Care Home: The Chestnuts

Similar services:

• 2 Perhaver Park
• The Vicarage
• St George`s
• 5 Seafield Road
• Radfords
• Honeybourne House
• 32 Beaumont Way

What the care home does well Information was available in a statement of purpose and service user guide so that people could make an informed decision about where they lived. People`s individual needs and aspirations were fully assessed so that their needs could be met. Each person had a licence agreement and statement of terms and conditions so that they had information about what they had to pay for. People`s assessed needs were reflected in care and support plans and reviewed and changed as necessary so that their diverse needs would be met. People were assisted to make decisions about their lives. People were supported to take risks to promote their independence. People had opportunities to be part of the community and to take part in appropriate day time and leisure activities. People maintained relationships with their family and friends. People`s rights were respected and their responsibilities were recognised in their every day lives. People were offered a healthy diet and enjoyed their food. People received personal support in ways that they preferred and needed. Their physical and emotional health needs were being met. The arrangements for managing and recording medication generally made sure that people were protected. There was a complaints procedure and people`s views were listened to and acted upon. There were policies and procedures about safeguarding adults and staff received appropriate training. This helped to protect people from abuse, neglect and self harm. There were a lounge and a dining area and each person had a single room. The laundry facilities were separate from food preparation areas. People lived in a homely, comfortable, clean and hygienic environment suited to their needs. People were supported by an effective staff team, who were appropriately trained, qualified and competent to meet people`s needs. People were protected by the home`s recruitment practices. The manager had been approved as a fit person to manage the home and people were benefiting from a well run home. There was a quality assurance system and people`s views were collected using questionnaires and during reviews. People`s views underpinned all self-monitoring, review and development by the home. There were comprehensive health and safety systems and measures so that people`s health, safety and welfare were promoted and protected. What has improved since the last inspection? Most of the staff had received training about prevention of abuse so that they knew how to protect people from abuse and harm. Two bedrooms had been recently redecorated and new furniture had been purchased. Each lounge had a new flat screen television. The kitchen in Woodlands had been replaced and the kitchen in Meadowview had been redecorated. What the care home could do better: The risk assessments could be improved by including the benefits to the person of taking the risk to show how risk taking promotes their independence. Improvements need to be made to the recording of medication so that it is possible to tell that people are being given the right medicines at the right times. The manager should check whether the current arrangements for storing controlled drugs meet the new regulations about storage. This will help to make sure that any controlled drugs prescribed are stored properly. The responsibility for giving medicines by special methods should be properly delegated to the staff giving these medicines. This will make it clearer about who is accountable for giving the medicines. People should be reminded about the complaints procedure so that they know how to make a complaint. The records of complaints should include the outcome of the complaint investigation and whether the complainant was satisfied with the outcome. Key inspection report Care homes for adults (18-65 years) Name: Address: The Chestnuts 9 Lodge Road Yate South Glos BS37 7LE     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: Elaine Barber     Date: 1 5 0 9 2 0 0 9 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) 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 30 Information about the care home Name of care home: Address: The Chestnuts 9 Lodge Road Yate South Glos BS37 7LE 01454227188 01179709301 max@aspectsandmilestones.org.uk admin@aspectsandmilestones.org.uk Aspects and Milestones Trust care home 8 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) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home The Chestnuts is registered to accommodate up to eight people with learning disabilities. The Home is run by Aspects and Milestones Trust and is divided into two segregated units called Woodland and Meadow View, which are managed as one. The Home is situated in a quiet lane with few other residential buildings nearby. The centre of Yate is about a mile away. The property consists of a large, extended Victorian house set in its own grounds with a garden and patio area. The home has two cars for the use of people who live there and there is public transport a short distance from the home. Parking is available at the front of the building. The fees charged for staying at the Home are 1874 pounds 60 pence a week. Information is available in a statement of purpose and inspection reports are available from the home. They can also be downloaded from our website www.cqc.org.uk. 8 Over 65 8 Care Homes for Adults (18-65 years) Page 4 of 30 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: We asked the home to complete an Annual Quality Assurance Assessment, known as the AQAA. This was their own assessment of how they were performing. It also gave us information about what has happened during the last year, and about their plans for the future. We sent out surveys so that these could be completed by the people who lived in the home and by the staff. We had surveys back from four people who lived in the home and one staff member. We looked at all the information that