Care Home: The Chilterns

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What the care home does well The service provides individualised care in a way that respects the rights of the service user and promotes their independence. There are lots of opportunities in the home to develop new skills and to get involved in the running of the home. Everyone agrees their own care plan and how their support will be provided. The manager of the home always talks with the people using the service to get their views and to check they are happy with their care. Each week an independent advocate visits the service and is available for people to talk to about any concerns. There are also twice weekly `community meetings` in the home, which are run by the service users and are an opportunity for people to discuss matters affecting everyone in the home and to share ideas. The staff that work in the care home have an excellent relationship with the people that live there and understand what their needs are. People using the service say the staff are supportive and that they feel they can talk to the staff or manager about any concerns they may have. One person commented that "things do get sorted quickly if you have a problem". They tell us that they are happy with their care and that they feel their needs are met. One person said that "they are helping me to do more things for myself". What has improved since the last inspection? Since the last key inspection the service has amended the Statement of Purpose to reflect the new range of service user need it is able to meet. The service now provides support to adults with learning disabilities and mental health issues. One unit of the home has had some refurbishment and further work is planned to both this unit and the other unit in the home. A new manager has been appointed and registered and has begun work developing the staff training and recruitment arrangements. What the care home could do better: Some areas of the home still require redecorating and furnishing to provide a more homely environment. Service users said they felt improvements could be made to the environment and one person commented that "it has the feel of a hospital and its quite old fashioned". the manager said that plans are in place to improve the environment in the next few months. Staff require training in safeguarding adults and some staff require updates in some areas, for example food hygiene and first aid. The manager of the service needs to review the documentation in the home to ensure it reflects the service as a care home rather than a nursing home. The manager of the home has told us that plans are in place to address the requirements made in this report and they should write to the Commission to tell us when these have been completed. Key inspection report Care homes for adults (18-65 years) Name: Address: The Chilterns 5-7 Sea Road Westgate on Sea Kent CT8 8SA     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: Date: 2     1 0 7 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 32 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 32 Information about the care home Name of care home: Address: The Chilterns 5-7 Sea Road Westgate on Sea Kent CT8 8SA 01843832628 01843833649 baycourt@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Optima Care Ltd Name of registered manager (if applicable) Mrs Susan Scarlett Type of registration: Number of places registered: care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 26. 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) Mental disorder, excluding learning disability or dementia (MD). Date of last inspection Brief description of the care home The Chilterns provides residential care and support for up to 26 people with learning disabilities and mental health problems. The service provides step down support to individuals who may have previously been in more secure settings. The home comprises of two adjoining properties adjacent to the sea front in a residential area of Westgate and is within short walking distance of local amenities such as rail and bus Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 0 26 26 Brief description of the care home services, health centres, shops, churches and library. The Responsible Individual has a high level of input into home on a daily basis. Fees for the service begin at GBP455. Further information and a copy of the Statement of Purpose for the service can be obtained from the manager of the home. Care Homes for Adults (18-65 years) Page 5 of 32 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 was a key unannounced inspection of The Chilterns. The previous key inspection took place on 26th July 2007 and an Annual Service Review was completed on 9th July 2008. The inspection involved a visit to the service, which took place on 21st July 2009 between 11.00am and 4.30pm, and a review of information we have received about the service since the last key inspection. At the inspection visit we spoke with the manager of the home, looked at some care plans and records and observed some of the practices in the home. We also spoke with four people that use the service during our visit to get their views of the care they receive. We also received completed surveys from seven people that live in the home telling us about their experiences of using the service. Prior to the visit to the home the registered provider was required to complete and return an Annual Quality Assurance Assessment (AQAA). This assessment is aimed at Care Homes for Adults (18-65 years) Page 6 of 32 looking at how services are performing and achieving outcomes for people. The AQAA was returned within the required timescales and provided us with useful information about improvements that have been made since the last inspection. Judgements have been made with regards to each outcome area in this report, based on records viewed, observations and verbal responses given by those people who were spoken with. These judgements have been made using the Key Lines of Regulatory Assessment (KLORA), which are guidelines that enable the Care Quality Commission (CQC) to be able to make an informed decision about each outcome area. Further information can be found on the CQC website at