admission procedure in place and a pre placement assessment is carried out. During this visit we looked at the assessment carried out for the most recent person who had been admitted into the home. This was clear and detailed and covered peoples health, personal, emotional, communication and social needs. Other information is also obtained from care managers and other social and health care Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: professionals. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person has a plan of care and their needs and goals are met. People are supported to make decisions about their life and they are able to take risks as part of an independent lifestyle. Evidence: The service is currently developing person centred care plans for each person that are based on up to date, detailed assessment of needs. During this visit we sampled five peoples care plans. The plan incorporates needs, goals , guidelines and peoples dreams, hopes aspirations. Care plans contained current and detailed information. Each person has an assigned key worker and monthly meetings take place. Daily records sampled linked into peoples goals. The service have systems in place and they are planning further developments to ensure the views of people living in the service are promoted. Information supplied in the AQAA states that staff attend essential update training, which includes Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: communication to enable them to effectively communicate with people and they are planning to provide further in house training in using a recognised communication tool. Care plans sampled during this visit contained information about peoples communication needs and how these are to be supported. During this visit staff were observed to have a good understanding of peoples means and methods of communication and they were able to respond effectively. Specialist information technology equipment has been sourced and three people are able to access specialist PC programmes to enhance their communication and to be able to use the internet. People have been provided with the opportunity to make choices about the replacement of furnishings in the home. People were shown pictures to help assist them make choices about preferences of colours. People have also been out to a furniture store to look at individual seating accompanied by the physiotherapist and they are now sourcing specialist seating with the views of people in mind. During this visit we saw communication boards on display, which provided information to people such as pictures of staff to assist them to identify who is on duty. The service is planning to expand this information further. We were also informed that a person using the service participated in staff interviews. The service has implemented a wide range of risk assessments, which we sampled during this visit including, eating and drinking, home activities, maintaining a safe environment, epilepsy, moving and handling,community participation and emotional needs. The plans would benefit in identifying whether the risk is high, medium or low. It was also noted that a number risk assessments were not signed or dated making unclear when these had or were next due for review. Read and sign systems were in place to monitor that staff had read these. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples educational, recreational , social, cultural and diverse needs are met. People maintain contact with their family , friends , representatives and the local community. People are being supported to exercise choice over their lives and are in the main provided with varied and well balanced meals. Evidence: Peoples educational, therapeutic, recreational, social and leisure activities were outlined in their weekly activities time table within their care plan. People are supported to make choices about their preferred activities. People have the opportunity to attend day services, which is situated on site where they can participate in sensory and communication groups.One person goes to college. Music, communication and physiotherapy sessions are also run in the home. One persons care plan identified that they attend drama, hydrotherapy, cooking and art and another person participates in carriage driving . Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: People are supported to participate in a range of social activities and use community facilities. A person living in the service said, I go shopping and I went on holiday to France. Another person had been away on holiday on a cruise. A member of staff stated, At the weekend we organise outings such as lunch in restaurants and shopping. There are also opportunities to visit the cinema, visit the pub and attend concerts.The service is also intending to further develop evening and weekend activities. The service is developing photograph albums for each person, which contained photographs of social and leisure activities that people have participated in. However it was noted that in one bungalow that these were maintained in holders near the entrance door and we highlighted the appropriateness of this to the manager. Peoples birthdays and cultural events are celebrated and their religious needs are respected. The service is planning to source information regarding local religious and community groups, which people may wish to participate in. A social and health care professional surveyed said, Life experiences and opportunities of social inclusion and positive social interaction have significantly increased. A majority of people living in the service maintain links and have regular contact with their family and friends. People are also supported to email and one persons care plan identified that they use skype to maintain contact. During this visit people were observed to have access to all areas of the home and some people were spending time with staff in the kitchen. During this visit a person chose to go to their room,which was respected by staff. Activities were taking place in the home at the time of this visit where good, positive interaction was observed between people and members of staff who were responsive. During this visit we spoke with a new deputy manager, who spoke positively about the changes they wish to make to increase peoples choice and decision making. People are involved in weekly menu planning and pictures are used to assist them with their communication. A menu seen in one bungalow was varied and we observed a member of staff offering a choice of lunch for people choose their preference. Peoples likes and dislikes were recorded in their care plan. At the time of this visit some people were observed eating their breakfast and good support was provided by staff. A person living in the service told us they enjoy their meals and a relative said,My relative loves their cooking. