Care Home: The Limes (Northampton)

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What the care home does well The Limes is an established small care home providing support and accommodation to adults. The property is situated on a main busy road and blends in with the other local residential properties in the area. The home is registered to accommodate up to 8 people, in 4 single bedrooms and 2 shared bedrooms. The bedrooms are located on each floor. All the bedrooms have shared toilets, bathroom on the first floor and a shower room on the ground floor accessible to people who use walking aids or a wheelchair. There is good information available to people about the home, the services and facilities and the range of support people can expect to receive. People are encouraged to visit the home to help them decide if it is the right place for them. People are involved in the process to assess their needs and where appropriate liaises with other health professionals who are involved in their care. People choose to move to the home are supported by nominated staff known as `key workers`. People make decisions about their daily life and are supported to maintain their own personal care, where possible. People are supported with their health needs, access health services and supported with their medication. People using the service are part of the local community, take part and use local amenities and leisure services. People are encouraged to manage their own money or with help from staff to be more independent and confident. People also take responsibility for the looking after their belongings, laundry and keeping their bedroom tidy. The complaints procedure is clear and concerns raised are addressed quickly. People who use the service have the opportunity to raise concerns at any time, individually, at the residents meetings, review meetings and with their key worker. The staff recruitment and training is good. There is a stable staff team who receive regular training, supervision and support to meet people`s needs. There are good communication systems in place between the staff and to meet the needs of people using the service. Some of the comments received in the surveys from the people using the service, staff and health care professionals and from our discussions during the site visit, included: "Looks after me" "I feel safe here - the angels looks after me" "Say what you need to at the residents meetings" "Provides stability for a physically disabled (leg-less) person and a quasi-halfway house transition for other occupants" "Provides a good setting for staff to work in and share information" "Actually, ...... (Registered Manager) is very good, especially when something happens with a resident and she knows you just need to talk or given some time out. I know because she`s been there for me" "Good communication with our service" "I am generally pleased and satisfied with the service they provide to our service user who has `......` needs and choices that values partnership working with them and regularly review progress and re-negotiate care plan arrangements due according to fluctuations and variable needs" "Manage a diverse and challenging residential population" "Seeks advice, listens and actions" What has improved since the last inspection? The Limes has addressed the requirement and recommendations made at the last Key Inspection of the service. The Limes is currently undergoing a major refurbishment programme of the home that includes the decoration of communal areas, relocation of the office to the ground floor and widening the doorways for better wheelchair access. The trees and bushes in the rear garden have been pruned and cut back providing more natural light and a pleasant view. There have been improvements made to the assessment of needs and care planning process. Comprehensive information is gathered about individual needs ensures person centred care plans are developed with individual views and provides clear guidance for staff to follow. People who use the service have key workers that take responsibility in supporting individuals, having regular review meetings where changes to care and support needs can be addressed quickly. People who use the service are consulted regularly through the `residents meetings`, review meetings with the key worker and the annual quality assurance surveys. The Limes has recruited additional staff to provide a stable staff team who have clear roles and responsibilities. The staffing levels support people who use the service to be able to take part in social and leisure activities. There are weekly staff meetings to ensure staff are kept up to date with matters relating to the people who use the service, training and the day-to-day management of the service, where appropriate. There is a staff training programme in place to ensure all staff maintain their knowledge, skills and understanding of best practice to meet the needs of the people who use the service safely. This includes training in safeguarding adults, basic IT skills, Mental Capacity Act and the Deprivation of Liberty`s to protect and promote people`s well-being and safety. There are `monthly manager`s meetings and supervision` to ensure the service is supported and managed. There are systems in place to demonstrate health and safety checks carried out in the home. What the care home could do better: This was a positive inspection of The Limes. The information we received from the people who use the service, staff, health care professionals and the information we gathered from the site visit demonstrated the practice within the service protects and promotes the well-being of people who use the service. We identified a few areas of practice and recording with regards to medication that should be addressed and monitored to ensure people`s health and well-being. The home should ensure the programme of refurbishment is completed on time to ensure it does not inconvenience the people who live at the home for an extended period of time. We have also made a number of good practice recommendations that we discussed with the Registered Manager and the Quality Assurance and Development Manager. The recommendations made may benefit the people who use the service and improve the management systems and practice within the home. Key inspection report Care homes for adults (18-65 years) Name: Address: The Limes (Northampton) 193 Weedon Road Northampton Northants NN5 5DA     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: Rajshree Mistry     Date: 0 9 1 2 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 40 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 40 Information about the care home Name of care home: Address: The Limes (Northampton) 193 Weedon Road Northampton Northants NN5 5DA 01604751948 01604751948 limescare@majproperties.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Philip Henry Keet,Mrs Maureen Elaine Keet care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: No person falling within the category mental disorder (MD) can be admitted where there are already 8 persons of category mental disorder (MD) in the home. ( Total number of service users in the home must not exceed 8. Two people whose primary need is mental disorder (MD) but who also have a physical disability (PD) may be accommodated. Date of last inspection Brief description of the care home The Limes is a care home providing personal care for a maximum of 8 people aged between 18 and 65 years who have mental health problems and up to 2 people with a physical disability. Mr and Mrs Keet own The Limes. The Limes is a large semi-detached property, situated in the suburb of Northampton. There is a local shopping centre within walking distance and the town centre is approximately 2 miles away. There is good public transportation close to the home. Care Homes for Adults (18-65 years) Page 4 of 40 Over 65 0 8 1 5 1 2 2 0 0 8 Brief description of the care home The accommodation consists of 4 single and 2 double bedrooms. The two double rooms are currently occupied as singles and this will only change where there is a special request by two people to