Care Home: The Corner House

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What the care home does well +2The people in charge of The Corner House are making it better for everybody and two people have come to live there in the past year. The people in charge of The Corner House are always listening to the people who live there and have changed things in the ways that they want. People from outside, such as doctors, nurses and social workers, are regular visitors to the home and they have helped staff at the home to look after people properly and to be healthy. Staff at the home work well to give people a good lifeand they get regular training to help them do things even better. Staff look after people properly and treat them with respect.The manager at the home does a good job.The home has been made a nicer place to live in by improvements to the areas that everybody uses. People living at the home have said what they want changed about the building. What has improved since the last inspection? The people who run the home have done everything they were asked to at the last inspection and the way they run it has been improved.The home is better place to live and this includes the improvements to the building.Staff have had more training which has helped them do their jobs better and some have achieved an approved qualification. What the care home could do better: X2Two legal requirements have been made as a result of this inspection. Everything is going well at the home and the people who run it don`t have to do too much more to improve things. Key inspection report Care homes for adults (18-65 years) Name: Address: The Corner House The Corner House 65a Welbeck Street Whitwell Worksop Notts S80 4TW 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: Brian Marks Date: 0 7 0 1 2 0 1 0 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 32 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 © (2010) 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 Corner House The Corner House 65a Welbeck Street Whitwell Worksop Notts S80 4TW 01909720899 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) : Mrs Ann Gibbins,Dr Edward Marcion Ranjit De Saram care home 3 Number of places (if applicable): Under 65 Over 65 3 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is 3 The registered person may provide the following category of service only: Care home only - Code 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 - Code LD Date of last inspection 2 8 0 1 2 0 0 9 Care Homes for Adults (18-65 years) Page 4 of 32 A bit about the care home The Corner House is a terraced house on an ordinary street. Whitwell x3 The home is situated in Whitwell. Accommodation in the house is provided for up to three people, and there are gardens accessible to residents. People have their own rooms and there is also shared facilities in the house. People are encouraged to use community facilities, using the home’s transport. Fees for accommodation are individual to each person. 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 Care Homes for Adults (18-65 years) Page 6 of 32 How we did our inspection: This is what the inspector did when they were at the care home We came to the home without telling the manager before we came and spent part of a day there. We had received a lot of information about the home from the manager, the staff and people living at the home before we came. The information we received before we came helped us plan what we would do when we arrived. At the home we spoke to the manager who told how things had changed since we last came. We looked at a lot of papers and documents in the office that told us about the home. We spoke to the staff who was working during the time we were at the home. X2 Care Homes for Adults (18-65 years) Page 7 of 32 X2 We spoke to two people who live at the home about their rooms and how much they enjoy living there. We walked around the home and saw how it had been improved. This is the first inspection of this home since 28 January 2009 - one year ago. What the care home does well 2 The people in charge of The Corner House are making it better for everybody and two people have come to live there in the past year. The people in charge of The Corner House are always listening to the people who live there and have changed things in the ways that they want. People from outside, such as doctors, nurses and social workers, are regular visitors to the home and they have helped staff at the home to look after people properly and to be healthy. Staff at the home work well to give people a good life Care Homes for Adults (18-65 years) Page 8 of 32 and they get regular training to help them do things even better. Staff look after people properly and treat them with respect. The manager at the home does a good job. The home has been made a nicer place to live in by improvements to the areas that everybody uses. People living at the home have said what they want changed about the building. What has got better from the last inspection The people who run the home have done everything they were asked to at the last inspection and the way they run it has been improved. Care Homes for Adults (18-65 years) Page 9 of 32 The home is better place to live and this includes the improvements to the building. Staff have had more training which has helped them do their jobs better and some have achieved an approved qualification. What the care home could do better X2 Two legal requirements have been made as a result of this inspection. Everything is going well at the home and the people who run it dont have to do too much more to improve things. If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 10 of 32 If you want to speak to the inspector please contact: Brian Marks Regulation Inspector Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 11 of 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 12 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. The support and care needs of people are properly identified before they move to the home; this ensures that the home is right for them and that their wishes and needs are properly planned for. Evidence: In the AQAA we were told that the homes Statement of Purpose and Service Users Guide are being updated with the involvement of the people living at the home but that they had not developed any versions