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience 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 personal care needs are met and their preferences for support are respected. The home supports people with their medication in a safe way. Evidence: Peoples care plan and health action plan included information about, What is important to me, day and night routines, likes dislikes and preferences such as preferred name of address. Detailed action plans were in place to support people with their personal care.Information supplied in the AQAA stated that peoples choice is promoted regarding style and their individual personalities. One persons care plan identified that they like to wear makeup, which staff had assisted them with applying. Information supplied in the AQAA stated that that people receive regular input from a range of health care specialists such as, General Practitioner, occupational therapy, speech and language therapy, physiotherapy, community team for people with learning disabilities and behaviour specialists, which we saw evidence of recorded in peoples care plans. We saw information and guidelines to guide staff as to how people Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: needs are to be met such as support with their with epilepsy, asthma, moving and handling, emotional needs and eating and drinking. A person living in one bungalow had guidelines in place for eating and drinking and they were identified at being at risk of losing weight. Records were maintained of their dietary intake. However a person living in another bungalow was identified as requiring a high calorie intake and there were no records in place to monitor this. The inspector noted that foods maintained in the fridge were low fat products. Some peoples weight records seen during this visit were also not up to date but we were told that these are also checked by the physiotherapist, who also maintains records, which were provided to us during this visit. The inspectors noted that staff had not received nutrition awareness training. This matter was discussed with the manager who said that they would address this. A social and health care professional surveyed said, The organisation has made significant improvements in their care and support for residents. Peoples privacy was respected and a member of staff was observed knocking on a persons bedroom door to gain their permission before entering. During this visit staff were observed to be caring, attentive and spoke to people in a respectful manner. A person living in the service also confirmed to us that staff respect their privacy and they also said, I like living here and the staff are kind. A relative surveyed said, My relative has been more happier at The Cedars then anywhere else they have lived. The staff are particularly caring and considerate and look after my relative extremely well. During this visit we viewed one of the bungalows medication administration practises. Medication was stored appropriately. Records were maintained for the receipt of medication. Medication is dispensed using the monitored dose system (MDS). A list was maintained of all staff that were trained and authorised to administer medication. Medication administration records sampled showed us that people were receiving their medication correctly. Medication profiles were in place for each person and the way they like to receive their medication was recorded. Currently there are no people living in the service who are able to self administer their medication. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If people have concerns they know how to complain and they are safeguarded from abuse. Evidence: The service has a complaints procedure in place, that has been formulated in an accessible format, which was seen in display in each home. We were informed that a copy is also provided to each person. Since the last inspection the service has received four complaints. The service maintain a complaints log record. At the time of this visit these complaints had not be recorded in their log record, however since this visit we have been informed that this information has now been documented. The commission was made aware of some matters, which the service was asked to investigate and they provided information back to the commission with the outcome of their investigation.Information supplied in the AQAA states that the service intends to educate and raise awareness amongst people living in the service how to complain. Five people surveyed said that they know who they would speak to if they were not happy. This was also confirmed by a person spoken with during this visit. Two relatives surveyed said that the service usually or sometimes respond appropriately if they have raised any concerns. A social and health care professional said, Problems /concerns raised are dealt with promptly and professionally. The organisation has safeguarding vulnerable adults from abuse procedures in place, Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: although they were advised to obtain the most recent local authority multi agency safeguarding vulnerable adults from abuse procedure as this was not available at the time of this visit. Staff training records sampled indicated that they have received safeguarding training. A member of staff spoken with confirmed their attendance and was aware of their responsibilities should they witness or be made aware of any incident where the safety of a person may be compromised. There have been six safeguarding referrals made, which have resulted in further investigation by the local authority or by the organisation. These matters are now closed and currently there are no open safeguarding matters. At the time of this visit the services accident/ incident forms were viewed and it was observed that recent incident between two people living in the service had recently taken place, which had resulted in one person being scratched. This matter had not been reported to the appropriate agency or to the Commission at the time ,which was addressed with the organisations operational manager, who also said that they had not seen this incident form. The operational manager stated that they would follow this matter up and bring reporting protocols to the attention of staff. Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is safe, well maintained, comfortable, homely and clean. Evidence: Accommodation is provided in three purpose built bungalows. During this visit the service was observed to be well furnished and comfortable providing a homely atmosphere for people to live. Environmental improvements have been made such as the installation of new flooring and furnishings.A bedroom in Cedars 4 is being looked at regarding odour. There is a maintenance department on site and a health and safety specialist adviser is available. The current laundry facilities are external to the bungalows and the service is planning to re site these facilities in individual bungalows for people to be able to undertake their individual washing. Prior to this visit we were made aware of a concern about insufficient heating in one of the bungalows, particularly at night time, which has been brought to the attention of the organisation who have looked at this matter.At the time of this visit the home was found to be suitably heated. The service meets the needs of people using wheelchairs and is accessible throughout. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: Suitable equipment is provided including tracking, adapted bath rooms and specialist beds. Peoples viewed were comfortable, reflected their gender and were personalised. A person living in the service invited us to see their bedroom and told us that were getting a new wardrobe and a new television. During this visit the home was observed to be cleaned to a good standard and was hygienic. Suitable hand washing facilities and equipment were available. Infection control procedures are available and staff receive training. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are supported by sufficient numbers of staff. Arrangements are in place to ensure that sufficient numbers of staff will have completed National Vocational Qualifications to ensure that people are supported by competent staff. Peoples safety is protected by the homes recruitment policies and practises. Evidence: Information provided in the AQAA states that a review of staffing levels with in the service has taken place, that has resulted in an increase in staffing levels. An additional member of staff is on shift during the day in each home. At the time of this visit we were informed that there were three members of staff on duty in Bungalows Cedars 3 and 4 and two members of staff on duty plus a new member of staff who was on induction in bungalow 2. At night time people living in all three bungalows are supported by four members of staff. The duty rota was sampled, which indicated that the agreed staffing levels are provided. The AQAA has identified that they need to improve recruitment of vacant support worker positions, which are higher at present as a result of staffing level increase in the home. The service uses regular agency workers to maintain consistency and continuity. The AQAA has identified that four members of staff have left over the last year and staff retention and recruitment is currently being addressed by the Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: organisation. Social and health care professionals and relatives surveyed said, Employ long term carers and service users are confused by the disturbing turnover;Staff retention needs improvement;New staff have all approached their work with enthusiasm but have left in quick succession. New staff receive induction following Skills for Care induction standards. We were informed that currently out of twenty carers employed seven have obtained National Vocational Qualifications. Since this visit we have recieved written information to confirm that a further three members of staff have been booked onto the training and they are planning to enrol another five members of staff on the training, which will ensure that the service will have the required number of staff with this qualification. The service maintains a training matrix , which details the training that staff have received. Copies of staff training certificates were also maintained in their personal files. During this visit we looked at the training matrix and sampled some members of staff training records which indicated that a good proportion of the staff are trained in specialist topics including, autism, epilepsy, pain management, autism ,medication , strategies for crisis intervention prevention (SCIP)and statutory training. However some of the dates recorded on the matrix were out of date. Information supplied in the AQAA has identified that there are some gaps in training and a staff skills audit is currently being carried out. The service is also intending to increase in house training to reinforce and further develop knowledge and understanding gained at formal training.The AQAA states that staff receive equality and diversity training. We were informed that managers have attended deprivation of liberty safeguarding training. The service is advised to ensure that this training is cascaded to care staff to raise their awareness and understanding. A member of staff surveyed said, they usually feel they enough support, experience and knowledge to meet the different needs of people who live in the service and their manager meets with them often to discuss how they are working. Staff recruitment is based on equal opportunities. During this visit we sampled four members of staff personal files, which contained the required information including, a fully completed application form, two written references. Protection of vulnerable adults first check (POVA) and criminal records bureau check (CRB). Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A permanent manager needs to be appointed who needs to be registered. The service seeks the views of people living in the service and their representatives regarding the quality of its service. Systems are in place ensuring that peoples welfare and safety is promoted. Evidence: Currently there is no registered manager running the home and over the last year the home has experienced two management changes. The home is currently being over seen by two registered managers from other services that are based on site and close by. The organisations operational manager also maintains close links with the service. Comments received from social and health care professional and relatives included, Greatly improved service over the last twelve months, instability of management in the home in the home is a concern, which needs addressing;Employ a good, permanent home manager; Engagement with this service proves difficult due to the frequent changes of managers. Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: The AQAA provided to us had been completed by the organisations operational manager who provided us with detailed information about the improvements that the service has made, where they could do better and the future plans for development of the service. The AQAA has identified that changes to the management structure within the home have impacted upon consistency. Since this visit we wrote to the Responsible Individual requiring them to inform us what arrangements are being made to appoint a permanent manager, who must register with us. We have received written confirmation that a new manager will be taking over this post in February 2010,who will be making an application to register with the Care Quality Commission. The organisation has have also appointed two team leaders and a third team leader is to be recruited to be based in each bungalow who will report to the manager to further develop the service and service delivery. Information supplied in the AQAA states that a quality improvement team in place and additional support and resources are being given to the home. Systems are in place to ensure that the views of people, their families and other representatives are sought as part of the services quality assurance systems. The service also provides feedback surveys to other stakeholders and staff. At the time of this visit we were informed that questionnaires have recently sent out again for this year. Monthly quality monitoring visits are conducted and reports were available in the service for us to view. Regular health and safety audits are carried out. Staff training records sampled demonstrated that they receive statutory training including first aid, fire awareness, food hygiene, moving and handling and health and safety. Records were maintained ensuring that regular water temperature monitoring is conducted. Hazardous cleaning materials were stored and locked away securely. Records sampled indicated that maintenance and servicing of equipment takes place. Incident and accident records were maintained in the service, although one matter was identified needing improvement. (Refer to standard 23). Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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. Care Homes for Adults (18-65 years) Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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