share. The communal areas consist of a large lounge areas and a kitchen/diner. There is a rear garden and off road parking at the front of the house. The Regisetred Manager provided us with the fees charged. These range from £1350 to £1500 per week. There are additional personal expenses for personal toiletries, magazines, outings and holidays. The fees are determined upon the individual assessment of needs and requirements. People considering using The Limes should contact the home directly to discuss individual needs and requirements. Full details for The Limes and any specific requirement can be obtained in the form of the Statement of Purpose and the Service User Guide. The latest Inspection Report from the Care Quality Commission is available at the home or accessible via our website: www.cqc.org.uk Care Homes for Adults (18-65 years) Page 5 of 40 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: The quality rating for The Limes is 2 star. This means the people who use the service experience good quality outcomes. We as it appears throughout this Inspection Report refers to the Care Quality Commission (CQC). This key inspection started with the review of the last Key Inspection dated 15th December 2008. We looked at the information we had about the management of The Limes and the events that affects the well-being of the people who use the service. This includes any concerns or complaints that we may have received about the quality of care people receive and the management of the service. We received from the Registered Manager the completed Annual Quality Assurance Assessment (AQAA) document. This is the homes self-assessment of the standards Care Homes for Adults (18-65 years) Page 6 of 40 within the service. We sent out 6 surveys to the people who use the service of which 3 were returned. All the responses received indicated people received information and chose to move to the home. All the responses indicated people were satisfied with the quality of care and support they receive from staff, services and facilities provided. All the responses indicated people make decisions about their daily living and are able to live their choice of lifestyle. All the responses indicated people know how to complain. All the responses indicated staff treat people well, listen and act on what they say. All the responses indicated the home is fresh and clean. The comments received in the surveys are included throughout this Inspection Report. We sent out 15 surveys to health and social care professionals of which 1 was returned. The responses received in the survey indicated they were satisfied with the care and support provided to people with regards to meeting their social, health and personal care needs. The comments received in the surveys are included throughout this Inspection Report. We sent out 10 staff surveys, of which 3 were returned. The majority of responses indicated they have up to date information about the people who use the service. The majority of responses indicated staff were recruited with pre-employment checks and received training to meet the needs of the people who use the service. All the responses indicated there is a good communication system in place to ensure people are supported safely and staff receive regular support from the manager. The comments received in the surveys are included throughout this Inspection Report. We visited The Limes on 9th December 2009, starting at 10.30am and lasted over 6.5 hours. The Registered Manager assisted us during the site visit and later joined by the Quality Assurance and Development Manager. The main method of inspection we used was case tracking. This means looking at the range of health, personal care and support people receive that is met by the staff at the home. We selected three people to case tracked all having differing levels of care and support needs. We looked at how peoples rights, choice, dignity and independence is promoted by staff. We spoke with some people using the service at the time of our visit. We read their care files containing information about their health and personal care and support needs, lifestyle, and how these are met. We made observations of how people are treated and supported by staff with regards to promoting and maintaining independence and well-being. We spoke with the staff on duty with differing roles and responsibilities to ascertain the recruitment process, training, staff skills and the management of the home. We made observations of how staff interact with people who use the service and the deployment of staff to ensure people are supported. We looked at the staff files that demonstrated staff recruitment, training and the skill-mix of staff. We looked at the accommodation offered to people who use the service. This included the communal areas, bathrooms and some bedrooms. We read the information people received about The Limes. We looked at how the policies and procedures are followed by staff that ensures health and safety. We looked at specific records that demonstrated the day-today management of the home and how Care Homes for Adults (18-65 years) Page 7 of 40 people that use the service are informed and consulted about the quality of support they experience. The Registered Manager provided us with additional information to demonstrate the practice within the service and how it benefits the people who live at The Limes. The Care Quality Commission has a focus on Equality and Diversity and issues relating to these are included throughout this Inspection Report. Care Homes for Adults (18-65 years) Page 8 of 40 What the care home does well: The Limes is an established small care home providing support and accommodation to adults. The property is situated on a main busy road and blends in with the other local residential properties in the area. The home is registered to accommodate up to 8 people, in 4 single bedrooms and 2 shared bedrooms. The bedrooms are located on each floor. All the bedrooms have shared toilets, bathroom on the first floor and a shower room on the ground floor accessible to people who use walking aids or a wheelchair. There is good information available to people about the home, the services and facilities and the range of support people can expect to receive. People are encouraged to visit the home to help them decide if it is the right place for them. People are involved in the process to assess their needs and where appropriate liaises with other health professionals who are involved in their care. People choose to move to the home are supported by nominated staff known as key workers. People make decisions about their daily life and are supported to maintain their own personal care, where possible. People are supported with their health needs, access health services and supported with their medication. People using the service are part of the local community, take part and use local amenities and leisure services. People are encouraged to manage their own money or with help from staff to be more independent and confident. People also take responsibility for the looking after their belongings, laundry and keeping their bedroom tidy. The complaints procedure is clear and concerns raised are addressed quickly. People who use the service have the opportunity to raise concerns at any time, individually, at the residents meetings, review meetings and with their key worker. The staff recruitment and training is good. There is a stable staff team who receive regular training, supervision and support to meet peoples needs. There are good communication systems in place between the staff and to meet the needs of people using the service. Some of the comments received in the surveys from the people using the service, staff and health care professionals and from our discussions during the site visit, included: Looks after me I feel safe here - the angels looks after me Say what you need to at the residents meetings Provides stability for a physically disabled (leg-less) person and a quasi-halfway house transition for other occupants Provides a good setting for staff to work in and share information Care Homes for Adults (18-65 years) Page 9 of 40 Actually, ...... (Registered Manager) is very good, especially when something happens with a resident and she knows you just need to talk or given some time out. I know because shes been there for me Good communication with our service I am generally pleased and satisfied with the service they provide to our service user who has ...... needs and choices that values partnership working with them and regularly review progress and re-negotiate care plan arrangements due according to fluctuations and variable needs Manage a diverse and challenging residential population Seeks advice, listens and actions What has improved since the last inspection? The Limes has addressed the requirement and recommendations made at the last Key Inspection of the service. The Limes is currently undergoing a major refurbishment programme of the home that includes the decoration of communal areas, relocation of the office to the ground floor and widening the doorways for better wheelchair access. The trees and bushes in the rear garden have been pruned and cut back providing more natural light and a pleasant view. There have been improvements made to the assessment of needs and care planning process. Comprehensive information is gathered about individual needs ensures person centred care plans are developed with individual views and provides clear guidance for staff to follow. People who use the service have key workers that take responsibility in supporting individuals, having regular review meetings where changes to care and support needs can be addressed quickly. People who use the service are consulted regularly through the residents meetings, review meetings with the key worker and the annual quality assurance surveys. The Limes has recruited additional staff to provide a stable staff team who have clear roles and responsibilities. The staffing levels support people who use the service to be able to take part in social and leisure activities. There are weekly staff meetings to ensure staff are kept up to date with matters relating to the people who use the service, training and the day-to-day management of the service, where appropriate. There is a staff training programme in place to ensure all staff maintain their knowledge, skills and understanding of best practice to meet the needs of the people who use the service safely. This includes training in safeguarding adults, basic IT skills, Mental Capacity Act and the Deprivation of Libertys to protect and promote peoples well-being and safety. There are monthly managers meetings and supervision to ensure the service is Care Homes for Adults (18-65 years) Page 10 of 40 supported and managed. There are systems in place to demonstrate health and safety checks carried out in the home. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 11 of 40 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 40 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have information about the service and are involved in the assessment of needs process to ensure their needs are met Evidence: We wanted to find out what information people received about The Limes and the process by which they move to the home. The information we gathered from the selfassessment completed by the Registered Manager stated, service user guide and the statement of purpose are given to residents, both are available in alternative formats and there is a good pre-admission assessment process that involves the person. The survey responses received from the people who use the service indicated people did receive information and were asked if they wanted to move to the home. We read the Statement of Purpose and the Service User Guide, which gives people information about the service, the management and staffing of the service, the facilities and opportunities available and the aims and objectives. There are key procedures detailed such as the admissions and the complaints procedure. The Registered Manager told us that whilst the service is registered for 8 people, they are Care Homes for Adults (18-65 years) Page 13 of 40 Evidence: only providing accommodation for 6 people. They said this was to provide people with individual bedrooms although there are plans to extend the accommodation to provide 8 single bedrooms. Therefore, the information in the statement of purpose and the service user guide needs to be updated. Since the last key inspection the service no new people have moved to the home. Although we spoke with some people briefly about their experience of moving in, they were unable to remember the process or did not want to tell us. We also tried to speak with the people who had indicated in their surveys to us that they wanted to speak to the Inspector, but declined on the day. Therefore, we based our finding on the information we received in the surveys and the records viewed. We identified 3 people to case track and read their care files. All the files contained record of their needs identified through the assessment of needs process. The assessments are completed by the Registered Manager with the person involved and their representative. There was good information gathered about the person, their previous medical, physical and mental well-being, challenging needs and behaviours, cultural needs, aspirations and the level of support they required. This has been improved and the assessment process has taken into account the number of staff required to support each person. We noted that there was no information with regards to the medication. This was highlighted when we read one persons assessment, which had no information with regards to medication and a discharge letter from the hospital that had a list of medication they were prescribed. We brought this to the attention of the Registered Manager and how information with regards to medication and any other medical treatment required may affect the quality of support people receive. They accepted the need to include medications taken in the assessment of needs process, which can be checked again when the person moves to the home. This would ensure the assessment of needs process is robust and individual needs would be met. The responses in the staff surveys indicated, staff receive information about individual needs and have up to date with information such as care plans. This was consistent with what staff told us on the day. They told us that the Registered Manager tells them about any new person moving to the home through the handover meetings, staff meetings and have detailed care files in place for staff to read. All the care files we read had individual signed contracts of stay with the terms and conditions. In addition, there were placement agreements from the organisations that financially supports the individual. Therefore, people who live at The Limes have agreed contracts of stay. Care Homes for Adults (18-65 years) Page 14 of 40 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 are supported with their individual needs by trained staff, good communication and care planning that promotes their well-being and independence. Evidence: We wanted to find out how peoples needs are met and whether they make their own decisions and choices about their life. The information we gathered from the selfassessment completed by the Registered Manager stated, provides individual care plan and risk assessments in conjunction with other supporting agencys, family members and the service users. It stated the care plans, risk assessments and key working sessions are recorded and maintained on file. The responses and comments received in the surveys from the people who use the service indicated people make decisions about what they do each day and that staff treat them well and listens to them. The responses and comments received in the surveys from the health care professional also supported this view that individual needs are met and people are supported appropriately. Some of the comments Care Homes for Adults (18-65 years) Page 15 of 40 Evidence: received in the surveys were: Provides stability for a physically disabled (leg-less) person and a quasi-halfway house