in alternative formats for easier understanding. We were also told how comprehensive assessments are carried out as a new person moves to the home and this involves other professionals where appropriate. We were told that trial visits and transition periods are organised and these allow for the person to plan their room, and to see how well they will get on with other people at the home. We were also told how a keyworker is assigned as soon as the person makes their first visit to the home, in order to build up a relationship and to support consistency. Since the last inspection one person has left the home and two others have moved in, both present at the time of this inspection. We looked at their care records to see how their move had been planned and how their ongoing care and support was being Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: arranged. From looking at these records we were able to confirm that staff had received detailed information about them before they came to live at the home, one of whom had previously been living in a specialist hospital. Records included a personal profile, background history and descriptions of healthcare needs with any associated problems. Documents were completed by senior staff from the home as well as professionals from relevant health and social care services and further assessments were completed after trial stays had been completed. There was no documentation completed that relates to peoples ability to make decisions for themselves under the Mental Capacity Act; this will help make sure that peoples interests are fully protected. There was evidence that meetings had been held involving all concerned three months after they moved to the home, which indicates that actions and interventions by staff are based on up to date information. We were told that the style of documentation had been developed during the past year and, although all the key requirements had been covered, the style of all care records were staff centred rather more person centred. The manager told us that progress in this area was a priority for the next stage in the homes development. The two people living at the home were able to speak to us throughout the inspection and they told us that Its nice here and I do things I want to and meet people I want to, I like it here, Ive got my own room which is better than before, and I like peace and quiet and my room is good for that; I like to listen to music and watch my own TV. Care Homes for Adults (18-65 years) Page 14 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. Residents care needs have been assessed, risk factors identified and care planned in ways that reflect their individual preferences and abilities. Evidence: In the AQAA we were told that all the people living at the home have care plans, which identify their needs, choices and wishes and how staff will fulfill these being met. We were also told that they have two keyworkers, with whom they are encouraged to build up a close working relationship and who they meet every week to discuss concerns and possible problems. The people living at the home plan how they will spend their time and how the home is run. The AQAA also described a more person centred style being developed and involving them in developing a greater range of activities and getting more access to local advocacy services. We had a close look at the care records of both people living at the home and they were completed using the same structured documentation and to the same standard. They each had a comprehensive personal care plan, prepared mainly for use by staff but which was very detailed and individual to the person concerned. These support plans included Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: detailed actions for staff to take in all areas of the persons life such as management of aggressive behaviours, creating a structured routine, emotional needs, coping with roads and controlling impulsive habits such as excessive smoking and eating. All of the areas that indicated an element of risk were supported by detailed risk assessments that made sure nobody would come to any harm from the work being carried out. We also saw a strengths and needs profile, an OK Health Check document, but no documents that carried any reference to peoples ability to make decisions for themselves under the Mental Capacity Act, as mentioned above. The layout and content of the support plans were traditional in style rather than being person centred and, although signed by the person concerned to indicate that they had been involved in the process, they were very much of a style that centres around staff actions rather than being about the whole person. We found that all the support plans and summaries had been looked at regularly and updated where necessary and in all the records we looked at there was evidence of the involvement of outside professionals that included healthcare support from their GP and others. The care documentation indicated that staff were working with up to date information and in ways respected the individual. We spoke to both people living at the home throughout the inspection and, they were generally relaxed and happy in the way they presented themselves. There was one brief incident of bad language from one person and the staff immediately managed this as required by their support plan; we were told that by acting in the way they did helped prevent the situation escalating into something worse. We observed interactions between staff and the people living at the home and these were appropriate with friendly banter or casual conversation taking place in a relaxed and natural way. We also saw them helping the staff with lunch arrangements. Care Homes for Adults (18-65 years) Page 16 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 living at the home enjoy social and leisure activities, which they choose to do so by themselves or together; these are aimed at improving independence and decision making and to help them enjoy as many opportunities as possible. Evidence: In the AQAA we were told that people have been supported to maintain family links and been given the opportunity to access activities of their own choice and get involved in local community based facilities. We were also told about plans to assist one person to start a college or other