we had received about the home since the last inspection. This helped us to decide what we should focus on during our inspection. We visited the home on the 15th September 2009. We talked to one of the team leaders. We looked at some of the agencys records and talked to two members of staff. We met with three people who lived in the home and asked them about their experience of living in the home. The judgments contained in this report have been made from all the evidence gathered Care Homes for Adults (18-65 years) Page 5 of 30 during the inspection, including the visits. The last inspection of the home was on 23rd August 2007. Care Homes for Adults (18-65 years) Page 6 of 30 What the care home does well: What has improved since the last inspection? Most of the staff had received training about prevention of abuse so that they knew how to protect people from abuse and harm. Two bedrooms had been recently redecorated and new furniture had been purchased. Each lounge had a new flat screen television. The kitchen in Woodlands had been replaced and the kitchen in Meadowview had been redecorated. Care Homes for Adults (18-65 years) Page 7 of 30 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 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. People and their relatives had enough information to make an informed decision about whether the home was the right place for them. Each persons needs were assessed before they moved into the home so that their needs would be met. Each person had a licence agreement and statement of terms and conditions so that they had information about what they had to pay for. Evidence: We looked at the statement of purpose and the service user guide. These were in simple words and pictures and they contained all the required information. We received surveys from four people who lived in the home. They told us that they were asked if they wanted to move into the home and they received enough information about the home before they moved in to decide if it was the right place for them. No one had moved into the home since the last inspection. We noted on previous inspections that their needs had been assessed when they moved into the home. We looked at three peoples files and we saw that all three had had a reassessment of their needs by a social worker in 2006. We also saw that each person had a statement Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: of their terms and conditions and a licence agreement. 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 persons assessed needs were reflected in care and support plans and these were reviewed and changed as necessary so that their needs would be met. People were assisted to make decisions about their lives when able. When people were not able to make their own decisions the home made sure that decisions were made in their best interests. People were supported to take risks to promote their independence. Evidence: The manager told us in the AQAA that each person who lived in the home had their own essential lifestyle plan in picture format which was reviewed and updated every three to six months. We looked at the files of three people. We saw that each person had detailed support plans and a daily routine in words and pictures. These had all been rewritten in August 2009 and there were notes in the files to show that the support plans had been reviewed in February 2009. The plans were clearly written and Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: simple and showed how to support people in all aspects of their lives. The information in the plans had been summarised in simple words and pictures for agency staff to follow. Care planning was of a high standard. Two staff told us that people chose their meals and the menu was recorded using pictures on a white board. Another member of staff told us that people could choose how to keep their rooms. We observed people choosing where and how to spend their time in the home. We saw that there were examples in the files of people choosing activities. We observed staff asking people what they wanted to do and whether they wanted to go out. In their surveys two people said that they always made decisions about what they did each day and two said that they usually did. Two people said that they could do what they wanted during the day, evening and weekend. One person said that they could do what they wanted during the day and weekend but not the evening. One said that they could not do what they wanted at any of these times but did not explain further. When we looked at the files we saw that each person had a series of risk assessments for different aspects of living. Examples included eating and drinking, bathing, using a teapot, vacuuming and using the wheelchair. The risk assessments included the hazard, who would be affected and the control measures to reduce the risk. However, they did not include the benefits to the person of taking the risk. We received information in a regulation 26 visit report about one person who required dental treatment. The home had involved an Independent Mental Capacity Advocate (IMCA) to represent their views and a meeting was planned to decide what was in their best interests. A member of staff told us that the meeting had not yet taken place. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had opportunities to be part of the community and to take part in appropriate day time and leisure activities. People maintained relationships with their family and friends. Peoples rights were respected and their responsibilities were recognised in their every day lives. People were offered a healthy diet and enjoyed their food. Evidence: The manager told us in the AQAA that each person participated in a variety of activities in the community. These included swimming, walking, college, paid work, horse riding, church, lunch clubs, cinema etc as well as day trips and holidays. They said that people used local facilities such as shops, hairdressers and pubs. The manager told us that each person had a care plan with their preferred lifestyle incorporated into it. They also said that each person has an opportunity plan with their preferred activities on them and these were in picture format. The manager said that each person also had a development plan for household skills of cooking, laundry and Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: general housework. One person was in paid employment doing their paper round each week. One person had recently moved to their own flat. When we read the files we saw that each person had an opportunity plan which showed what activities they did each week. Two people who lived in the home and a member of staff talked about the activities that they participated in and about keeping in contact with their family. They showed us a record of activities that took place. This showed that people had a variety of activities and opportunities to access community facilities. These included various college courses, going shopping for personal items and for food, going for walks, visiting Westonbirt Arboretum, going to the leisure centre and visits and phone calls to relatives. The records showed that one person had a paper round and one person went horse riding. They also showed that people were involved in the daily routines of the home with support including shopping, cooking, making drinks, doing the laundry and cleaning their rooms. People could also go to church and attend a club. Everybody went to the hairdresser or barber. One person went to the hairdresser on the morning of our visit. They also went personal shopping with a member of staff. Two people went out to play tennis and two people went to the post office in the afternoon. The records showed that there were also in house activities such as games and puzzles and aromatherapy. We saw that there were televisions in both the lounges. One person spent time colouring. A member of staff told us that one person had recently moved into supported living. They said that another person lived in a flat upstairs and was developing their independent living skills. In the Meadowview side of the home staff told us that they chose the menu for people based on their likes and dislikes. They also told us that in Woodlands people were more involved in choosing their meals. A staff member and two people told us that they chose the meals on a Saturday then recorded the menu using pictures on a white board. When we looked at this we saw that the menu was varied and reflected a good mixed diet. We saw that the menu included plenty of fruit and vegetables, a member of staff told us that people were regularly offered fresh fruit and we saw people being offered fruit. Care Homes for Adults (18-65 years) Page 15 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. People received support in ways that they preferred. Peoples health care needs were being met. People were generally protected by the medication practices. Evidence: When we looked at the care plans we saw that these contained information about how people liked to be supported and their preferred routines. When we looked at the records of three people we found that each person had a health action plan which showed how their health care needs were to be met. They also had a health profile and an OK Health Check. The records showed that each person was registered with a GP. We saw that appointments with health care professionals were recorded with information about the outcome. People saw the GP, consultant psychiatrist, orthotist, physiotherapist, chiropodist, dentist and optician. One person had been referred to an Independent Mental Capacity Advocate (IMCA) to represent their views and a meeting was to be held to decide whether treatment was in their best interests. When we looked at the records we saw that each person had a medication profile. Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: These provided details of medication that each person took and any changes to medication. Medication was stored in locked cupboards. There was one for each side of the home. Each of these cupboards had a controlled drugs cupboard inside. It was not clear whether these complied with the new regulations for the storage of controlled drugs. There were records of medication received into the home, administered, returned and destroyed. When we looked at the administration records we saw that there were occasional gaps where no signature or symbol had been recorded to show whether or not the medication had been taken. One person had an epilepsy care plan completed by the community nurse. They had epilepsy medication given by a special method. A member of staff told us that staff received training about how to give this from the manager. We spoke to the manager on the telephone following our visit and they told us that they were a trainer for the Trust and they trained the staff in epilepsy procedures and deemed them competenct to give the medication. They said that they worked closely with the community nurse but the nurse did not provide the training directly to the staff. Care Homes for Adults (18-65 years) Page 17 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. Peoples complaints were taken seriously and their views were listened to and acted upon. People were protected from abuse, neglect and self harm. Evidence: The manager told us in the AQAA that people have regular meetings to discuss any complaints, concerns or changes they would like. When we looked at the statement of purpose we saw that it contained a copy of the complaints procedure. Three people said in their surveys that they knew who to talk to if they were not happy and they knew how to make a complaint. The fourth said that they did not know. We saw that there was a record of complaints about the home. There had been one complaint from a member of the public which had been investigated and the outcome was reported back to the complainant. The record of complaints included the nature of the complaint, the actions taken and the persons informed. However, the record did not always include the outcome of the complaint. One