www.cqc.org.uk Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Some areas of the home still require redecorating and furnishing to provide a more homely environment. Service users said they felt improvements could be made to the environment and one person commented that it has the feel of a hospital and its quite old fashioned. the manager said that plans are in place to improve the environment in the next few months. Staff require training in safeguarding adults and some staff require updates in some areas, for example food hygiene and first aid. The manager of the service needs to review the documentation in the home to ensure it reflects the service as a care home rather than a nursing home. The manager of the home has told us that plans are in place to address the requirements made in this report and they should write to the Commission to tell us when these have been completed. Care Homes for Adults (18-65 years) Page 8 of 32 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 9 of 32 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 10 of 32 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. Prospective service users are provided with the information they need about the services the home provides. They have their needs assessed before they move in and only admit people to the home if they are confident their needs can be met. The service has a clear Statement of Purpose outlining the range of needs it can meet. People looking to use the service have the opportunity to visit and stay overnight to test drive the service before they decide to move in. Evidence: Since the last inspection of the Chilterns the Statement of Purpose has been amended to reflect a change in the range of individual needs it aims to meet. The home now offers a step down service to people with learning disabilities and mental health problems, who have previously been detained in a secure unit or hospital setting, before they are ready to move into a more supported living environment. The Statement of Purpose and Service User Guide are made available to prospective service users when they express an interest in using the service. The wording in some areas of the Statement of Purpose and some other documents in the home could Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: provide misleading information for service users about the category under which the home is registered, in that the home is registered as a care home, not a nursing home. The manager said she will review all the documents in the home to ensure the language used accurately reflects the registration of the home. We received feedback from seven people using the service and spoke with four people during the visit. The feedback confirmed that they felt they were provided with clear information about the services the home offers and that they had been able to visit the home before moving in. Service users told us that they had been able to visit for meals and to stay overnight before they officially moved in to the home and this gave them the opportunity to meet other service users and staff. They also confirmed that they were given information about the complaints procedure and advocacy arrangements for the service. The manager and clinical director carry out the assessments of service users needs before they move in to ensure their needs can be fully met in the home. This involves reviewing the assessments provided by the PCT and relevant clinical specialists. The home has an assessment form that is also completed with the person to provide a holistic view of their needs, preferences and interests. The assessments were seen for two individuals and these showed that their views had been taken into account as part of this process. The manager has a clear view of the range of needs that can be met by the home and is currently supporting some people to move on where it has been identified their needs can be better met elsewhere. The service is currently undergoing some change to provide the service in two units, one for men and one for women and needs assessments for prospective service users are being completed. Care Homes for Adults (18-65 years) Page 12 of 32 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. People using the service have a care plan that is person centred and has been completed with their involvement. They are supported to make their own decisions about their support. Risks to service users are assessed, minimised and kept under review to ensure people are supported to lead independent lifestyles whilst remaining safe in the service. People using the service are involved in the running of the home and are consulted on their views of how the support is provided. Evidence: Everyone has their own care plan. During the inspection four people were spoken with who all confirmed they had a plan and that they had been involved in drawing this up. The plans were seen for two people using the service and these had been agreed and signed by them. The care plans are reviewed regularly by the senior staff and manager. Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: The care plans cover all areas of support need that have been identified in the assessment. Some of the language used in the plans and other associated documents may give the impression of the service being a nursing home or primary health service. For example, documentation refers to people being orientated to the ward when they are admitted and the care plans refer to individuals as patients. As this is a service designed to support people to move away from secure settings and hospitals and toward living successfully in the community the use of such terminology may undermine their progress. It may also give people misleading information about the nature of the services provided in the home. The manager agreed to review all documentation in the home to ensure it accurately reflects the services provided and promotes the dignity and independence of service users. The manager said that training is planned for staff in Person Centred Active Support with the Tizard Centre, a centre for training and research in learning disabilities. This is positive for the service users as they will benefit from being supported by staff that understand the importance of person centred support and of promoting