vocational activity, and to provide broader nutrition and catering experiences. Discussion with staff and observations made during the visit confirmed that the daily routines of the home continue to be flexible and residents were seen during the inspection around the home, by themselves or with staff. A structured activity plan has been developed for both people but it was clear from our conversations that this is a broad weekly guide around which life is structured; the latter is generally worked out Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: daily other than some fixed weekly events. These include the Tuesday evening bingo session at a local social club, shopping including the supermarket on Mondays and regular visits to an adjacent care home operated by the same company. On the day of the inspection they spent the morning relaxing in the living room, following the progress of the inspection, and talked about a possible outing for the afternoon if the weather permitted. Some activities are focused on improving domestic skills and one of the people we spoke to told us that she tidies her own room and helps with the laundry, food shopping and meal cooking. We saw her preparing a snack meal for lunch with staff. We talked with them and the staff about a range of leisure activities that they are involved in, both inside and outside the home, and these include music and DVDs, as well as the activities mentioned above and visits to local shops, pubs, cinemas and restaurants. Weekly swimming sessions and walks in the country park to feed the ducks are also popular. This indicates structure and less randomness in their lives and allows them to follow more a personally relevant lifestyle, although the manager mentioned in the AQAA the need also for people to enjoy unstructured leisure as they may want quiet time to themselves. Contact with families has been maintained and one person told us she telephones her mother weekly whilst the other told us about irregular visits to her family in Derby. One of the staff members said that the keyworker system works very well now and it encourages us to have one to one time to help them talk about any concerns or problems on their mind. The catering arrangements at the home are very domestic and flexible in style and we were told that the weekly menu is planned on Sundays by the people themselves with staff support. Staff told us that there is still room for change on the day depending what people feel like having, particularly at lunchtime. The feedback received was positive about the meals provided and staff confirmed that the people living at the home join in with the weekly supermarket shopping trips, and that eating out and takeaway meals are a regular feature. They also told us that home cooking and healthy eating are the basic principles being encouraged, and a good supply of fresh and vegetables was seen in the kitchen store. Overall foodstocks seen in the kitchen and storage areas were satisfactory. 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. The personal and health needs of people at the home are dealt with in a satisfactory way, and they continue to receive good support from outside professionals; they have access to local services like everybody else. Evidence: In the AQAA we were told that people living at the home receive support to get access to health professionals and to attend health and medical appointments. Since the home has been open we were told that staff have made sure that they receive adequate support for maintaining personal care and with personal choices. All appointments and their outcomes are recorded in individual care records and their keyworker makes sure that everything that is needed is provided for. Care records indicated that the two people living at the home require different levels of personal care support or prompting with self care, and one of them requires high levels of staff attendance to monitor their behaviours and the outcome of their autistic traits. That person requires two staff in attendance when she is out in the community and particular attendance is being paid to managing and improving road safety for both people. The care records indicated detailed steps for staff to follow, particularly when verbal behaviours result in the need for time out from the activity of the home. We saw this being put into operation and the member of staff carried out the required actions Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: successfully. The two staff we spoke to described how they now handle this aspect of their work with confidence but also with respect for the individual. The staff told us that the aggression management plan works very well and the card system is operated about once a week; consistency of staff actions is the key to success. The two people living at the home are encouraged to do as much for themselves as they can and this is reflected in the personal plans we looked at. Care plans also confirmed the involvement of local Learning Disability Services professionals where necessary, and both have support from a social worker and a psychiatrist, as well as one who gets specialist support due to her epilepsy. Records indicated that people also have routine access to general healthcare services such as GP but the manager confirmed they were generally both in good health. They both have an OK Health Plan completed that are used for documenting all of this activity. As noted above written risk assessments are identified on individual care records and they include such areas as hot water scalds, bathing and receiving personal care, mobility, nutrition and falls; there were records of regular checks taking place of weight and contact with opticians and dentists. We saw from written records that everybody receiving prescribed medication require staff help with its management. Examination of the arrangements for the receipt, storage and administration of medicines indicated that these were generally satisfactory. Medication was stored securely and a Monitored Dosage System for the dispensing of most of the medicines was in use. Entries in the written records had been made properly, apart from some handwritten entries that had not been signed and dated. We also found a stock of medicines in the medicines cabinet that were no longer being prescribed. The staff involved in medicines administration had received training from the homes pharmacist. 