transition for other occupants Manager a diverse and challenging residential population I am generally pleased and satisfied with the service they provide to our service users who has Ipiosuncaratic needs and choices that values partnership working with them and regularly review progress and re-negotiate care plan arrangements due according to fluctuation and variable needs We read the care files for the people we case tracked. The care files contained comprehensive and person centred care plans that covered individual needs, support, lifestyle to promote their well-being and independence. The care plans were divided ranging from quality of life that looks at cultural needs, physical and mental health, with regards support from other to self-care, which looks at personal care support. The care plans were current and reflective of individual needs and the level of support. The safety measures identified from the assessments of risk were detailed in the care plans. For example, the strategies to support people where they may be a risk to themselves or others. There was information with regards to treatment and support programme agreed and contact details of health care professionals such as the Clinical Psychologist or the Mental Health Team. This shows consideration is made to enable people to live their choice of lifestyle safely. We read the daily reports for the people we case tracked, which is written by the staff on duty each day. These were reflected of peoples well-being, the support provided, including attending appointments or review meetings and how the person spent the day. This showed care plans were followed and yet flexible to promote peoples wellbeing, rights and independence. People who use the service are supported by staff, known as key workers. We saw good evidence that care plans were reviewed every 2 weeks by the key worker with the person using the service. Staff told us that where there are changes in needs identified, these are discussed with the Registered Manager and respective health care professionals and new care plans are developed. This supported the comments we received in the surveys from the health care professional, indicating people are supported with their changing needs. Care Homes for Adults (18-65 years) Page 16 of 40 Evidence: We observed the lifestyle at the home. People chose what they did on the day. Some people were out, whilst others returned home, stayed in their bedroom or remained in bed for the most of the morning. It was evident that there were no restrictions placed on people with regards to making decisions and daily living. We spoke with two people who said they live their choice of lifestyle. Whilst one person clearly did not want to speak with us the other person was happy to share their experiences about the home and included the following comments: I like this room I can see for miles across the rooftops They help me a lot because I do forget I dont want to tell you anything I have to have a cigarette and I know its not really good for me Some people preferred to manage their own money whilst other people had money held in safe-keeping. A key worker told us that they would go to the shops with the person to buy clothes and will buy the agreed number of cigarettes to last them the week. The senior carer described to us the system in place where money is held in safe-keeping for them. The records viewed demonstrated accurate records of accounts and reconciliation of expenses are kept with receipts. This showed peoples money is protected by good systems. The staff we spoke with demonstrated a good understanding of the people who use the service and their individual, diverse and complex needs. Staff gave us examples of how support people to make decision, take responsibility for daily living and take part in social activities. Staff showed their awareness of how to best respond to people especially if they appear not to be having a good day, recognising behaviours and the manner in which people respond to daily conversations. This was supported by the knowledge of staff in understanding mental health and how it can affect people in different ways, as staff have received a range of training to support the people who use the service. The staff surveys responses indicated that staff share and communicate with each other well. This was consistent from our discussions with the staff on duty, who spoke about the information shared at hand overs meetings, team meeting, the communication book and through care plans and records. This shows people who use the service have their individual needs met and their rights and choices are promoted. Care Homes for Adults (18-65 years) Page 17 of 40 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 have their own lifestyle and routines at home and in the community that promotes their well-being and independence. Evidence: We wanted to find out the the opportunities and lifestyle people who use the service experienced. The information we gathered from the self-assessment completed by the Registered Manager stated,promotes service users life style and independence by engaging them in activities of daily living skills, socialising at home, in the community and educational opportunities. The evidence detailed to demonstrate the practice within the service included key working surveys, care plans and monitoring is recorded, permit visitors and friends between 10am and 10pm, all mail comes into the home is recorded in the post book and then distributed to individuals who sign to confirm they have received it. Care Homes for Adults (18-65 years) Page 18 of 40 Evidence: The responses in the surveys received from the people who use the service indicated that they made decisions about each day, what they did, and staff were available and supportive. The responses in the survey from the health care professionals and the staff surveys reflected how staff supported people and included the following comments: Provides a friendly and safe environment for staff and service users to interact Seeks advice, listens and actions We observed the lifestyle and individual routines of the people who use the service. People were clearly comfortable with their own space and company, some people preferred to go out into the community or spend a time in their bedroom. People who wish to smoke are able to do so outside the home and a smoking area has been created to the rear of the home, which is sheltered. The majority of people who use the service do their laundry with some support from staff as the cleaning products are locked away. People said they go by public transport into the community and the town centre, which shows their independence and links with the local community. One person told us they like to sleep till late in the day, which they are able to do so. Some people who had asked to speak with us, changed their minds. However, the people we did speak with said they experienced a supportive lifestyle and were not restricted. The staff we spoke with gave us information about the range of lifestyle people have at the home. Staff said some people have maintained links with their family and have visited family. A member of staff spoke about the visit from a relative after years of no contact with the person they key work. The daily records viewed also showed a range of activities people take part in such as visiting mother at .... and went into town to buy clothes. We also saw records showing contact made from other agencies such as the Job Centre and health care professionals. This shows some people have used other services within the community. We had received a comment with regards to mail not being received on time by the people who use the service. However, the two people who spoke with said they did. Staff told us that mail is booked in when it arrives. However, sometimes people have gone out before the post arrives, which has meant people may have their post late. This showed people do receive their post on time providing the post arrives early. We wanted to find out what opportunities and support is offered to people gain employment or go to college. The care plans read