individuals independence as far as possible. The service holds community meetings twice a week. These are meetings organised and chaired by the people using the service in order for them to discuss matters relating to how the service is run and issues that affect everyone in the home. Minutes are kept of the meetings, copies of which were seen during the inspection, and the actions from the previous meetings are discussed at the start of each meeting. People using the service told us that they are involved in running the service, for example, tending to the garden, choosing the decor for the home and planning the menus. They said that they felt the staff usually listen to what they think about things and that they are given support to make their own decisions. The manager said that service users have been involved in the recruitment of new staff by showing them around the home and it is planned that they will become more involved in this process in the future. The home employs a social worker who is available to provide support, advice and guidance to service users in a number of matters including welfare benefits, housing options, employment and family liaison. An independent advocate also visits the home once a week and service users said they can make an appointment to see them if they wish. Risk assessments have been completed as part of the care plan and these are personalised for each individual. Where the risk assessments result in a restriction on an individuals freedom, for example, only going out with staff support, this has been agreed with the individual service user and is kept under review with the individual Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: and their consultant. People using the service, that were spoken with during the inspection, said they understood the reasons for any rules and restrictions in the service and had agreed to them before they moved in. The manager is aware of the Mental Capacity Act and Deprivation of Liberty safeguards and ensures that support is provided to service users, as identified on their risk assessments, to enable them to go out in the community and to maintain contact with family and friends. Care Homes for Adults (18-65 years) Page 15 of 32 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 that use the service are supported to identify activities of interest to them and to participate in activities within their local community. They are supported to meet their responsibilities within the home and have their rights within the home respected. Service users are provided with the support they need to maintain contact with their family and friends. People using the service are provided with a balanced diet and are supported to choose and prepare their own meals if they wish to. Evidence: People that use the service said that they are supported to go out into the community for activities most days, but would like to be able to go out more often. Most people using the service require 1-1 staff support out when going out and those spoken with Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: said they receive 1-1 support for approximately four hours a day. The records confirmed that people have regular opportunities to go out into town, to the shops, for walks along the seafront and to the cinema and library, which are all located near to the home. The home has a number of lounge and dining areas across both sides of the home and there is a games room in one side of the building. All the lounge areas have a TV and music centre for service users use. Feedback from service users confirmed they are given support to visit their family members and friends if they wish and can receive visitors at the home. The manager said that most people have their own mobile phones, but that their is a payphone in one side of the home and also a payphone directly opposite the house, if they wish to contact family, friends or advocates. An adult education tutor visits the home weekly to carry out an education session. The manager said this is usually based on numeracy, literacy and independent life skills. The people that use the service said that they attend the adult education sessions, but sometimes find them boring. The minutes of the twice weekly community meetings show that people have the opportunity to make suggestions for activities they may wish to do. A number of service users were seen to be participating in some gardening during the inspection visit. They said they are growing vegetables for use in the home and have arranged a charity plant and veg sale for any excess produce they grow. Those that are involved in the gardening said they enjoyed this. None of the service users are currently in employment or seeking employment at this stage. The manager gave examples of where people have previously been supported in voluntary work and said that the social worker is available to advise people in this area as needed. All the service users spoken with said that their privacy in their own rooms is respected and that they have their own belongings, such as TV, music and games consoles. The use of these items is agreed in their care plan to ensure they can use them as they wish, but that they respect other people living in the home. Service users are responsible for cleaning their own rooms and doing their laundry. The support they require to do this was seen to be outlined in their care plan. Those spoken with said they were told about their responsibilities in the home before they moved in. Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: When a service user moves into the home they are asked to complete a diet form, which outlines any dietary requirements and preferences. The service users said the food provided is satisfactory and that they can ask for something different if they do not like what is on the menu. The home has a skills kitchen in one side of the building, which is used by service users to prepare their breakfasts and for them to cook their own meals. The manager said it is planned that a second skills kitchen will developed in this side of the building and that a skills kitchen will be added to the other side of the building when it is refurbished next month. It may benefit service users to be more involved in the preparation of the main meals in the home. Care Homes for Adults (18-65 years) Page 18 of 32 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 that use the service are supported to manage their own health care needs and access health care services as required. They are given the support required to safely manage their medication. People are given the support they need to manage their personal care and their privacy and dignity is respected. Evidence: People that use the service are supported to choose the GP, optician and dentist with whom they register. Most service users are registered at the nearby GP surgery and staff support individuals to make health appointments when they need to. The manager said that everyone living in the home has a health action plan and that they hold this in their own rooms to encourage them to take responsibility for updating it and planning their health support. Staff remind and support individuals with this as needed. Feedback from the service users confirmed this and also confirmed that they felt their health needs were being met. As previously identified in this report the registered person must ensure that the Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: service does not give misleading information about the provision of health and nursing services in the home. The home employs the services of a consultant psychiatrist, social worker and advocate to provide emotional and psychological support. Service users said that their privacy in their bedrooms and bathroom areas is respected and that staff only enter with permission. They are supported by staff to make hairdressing appointments in the local town and to go out to purchase clothing and personal items. Medication is administered by trained and qualified staff. The organisations training includes a theoretical session, a written assessment and five observations of administering medicines. Currently none of the service users manage their own medication, but the manager described how this is being gradually introduced starting with people being responsible for collecting their own prescriptions. Care Homes for Adults (18-65 years) Page 20 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service know how to make a complaint if they need to and can be confident their concerns will be taken seriously and responded to efficiently. They are safeguarded from harm and abuse whilst using the service. Evidence: Feedback from discussions with service users and the surveys they completed show that people know how to make a complaint about the service, if they need to, and feel confident to do so. One person spoken with said that things do get sorted quickly if you have a problem. The complaints record for the home shows that service users have raised issues, as they have needed to, and that these have been responded to quickly and effectively. The records also show that the person making the complaint receives a written response from the manager. In addition to the formal complaints procedure service users said they use the community meetings to discuss any concerns and raise any issues. Staff are made aware of the complaints procedure as part of their induction when they join the home. The manager told us that all staff have read the safeguarding vulnerable adults policy as part of their induction, but not all the staff have completed training in this area. A recent training needs analysis has been carried out by the manager and this training area was identified as the priority need. The manager said she has spoken with the trainers to arrange a date for this for all staff. Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: Service users told us they feel safe in the home and that they have the opportunity to access a social worker and independent advocate each week. The Care Quality Commission has not received any safeguarding information in relation to this service. Care Homes for Adults (18-65 years) Page 22 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment of the home provides service users with a clean and safe home, but they would benefit from further redecoration of the communal areas and bathrooms to provide a comfortable and homely living space. People using the service have bedrooms that meet their need and access to sufficient bathroom facilities. Evidence: The home is divided into two units. One unit has had some recent refurbishment and it is planned the other unit will be fully refurbished in August 2009. Generally the home requires some maintenance and attention to furnishings to ensure it provides a homely and comfortable feel. Feedback from people using the service included comments about the environment not being very homely, for example one person said it has the feel of a hospital and its quite old fashioned. Three people told us they would like to see more pictures around the home to make it feel more comfortable. On the day of the inspection the communal areas were quite bare and some areas required repainting. The manager acknowledged this and said that she was working with service users to choose some new paint colours and to choose pictures. The home employs a maintenance worker who said he plans to develop a rolling programme of decorating to prevent the fabric of home becoming worn. Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: Service users have access to a number of different lounge areas and there are two dining rooms in the home. One unit has a games room. There is a large main kitchen where all the main meals are prepared and a smaller skills kitchen on the first floor of one unit. The manager described plans to introduce more skills kitchen areas for service users to use as part of the refurbishment plans due to take place in August. Some bedrooms have en suite facilities and all have a minimum of a hand wash basin. There is a mixture of bathroom and shower rooms around the home. The shower room on the top floor is bare and shabby in areas. The manager said the service users are being consulted regarding the decor in this room. The front door to the home has a code lock for security, which means service users have to ask staff if they wish to go out. The manager said that most service users require staff support to go out and can ask for this at any time. Everyone