person had made a complaint about an incident at college and the staff had supported them to make a complaint to the college. There was information about how to make a referral about an allegation of abuse. At the last inspection we made a recommendation that all staff should attend training on the protection of vulnerable adults from abuse. This was so that staff could keep up to date in their understanding of the subject and how to protect people from the risk Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: of abuse. This had been addressed. The assistant team manager told us that staff received this training annually and the last session in January 2009 was attended by every member of staff except one new staff member. We looked at the staff training records which confirmed this. There had been two safeguarding issues in the last year which had been dealt with appropriately. Some people had management plans and risk assessments to help them with certain behaviours. The training records showed that staff had had training about how to manage behaviours. Care Homes for Adults (18-65 years) Page 19 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 lived in a homely, comfortable, clean and hygienic environment suited to their needs. Evidence: The manager told us in the AQAA that each person had their own bedroom which was decorated to their taste and needs. They also said that the communal areas were bright and spacious with televisions in the lounges and there were areas to listen to music and do activities. They said that the kitchens were safe environments to meet peoples needs. The manager told us that two bedrooms had been recently redecorated and new furniture had been purchased. They said that each lounge had a new flat screen television and some people had televisions in their bedrooms. They also said that the kitchen in Woodlands had been replaced and the kitchen in Meadowview had been redecorated. When we looked round the home and viewed the accommodation we saw that this was the case. We also saw that there was a well kept garden for each side of the house and a separate sensory garden. The manager told us in the AQAA that there were daily schedules to ensure the home was kept clean and tidy. They said that the laundry was kept separate and people were encouraged to do their own laundry when possible. During our visit we looked at the laundry room. A member of staff told us that people could do their own laundry Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: with support and the records confirmed this. Care Homes for Adults (18-65 years) Page 21 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. People were supported by an effective staff team, who were appropriately trained, qualified and competent to meet peoples needs. People were protected by the homes recruitment practices. Evidence: The assistant team leader told us about the staff cover for the home. They said that there were usually four support staff in the home, two for Meadowview and two for Woodlands. They said that during week days there was also a co-ordinator and a member of staff who was responsible for activities. They also said that there was one member of staff sleeping in at night in Woodlands and one member of waking night staff in Meadow View. The rota confirmed this staffing level. During our visit we saw that there were two staff on each side of the home and a co-ordinator. The assistant team leader said that they used bank staff to cover any vacancies but there were no vacancies at the time. A new staff member had just been recruited to fill the last vacancy. They also said that any holidays or sickness were often covered by staff taking extra shifts. One staff member completed a survey. They said that there are usually enough staff on duty to meet peoples individual needs. We looked at the recruitment records of the two staff who had started work since the last inspection. Both staff members had completed application forms. These contained Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: declarations about convictions but one member of staff had not completed this section. We spoke to the Human Resources Manager after our visit and they told us that the interview notes show that the person was asked about any convictions at interview and they had none. One member of staff had a gap in their employment history and a written explanation for this was provided. One member of staff had a copy of their passport and driving license as proof of identity and the other had a copy of their birth certificate. One member of staff had two written references which were received before the date when they started work. An enhanced Criminal Records Bureau check was received after the date when they started work. There was a letter from head office too confirm that a Protection of Vulnerable Adults (POVA) check was conducted before they started work as is required if a member of staff starts work before their CRB is received. The member of staff who completed a survey said that their employer carried out checks before they started work. For the other member of staff there was a copy of a letter confirming that a POVA first check and two written references had been received. There was also a letter to confirm that a CRB check had been received and the certificate number. The assistant team leader said that the references and CRB checks were kept at head office. We saw copies of the references at a later date. The member of staff told us that a copy of the CRB certificate had been sent to their home address. The manager told us in the AQAA that there were eighteen members of staff and ten had completed National Vocational Qualification (NVQ) level 2 or above. The assistant team leader told us that nine staff had NVQ Level 3 and one had NVQ level 4. They also said that three staff were working towards NVQ level 3 and three staff had a certificate in empowering practice from the University of the West of England. One member of staff, who had recently started work, showed us their induction folder. The