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 living at the home are protected by having their rights to complain upheld and by staff who understand their responsibility to report concerns and to safeguard vulnerable people from harm. Evidence: In the AQAA we were told that the complaints procedure is on display at the front of the home and also about the systems in place for documenting any complaints people make. We were also told how keyworkers support people to express their views and concerns as they arise and that this allows for things to be resolved quickly. The complaints procedure is not available in a simplified form, although we were told about the intention to prepare a pictorial version. We were also told about staff training in respect of safeguarding vulnerable people but that not everybody has achieved this in the past year. We saw the complaints policy on display by the front door and the manager confirmed that there had been no formal complaints made since the last inspection. The manager told us that staff try to deal with concerns and problems immediately and informally as they arise. The home has a copy of the statutory safeguarding procedures and other national guidance, and the manager confirmed that she and about three quarters of staff had attended training or briefing sessions on this subject. There has been no incidents which have been referred under these procedures for investigation by Social Services and Police; the manager and staff we spoke to seemed aware of how to act properly to report Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: and protect as they are required. Additionally detailed records of untoward incidents are now kept on each persons care record and the ones we noted were almost exclusively outbursts of verbal aggression of the one resident referred to above. We were told in the AQAA about plans for staff receive training in the management of violence and aggression and the manager told us about plans for staff training in the recently introduced legislation about Mental Capacity and Deprivation of Liberty. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home have continued to benefit from a homely domestic style environment that is equipped to meet their needs. Evidence: In the AQAA we were told that since it opened the home has been fitted out with new decor and furnishings and that a new conservatory and utility have been recently added. We were told that bedrooms have been personalised and the people living there are now turning their attention to the communal areas. The home is safe and we were told that all of the recommendations of the Environmental Health and Fire Officers have been followed. We made a brief tour of the building with one of the people who live there and one of the staff. We found the home clean, tidy and offering domestic style accommodation which people occupy in single rooms with all the required facilities. Good standards of decoration have been maintained and we saw that the vacant bedroom remains empty, since there are no plans for a third person to move in at the present time. The home had been visited earlier in the year by the Environmental Health and Fire Officers and we saw from their reports that all their recommendations have been dealt with. All the bedrooms are very much to each occupants individual choice of style and furnishing; for example one has made the choice to have her own television to use, whilst Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: the other chooses not to. The rooms are personalised with pictures, personal mementoes and photographs and one person has collection of DVDs on display. There is also a large garden and patio area, much enjoyed in the summer. Another new development has been the provision of a mobile intercom system for staff use when they are on duty and gives a direct link with staff at the adjacent nursing home; this has provided them with a feeling of improved safety when they are working alone. Staff are mainly responsible for cleaning and domestic arrangements around the building, but are helped by people tidying their own rooms. The laundry room is domestic in style and is in use most days; again the people living at the home take some responsibility for their own with staff support. Standards of cleanliness and hygiene around the home were good and clothes were clean and appropriate. We were told by the people living at the home that Ive got everything I need in my room and I can watch TV by myself if I want, and I help out with the laundry and sometimes do the ironing as well. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a staff team who are settled in their work and there are systems of recruitment, training and support in place that ensure the interests of the people in their care are supported with professionalism and in safety. Shortfalls in training and formal supervision will limit this being fully achieved and may place the latter at risk. Evidence: In the AQAA we were told that the home now has a full staff team and that there is minimal absence as a result. All staff are recruited properly for the home and using processes that are designed to protect the people living there. We were given details about staff training, induction and qualification and told how they are working towards achieving a higher qualification than is required by the National Standards. We were told about regular staff meetings and how each member of staff is assigned a specific responsibility within the home. The home employs 11 support workers, most of whom were recruited form the adjacent nursing home and started work in two groups as the two people moved in last year. This ensured that the people living there get a safe level of support and the staff roster indicated that there are always two staff on duty during the day and one at night. The people living at the home are enabled to access all the service and facilities they can. The manager is at the home for part of the week as she splits her time with another small home situated in a village a few miles away. None of the staff we spoke to felt that this Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: arrangement caused any difficulties and they felt that they were well supported at all times; if