contained information about peoples past life; work and family. Although the care plans did not reflect aspirations Care Homes for Adults (18-65 years) Page 19 of 40 Evidence: of finding employment or going to college, one person did want to live independently in their own home. The Registered Manager told us that no-one who uses the service at present have expressed an interest in seeking employment or going to college. We saw activity programmes in the care files. However, it was unclear whether the activity programmes were current as these were dated and of reflective of changing interests or aspirations following the 2 weekly review meetings that take place. One person we case tracked had recently been on holiday abroad. The records viewed showed the holiday was planned and arrangements made were supported by the staff to ensure their safety and well-being. This shows the service supports individual diverse interests and lifestyles. We wanted to find out the choice of meals provided and whether the people who use the service are consulted about the meals. The information we gathered from the selfassessment completed by the Registered Manager stated, there is a changeable menu and all special dietary needs are catered for. The care plans detailed individual dietary needs and preferences, showing information was gathered when the person moved to the home. Two staff on duty said they plan the menu, taking into account special dietary needs and share it at the residents meeting, where it is agreed. The menu for the week is displayed. Meal times are flexible and staff will prepare the meals, as we observed on the time. Staff said some people who use the service will go out with the staff to do the food shopping and take an interest in the meals that are prepared. Meals are prepared at home by the staff. People are encouraged to help. Staff said most people will make themselves snacks and a drinks. Care Homes for Adults (18-65 years) Page 20 of 40 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are met. The recording and administration of medication could be improved to promote safety and well-being. Evidence: We wanted to find out how people who use the service are supported with their personal care and health needs. The information we gathered from the selfassessment completed by the Registered Manager stated, personalised care plans are drawn up from the various assessments, ensures that a persons unique individuality is maintained and their needs are met at all times, all service users are registered with a GP, dentist and optician and a wheelchair user is provided with the necessary aids to assist him in moving around the home and service users are offered support from staff to attend appointments if they require. The responses in the surveys from the people who use the service indicated that they are supported with their health and personal care needs. This was consistent with the responses received in the survey from the Health Care Professional, also indicating that people are supported with their medication. Care Homes for Adults (18-65 years) Page 21 of 40 Evidence: Some people who use the service told us that they are supported by the staff with their personal care needs, whilst others manage their own personal care with the occasional prompt from staff. The staff we spoke with gave us examples of the level of support individuals required and the majority managed themselves. For example one person requires help to get in and out of the bath as they can be unsteady on their feet at times and ensure privacy and dignity is respected. This was consistent with the care plans that we read, which were comprehensive. The safety measures and guidance for staff to follow was clear to promote peoples hygiene and well-being. There is a large bathroom with a bath/jacuzzi and a separate shower on the first floor and a wet room with shower on the ground floor with a shower chair demonstrating there are sufficient facilities provided. Some of the comments we received from people who use the service directly, in the surveys and the staff included: Looks after me well Cares for people I like it here, the girls look after me I help ..... to get in and out of the bath, hes sometimes unsteady on his feet We observed staff treating people with respect, knocking on the bedroom door before entering and letting the person respond to the question or make a choice. Staff spoke with people in a caring manner, even if they had to repeat themselves several times to the same questions. From our discussions with the staff, it was evident that staff wanted to support the people who use the service, they showed an understanding how mental health affected people in different ways and the challenges. The staff training matrix viewed showed staff have attended training in mental health and other mandatory training to support the people who use the service. In addition, one member of staff has attended the dementia awareness training to support a person they key work. We noted that there was a member from the Forensic Team who was at the home attending a review meeting. Staff told us that people are registered with the local General Practitioner Surgery and have regular health checks with the Dentist and the Optician. The care files we read: care plans and daily records detailed the support provided by health care professionals. These included the District Nurse, Clinical Psychologist, General Practitioner (GP), Dentist and Optician. We noted that the daily Care Homes for Adults (18-65 years) Page 22 of 40 Evidence: records briefly described the purpose and the treatment given including instructions for the staff to follow. This supported the responses received in the survey from the health care professional and included comments such as: I am generally pleased and satisfied with the service they provide to our service user who has Ipiosuncaratic needs and choices that values partnership working with them and regularly review progress and re-negotiate care plan arrangements due according to fluctuation and variable needs With our support they have persisted and tried their best to help him onto a selfmanagement medication scheme - unfortunately this has failed 3 times We wanted to find out how people are supported with their medication. The medication is kept in a locked medication cabinet in a locked room. We observed two staff preparing to provide the lunchtime medication for one person, by putting on their protective gloves and checking the medication record. They both confirmed they had attended the in-house medication training. Staff told us they always administer medication with a colleague to avoid errors and omissions. The member of staff asked the person to be comfortable before taking their blood pressure, whilst the second member of staff recorded the reading. The person who was having their medication said the staff always reminded him to have his medication. The member of staff dispensed all the prescribed lunchtime tablets into a pot and handed the pot to the person to take, which they did, altogether. This practice we observed highlighted there is a risk of the person choking and it concerned us. We randomly checked the medication administration records for three people. We found there were missing dates on the blood pressure records. We also found a lack of clarity. For example we found an entry stating not on premises. It was unclear whether it meant the medication or the person, was not on the premises. When we brought this to the attention of the staff, they immediately told us that the person was out. We spoke with another member of staff with regards to the practice of administering medication. They clearly demonstrated the best practice followed whereby medication potted out is individually given to avoid the risk of choking or the medication being spat out. We brought to the attention of the Registered Manager our observations, anomalies in the recording and safe and best practice with regards to medication. They accepted our findings and confirmed that the two staff are yet to have their formal training in safe administration of medication. They