assistant team leader said that there was a lot of training and each member of staff had a development plan. We looked at the training records and saw that staff had training about values, Control of Substances Hazardous to Health (COSHH), risk assessment, drug competency, food hygiene, fire safety, moving and handling, first aid, safeguarding adults, preventing challenging behaviour, understanding autism, Makaton, medication, finance and giving of a medicine in a special way. The assistant team leader said that staff had training about equality and diversity but this was not reflected in the records. They also said that they had received training about management and supervision. The staff member who completed a survey said that they received training that was relevant to their role, helped them to understand and meet peoples individual needs, Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: kept them up to date with new ways of working and gave them enough knowledge about health care and medication. They also said that their induction covered everything they needed to do the job very well. The member of staff who filled in a survey said that the manager sometimes gave enough support and met with them to discuss how they were working. We looked at the supervision records and saw that staff had supervision every one to two months. The assistant team manager said that they aimed to provide supervision once a month. 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. People were benefiting from a well run home. Peoples views underpinned all selfmonitoring, review and development by the home. Peoples health, safety and welfare were promoted and protected by the health and safety measures. Evidence: The manager told us in the AQAA that there were five members of the management team and the deputy was currently on secondment. The management team consisted of one home manager and four assistant team leaders. The manager is a qualified Learning Disabilities nurse and has been in post for approximately seven years. The manager also holds the Registered Managers Award (RMA). Each Assistant Team Leader has an NVQ3 and is currently undertaking an e-learning course in challenging behaviour management. The home has two Assistant Team Leaders on each side to support the team, hold regular supervisions and oversee two people, who live in the home, each. They also have other responsibilities in the general running of the home. When we looked at the training records we saw that the members of the management team kept their training up to date. Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: When we looked at the service user guide we saw that this contained questionnaires to people who lived in the home to gather their views. The assistant team leader told us that the manager conducts quality assurance audits of other homes and another manager conducts quality assurance audits of this home. We saw the audit tool for December 2008. There was also an action plan for developments in the home. A senior manager in the organisation conducted monthly visits of the home as required by Regulation 26 of the Care Homes Regulations. The manager had a completed an Annual Quality Assurance Assessment (AQAA) and sent it to CQC. This was clear and contained all the information we asked for and told us about what had improved in the last twelve months and their plans for further improvements. We looked at the arrangements for maintaining health and safety. There was a health and safety policy. The training records showed that staff had training about health and safety. There were monthly health and safety checks. The manager had provided dates of servicing of equipment, portable appliance testing (PAT) and gas safety in the AQAA and these were all up to date. We saw certificates for hoist inspection, gas safety, PAT testing and the nurse call alarm check. The Environmental Health Officer had visited the home on 12th November 2008 and given the home five stars. There was a fire evacuation procedure in words and pictures for each side of the home. We saw records to confirm that checks of the fire panel, emergency lighting, fire fighting equipment, fire alarm system, smoke detectors and fire doors took place. Service visits were recorded and these were up to date. There was a fire drill on 9th March 2009 and another drill was due. There were certificates to show that staff received fire instruction. The Fire Safety Officer visited on 22nd April 2009 and said that there was a satisfactory standard of fire safety. There was a fire risk assessment and a disaster plan. 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 20 13 The registered person must make sure that when staff give medication to people they sign the medication administration record or insert an appropriate symbol. So that it is possible to tell if the right medication was given at the right time. 23/10/2009 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 9 The risk assessments could be improved by including the benefits to the person of taking the risk to show how risk taking promotes their independence. The registered person should make sure that the controlled drugs cabinets meet with the new requirements for the storage of controlled drugs (The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007). The registered person should make sure that when staff are trained to administer medicines by a specialised technique, Page 28 of 30 2 20 3 20 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 the responsibility has been delegated to the staff by the responsible medical professional. They should also make sure that the homes insurance covers the staff for this task. 4 5 22 22 People should be reminded about how to make a complaint. The records of complaints should include the outcome of the complaint investigation and whether the complainant was satisfied with the outcome. 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. 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 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!