they had any difficulties there was always somebody who was a phone call and short distance away. We were told that all staff have an agreement for formal meetings with the manager (supervision), and staff agreed that were taking place but not everybody had received them at the required regularity. We were told that if anything happens the manager is at the end of the phone and the walkie talkie system works well with the nursing home. We were also told that one of the proprietors visits the home every Saturday and issues can be raised with him direct. We were not able to look at the recruitment file of any of the staff since, although it had been previously agreed they could be kept off site, the weather conditions on the day of the inspection meant that they could not be brought in for examination. The AQQA described the recruitment process in general terms and the manager confirmed that only one member of staff had not been recruited from the nursing home so that she was well acquainted with them before they came to work at the home. Similarly the training records for the staff team were also retained at the other home but the manager and the staff present were able to confirm achievements in general terms. They confirmed a good standard of training practice during the past year with a high level of completion in the National Vocational Qualification (NVQ)at the higher level 3; this indicated that the required target was exceeded, which is to be commended. We were told about a good level of training successes with first aid, safe manual handling, safeguarding vulnerable adults, fire and other key areas of health and safety. A programme of training about recent legislation concerning peoples mental capacity and restraints on freedom is being planned, although the staff we spoke to did not indicate any awareness training in specific conditions such epilepsy and autism. 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. The home is a well-managed and safe environment in which to live and work. Evidence: In the AQAA we were told about management and administration activities that have occurred during the past year; these have included the development of policies and procedures, and of a budget for the home as well as general health and safety practices that have been kept up to date. We were also told about the involvement of the proprietors with the home and the arrangement of regular staff meetings so that everybody has a clear understanding of the aims of the home and what needs to be achieved to develop progression. During the inspection, the manager confirmed that she has completed a Managers qualification at NVQ level 4 in care and management and she told us about other training she has taken part in, mostly with the other staff as it have been arranged. The manager has completed the registration process with the Commission and has experience of managing residential services for people with a learning disability in other settings, most recently at the adjacent nursing home operated by the same company responsible for this home. There was a relaxed atmosphere at the home throughout our visit and Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: everybody spoken to was positive about the support available from the manager to get things done. Staff told us that the manager has developed a stable atmosphere at the home and we all work well together and support each other for the sake of the residents. As reported above, she is supported by a staff team that enjoys improved stability, and the resulting consistency has allowed for time to plan the future of the home. The manager told us that this will be formalised in the coming year through an Annual Plan for the home and a more structured approach to getting feedback about the home from all concerned. As mentioned above one of the proprietors is a weekly visitor to the home and another experienced manager completes a monthly report for the company as is required by law. Everybody living at the home has had a number of external review meetings in the past year with their social worker, and all key people in their lives are invited to contribute to this and give their opinion as to how things are going. Outside advocacy services have not been used but staff told us about the weekly consultation meetings they have with people living at the home; this gives them the chance to have their say and this was confirmed by one of the people we spoke to. In the AQAA the manager told us about standards of health and safety activity and regular servicing of equipment at the home, and observations made around the building and from a sample of fire safety and servicing records indicated that the home was hazard free at the time of the inspection. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 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 Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 20 13 Medicines managed on behalf 28/02/2010 of the people living at the home must be administered as prescribed and appropriate record keeping practices must be maintained. This is so that the health, safety and well being of people living in the home can be maintained. 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 2 Assessment processes should be developed in ways that are person centred and which demonstrate a more individualised approach to planning and delivering care. Care planning and support documentation should be developed in ways that are person centred and which demonstrate a more individualised approach to planning and delivering care. 2 6 Care Homes for Adults (18-65 years) Page 30 of 32 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 3 35 All staff should receive training or instruction that helps them to fully protect the rights of the individuals in their care and to safeguard them from harm. All staff should receive formal 1 to 1 supervision from the homes senior staff, at intervals of every two months. This will ensure the opportunity for regular consultation about and monitoring of their work. The owners of the home should introduce formal systems for assessing how well the home is performing and for reviewing the quality of care being delivered. 4 36 5 39 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2010) Care Quality Commission (CQC). 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