also confirmed that there would undertake more rigorous checks on recording and record keeping to avoid errors and omissions. Care Homes for Adults (18-65 years) Page 23 of 40 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 are confident to complain, complaints are addressed quickly and trained staff ensure people are safe and protected from harm, risk and abuse. Evidence: We wanted to find out whether people who use the service were aware of the complaints procedure and what support is available to them to make a complaint. The information we gathered from the self-assessment completed by the Registered Manager stated, the views of the service user and their families is very important hence effort is made to provide a safe and supportive environments and views and concerns are taken seriously and acted on. It stated the complaints procedure is included in the Service User Guide and is displayed in the communal area. The responses received in the surveys from the people who use the service indicated they know who to speak with if they are unhappy or have a complaint. This was consistent with the responses received from the health care professional who indicated that the service addresses concerns quickly and included the following comments: Good communication with our service Seeks advice, listens and actions We read the complaints procedure, which had been moved to the office whilst Care Homes for Adults (18-65 years) Page 24 of 40 Evidence: communal areas of the home was being decorated. The complaints procedure clearly set out the process of investigation and the set timescale. The contact details for the local Advocacy services were also listed. The complaints procedure is available in alternative format, upon request. The people we spoke with were confident to express concerns to the staff of duty and to make a complaint. It was evident from our observations that people who use the service felt safe with the staff and approached staff confidently. Some of the comments received from the people we spoke with included: Talk to the staff Say what you need to at the residents meetings I feel safe here - the angels look after me We read the minutes of the residents meetings on 3rd December 2009. The range of topics discussed were recorded, which included staff duties, laundry, activities, menu and individual issues raised by the people who use the service. The responses in the staff surveys indicated staff were confident to receive concerns from the people who use the service. The staff we spoke with on the day were confident to receive complaints and would pass the concerns to the senior carer or the Registered Manager. Staff told us they have good systems of communication, sharing of information between staff and benefit for having review meetings with people every two weeks or more frequently, if required. This supported the responses in the surveys and the information we gathered from the self-assessment. We read the complaints log and noted 2 complaints were received about the home. The records showed both complaints were investigated and were partially substantiated. The Care Quality Commission received 1 complaint and it was referred to the home to investigate using their own complaints procedure. The Registered Manager provided us with the outcome of the complaint and advised us that the complainant had also been formally advised. We wanted to find out whether staff knew what is meant by the term safeguarding. Safeguarding means protecting and promoting the well-being of people from risk, harm and abuse. The responses received in the staff surveys indicated staff had Care Homes for Adults (18-65 years) Page 25 of 40 Evidence: received information and training on safeguarding adults. The staff we spoke with all demonstrated a good understanding of the various forms of abuse, the actions they would take if they witnessed or suspected abuse and referred to the procedures available to them. Staff gave us examples of peoples vulnerability and how they support people to be safe. For example one member of staff spoke about recognising how people may respond or behave towards you, known as triggers and said: Saying morning to him and if he replies in a certain manner you know not to say too much to him Other times hes smiling, he can cook but if Im working he will ask me to cook fish or curry with rice for him This showed staff knew the people they support in their role as a key worker that promotes peoples health, safety and well-being. The staff we spoke with said they had received training in safeguarding procedures. We looked at the staff training matrix and the Registered Manager confirmed the majority of staff had completed the safeguarding training and the remainder are booked to attend. The care files viewed contained records and reports of incidents and accidents that affect the health and safety of people who use the service. The Registered Manager has submitted timely Regulation 37 notifications, which are a legal requirement detailing incidents and accidents that have happened at the home or the people who use the service. This shows the service complies with the regulations and obligations to ensure the well-being and safety of the people. We wanted to find out how people are supported to manage their money. The people we spoke with are supported to manage their money, which is held in safe-keeping. The senior carer said the majority of people manage their own money and staff have supported them to set up their own bank accounts. They described the system in place where peoples money is held in safe-keeping. We were shown the records of the financial transactions and reconciliation. This demonstrated there is a good system in place to protect peoples money. Care Homes for Adults (18-65 years) Page 26 of 40 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean and comfortable home benefiting from the home being refurbished. Evidence: We wanted to find out what type of home and accommodation people live in. The information we gathered from the self-assessment states, the home has a homely and well-maintained environment that is currently undergoing a refurbishment programme. The responses in the surveys from the people who use the service and the health care professionals indicated the home is fresh and clean. There were some comments received with regards to how the service could be improved: Improve environment, decoration and maintenance More prompt with repairs, etc We shared these comments received with the Registered Manager. They accepted the comments and acknowledged that this had been an issue, hence the refurbishment programme at the home. Care Homes for Adults (18-65 years) Page 27 of 40 Evidence: The home is situated in a residential area, set back from the main road and has the appearance of a large family home. The refurbishment and decoration of the home was ongoing, including the widening of doorways for better accessibility for people using a wheelchair. The office has now been moved to the ground floor. The Registered Manager confirmed that the majority to the works has been completed and the remainder would be completed within a week. The Limes is registered for 8 people, with 6 bedrooms of which two are large enough to be shared room. The Registered Manager said they had considered the option of reducing the number of registered places to 6 but are now planning to extend the property to have 8 bedrooms in total. We advised the Registered Manager to ensure the information about the accommodation is accurately reflected in the Service User Guide and the Statement of Purpose. All areas of the home were clean and tidy. We saw the communal areas consisting of the main lounge, kitchen and dining room were decorated and created a homely atmosphere. There is a wet room with a shower on the ground floor and a large bathroom with shower and a jacuzzi bath on the first floor. We noted that the door strip on the door leading out to the smoking area was broken and detached from the door. This needed replacing as it was a risk and was letting in the cold through the gap. We saw several bedrooms with permission. They