has their own bedroom and are supported to decorate this as they wish to. The home supplies furniture for the room, but people can bring their own items if they wish. Service users spoken with said they are happy with their rooms and that they have all the furniture they require. Care Homes for Adults (18-65 years) Page 24 of 32 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. Service users are safeguarded by robust staff recruitment procedures and are supported by qualified and competent staff. The staff that support them have received some of the training they require and would benefit from further training and updates. Staff are supervised in their roles to ensure they can effectively support people in the home. Evidence: The staff recruitment records were inspected for two members of staff, one of which has recently joined the home. These showed that the appropriate checks had been made before employing staff into the home, including a criminal records check, written references and a health check. All staff undergo an interview with the manager. Staff are employed at the home once their POVA (protection of vulnerable adults)check has been received and they work under supervision until all other checks have been satisfactorily completed. All new staff work supernumerary to the rota for at least a week and are required to undergo the skills for care induction programme and workbook. The manager said that she is also completing the induction with existing staff to revisit their knowledge and skills. The manager has completed a recent training needs analysis and identified areas of Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: training required in the home. The training records were seen as part of the inspection and these showed that staff have completed some of the core courses they require to safely support people. However, as previously reported staff have not completed training in safeguarding adults and the manager said this is being arranged. There were also some gaps in staff training, for example food hygiene and first aid, and some courses had been completed some time ago. None of the staff have completed any training in person centred planning yet, but the manager said that Person Centred Active Support training is currently being booked for staff with the Tizard centre. The majority of the staff team have completed an NVQ or are currently working toward the award. The manager said the home plans to work toward achieving the Investors In People award over the next year. All staff have a supervision session with their manager at least every six weeks. A record is kept of this to allow the manager to monitor that this is taking place. Care Homes for Adults (18-65 years) Page 26 of 32 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. Service users benefit from a well run home and a competent and experienced manager who knows what improvements need to be made to the service. The service is run in their best interests and they are consulted on their views at regular intervals. The health, safety and welfare of service users and staff is promoted and safeguarded in the home. Evidence: The manager is a registered nurse in Learning Disability and is commencing the Diploma in Management Studies. She has a number of years experience in working with people with learning disabilities and mental health needs and has been registered as the manager of the home since our last inspection of the service. The manager has completed recent training in the Mental Capacity Act and Deprivation of Liberty Safeguards and keeps up to date with relevant changes in legislation and practice through training and workshops. The manager is also a trainer is safeguarding adults. Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: There are a number of systems in place within the service for monitoring the quality of the home. The manager described a full programme of audits and showed the inspector examples of audits and checks that are carried out in relation to staffing, safety and care practices. The AQAA for the service was completed to a high standard and demonstrates a good understanding of the areas of the service that would benefit from improvement. The service users are asked their views of the service through a number of means including the twice weekly community meetings and their care reviews. The manager also spends time each day talking with people in the home to ensure their views are heard and is available for service users to see her when they wish. The manager said it is planned to widen the annual quality review of the home to include service user surveys this year. There are no health and safety concerns in the home and the manager has completed risk assessments for the general environment as well as for individual service users. It may benefit service users to attend training in food hygiene as they will be making more use of the skills kitchens in the future. Care Homes for Adults (18-65 years) Page 28 of 32 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 29 of 32 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 1 4 The registered person must 31/08/2009 ensure that the Statement of Purpose, care plans and other documentation in the home reflect the service as a care home and not a nursing home. To ensure that people have accurate information about the care the service is registered to provide. 2 24 23 The registered person must 30/09/2009 ensure that the home is kept in a good state of repair and is decorated to a reasonable standard. To provide a comfortable and homely environment for service users. 3 35 19 The registered person must ensure a training plan is in place to address all areas of staff training need. 31/08/2009 Care Homes for Adults (18-65 years) Page 30 of 32 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 To ensure staff receive the training and updates they need to effectively support service users. 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 28 It is recommended that more furnishings and pictures be used to create a homely environment in response to service users requests. Care Homes for Adults (18-65 years) Page 31 of 32 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. 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