were furnished, individual decorated and personalised with pictures. One person said they had decided to spend the day at home organising their collection of CDs and DVDs. The laundry room is now located on the first floor, away from areas where food is prepared. People who use the service said they do their own laundry and have specific laundry days. All cleaning products and sharp implements are kept secure to avoid any risks to people who use the service. Staff said they provide people with the detergent and will check the setting is correct on the washing machine. Staff said people are encouraged to take responsibility for keeping their bedroom and the home clean and tidy. We observed staff wearing gloves when preparing meals. Staff showed a good understanding of health and safety and infection control practices. Staff training records showed staff had received training in health and safety, infection control and food hygiene. This showed trained staff support and promote peoples health and safety and benefit from living in a comfortable and clean home. Care Homes for Adults (18-65 years) Page 28 of 40 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected and supported by robust staff recruitment process and training that promotes peoples well-being and independence. Evidence: We wanted to find out whether the staff recruitment process, the skill-mix of staff and the staffing levels met the needs of the people who use the service. The information we gathered from the self-assessment completed by the Registered Manager stated, all staff at The Limes are products of a robust recruitment and selection process. It states the majority of staff have completed the induction programme, staff have regular supervision and training to maintain the skill-mix and staff knowledge. The majority of responses in the staff surveys stated the employer carried out preemployment checks on staff. We spoke with two staff on duty who described to us the recruitment process, which included being interviewed by the Registered Manager before they were offered a job. Staff said they started the induction training after the checks were carried out. We checked 3 staff files. All contained evidence of the interview records and the pre-employment checks. These included two satisfactory written references, criminal records bureau (crb) check and a protection of vulnerable adults(pova) check. These are checks to assess the suitability of the applicant to work with vulnerable people. Care Homes for Adults (18-65 years) Page 29 of 40 Evidence: Staff told us they have had regular training and updates to support the people who use the service. Staff gave us a list of training they had completed recently, which included updates in safeguarding and medication practice. Some staff have completed specialist training to support the people who use the service such as mental health awareness and dementia awareness. The Registered Manager maintains a staff training matrix of the skill-mix of staff and included the new staff that have completed the induction training. We looked at the staff training matrix and training certificates in the staff files, demonstrating the range of training completed. These included health and safety, manual handling, first aid, safeguarding awareness, infection control, fire awareness, food and hygiene and medication training. The staff we had spoken with confirmed they had completed the National Vocational Qualification (NVQ) level 2 in care. The Registered Manager confirmed that the majority of staff had completed the NVQ level 2 in care or were in the process of completing NVQ level 2. We spoke with the Registered Manager about our observations of staff administering medication and what other staff had told us with regards to the medication procedure. We highlighted the inconsistency of practice and the risk to people who use the service from the observation we had made. Therefore, it is important to ensure staff knowledge, understanding, competency and practice is in line with best practice. The staff surveys we received all indicated that they receive support from the Registered Manager with regards to work. This was consistent following our discussions with staff who complimented the Registered Manager and the senior carer for the spontaneous support that they receive. Staff confirmed they have formal supervision meetings that are planned and are able to speak with the Registered Manager at any time. Some of the comments received from staff included: Actually Joan (Registered Manager) is very good, especially when something happens with a resident and she knows you just need to talk, or given some time out. I know because shes been there for me I have supervision with Joan (Registered Manager) every month or so Provides a good setting for staff to work in and share information We also read the communication book and the staff meeting records. Staff meetings take place weekly to ensure staff are kept up to date about the needs of people who Care Homes for Adults (18-65 years) Page 30 of 40 Evidence: use the service and any changes to the service, for example the refurbishment programme or new people moving to the home. We noted that staff do not consistently record dates in the communication book. Therefore, it is unclear when some information was actually recorded and communicated to staff, which may affect the support people receive. We wanted to find out whether the staffing levels supported the needs of the people who use the service. The interaction of staff with the people who use the service showed they knew the people who live at the home, individual routines and personalities. The people at home at the time of our visit spoke positively about the staff with regards to how they are treated and supported. Staff told us that staffing levels has improved and is stable. The Registered Manager confirmed staffing levels are stable following the recruitment of additional staff. There are 3 staff during the day and evenings and 2 at night, providing stability and consistency of staff, to promote peoples lifestyle and independence. Care Homes for Adults (18-65 years) Page 31 of 40 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 management of the service is good ensuring people are consulted and their safety and well-being is promoted by trained staff and management systems. Evidence: We wanted to find out whether the management of The Limes protects and promotes the well-being of people who use the service. The information we gathered from the self-assessment stated, the manager is the head of administrative hierarchy; leads by example; communicates effectively the needs of the service users and the needs of the business to the staff team; responsible for the evaluation of the staff needs, supervision and day-to-day management of the home. The self-assessment also indicated the improvements made, which included the monthly manager meeting and the managers supervision. The Limes is managed by the Registered Manager who is currently in the process of completing the NVQ level 4 in Health and Social Care. The Registered Manager is experienced in working with people with mental health diagnosis and liaises with respective health and social care professionals to benefit the people who use the Care Homes for Adults (18-65 years) Page 32 of 40 Evidence: service. The people who use the service and staff spoke positively and highly of the Registered Manager. This was also reflected in the responses received in the survey from the health care professional. Staff said the Registered Manager was supportive, addresses issues and manages the home to benefit the people who use the service and the staff. The management of the service and deployment of staff benefits the people who use the service. Staff described their roles and responsibilities indicating the service is managed and has good communication and emergency procedures in place. For example, staffing levels have increased and there is now a stable staff team following staff recruitment. We wanted to find out how people who use the service are involved, informed and consulted about what happens at the home that may affect them. We observed people who use the service were comfortable and had their own daily routines. Some people were out in the community, whilst others chose to remain at home. Staff were visible, available and supportive to the people at home. People who use the service spoke about the residents meetings that are held every month. People said staff remind them and they can choose to attend the meetings. We read the minutes of the last residents meeting held on 3rd November 2009. The topics discussed included staff duties, laundry, xmas cover, activities, menus and keyworking. The Registered Manager gave us examples of how views received at the residents meetings have influenced the service with regards to the refurbishment programme. The Quality Assurance and Development Manager who was present at the time of our site visit to the home said that a quality assurance survey was carried in July 2009. They said surveys were sent out to the people who use the service at the time and surveys have recently been sent to the staff and health care professionals. The results of the surveys have not yet been compiled or analysed. We discussed with the Registered Manager and the Quality Assurance and Development Manager the some consideration should be made to making the report available to the people who use the service, staff and professionals. We also suggested that they should consider measuring the outcome of the quality assurance against the statement of purpose. This would show if peoples experiences and expectations of the service are consistent with what the service had stated as the aims and objectives. We read the monthly visit report dated 12th October 2009 carried out by the Quality Assurance and Development Manager on behalf of the Responsible Individual. There Care Homes for Adults (18-65 years) Page 33 of 40 Evidence: are monthly visits are a legal requirement and are known as Regulation 26 visits. It demonstrated that people who use the service are asked about the home, the quality of support and service they experience. It showed records are checked with regards to care files, staff files, health and safety checks and checks made on the home environment with regards to health and safety. The report was concluded with an action plan, which the Registered Manager addresses. The Quality Assurance and Development Manager confirmed a further visit was conducted in November 2009 but the report had not yet been finalised. Staff were knowledgeable about the policies and procedures they were required to follow and knew where these are kept. Staff confirmed updates and changes to the policies and procedures are shared with them at the staff meetings. The information gathered from the self-assessment stated policies and procedures were in place and some were last updated in October 2009. This demonstrated staff are provided with clear guidance to ensure the protection and well-being of the people who use the service. The management of records has significantly improved. The care plans we read were up to date and reflective of peoples needs, aspirations and the level of support required to promote their independence and well-being. Some attention to detail is required with regards to ensuring records are dated and signed by staff. These relate to the communication book, clear recording of medication administered and acknowledging achievements in the review meetings to show progress, which helps to identify new goals and aspirations, if any. We shared these practice issues with the Registered Manager and the Quality Assurance and Development Manager at the time and has been referred to earlier in this Inspection Report. The Registered Manager confirmed the Fire Officer carried out a site inspection of the home in August 2009. We read the report that indicated the service was compliant with the Fire Regulations and a few minor recommendations were made. The care files we read for the people we case tracked contained assessment of risk and the safety measures were reflected in the care plans. There were clear guidance for staff to follow including support to manage challenging situations that places people including staff at risk. The service continues to submit timely notifications detailing specific incidents or events that affect the well-being of people who use the service. These are known as Regulation 37 notifications and are a legal requirement. The information we gathered from the self-assessment detailed the programme of routine maintenance, servicing and testing of equipment. We also read the records of Care Homes for Adults (18-65 years) Page 34 of 40 Evidence: the fire checks and tests and the health and safety records for the checks carried out within the home. Staff spoken with and training matrix viewed showed staff have receive regular training to ensure they follow the current best practice to protect and promote peoples safety and well-being. People who use the service also told us staff let them know when the fire checks are being carried out. The monthly visit reports also demonstrated checks are made on the home environment and the records with regards to health and safety. This showed that checks are routinely carried out, people who use the service are made aware and there is an internal monitoring system in place. Care Homes for Adults (18-65 years) Page 35 of 40 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 36 of 40 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 2 14 The Registered Person must ensure the assessment of needs process includes details of medication and other treatment required. This would protect and promote peoples health and well-being 15/01/2010 2 20 13 The Registered Manager 15/01/2010 must ensure all staff responsible for administering medication have been trained. This would protect and promote peoples health,s safety and well-being. 3 20 13 The Registered Person must ensure medication administered and accurate recording is maintained in line with best practice and procedures. 15/01/2010 Care Homes for Adults (18-65 years) Page 37 of 40 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 This would promote the health, safety and well-being of people. 4 24 23 The Registered Manager must ensure the all areas of the home are in good state of repair and maintenance. This includes the repair or replacement of the broken door strip on the door leading out to the smoking area. This would ensure peoples health and safety 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 15/01/2010 1 1 The Statement of Purpose and Service User Guide should be reflective of the number of registered places and changes to the accommodation. The activities programme guide for people who use the service should be dated to reflect the current interests and updated when new interests and aspirations are identified. The information about the accommodation is accurately reflected in the Service User Guide and the Statement of Purpose. To consider developing a system or method to ensure staff knowledge, competency and understanding is tested following any training completed. The staff should attend training to increase their knowledge and understanding of mental health and respective legislations to protect and promote the well-being of people 2 13 3 24 4 35 5 35 Care Homes for Adults (18-65 years) Page 38 of 40 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 with mental health diagnosis. 6 39 To develop a report detailing the finding of the quality assurance: - that can be shared with the people who use the service; and - is measured against the statement of purpose to ensure peoples experiences and expectations of the service is consistent with the aims and objectives of the service. This would also assist in the review and updating of the statement of purpose as the service develops. To maintain accurate records relating to people who use the service and staff communication, which includes entering dates and signatures. 7 41 Care Homes for Adults (18-65 years) Page 39 of 40 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). 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