Care Home: The Lombrand Limited

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What the care home does well People are assessed before they move into the home and this information is used to develop an individual plan of care. This information assists in making sure that the staff team are aware of the current needs of each person and how these needs are to be met. People are supported to have their health needs met, keeping healthy and living their lives. People are supported through risk assessments to undertake activities and to live their lives as they wish. This allows people greater choice and control in their lives. People like the food provided in the home. People are supported by a staff team that are correctly recruited to help ensure that they are suitable for the role and can help people to meet their needs. People like the home they live in, it is clean and comfortable for them. People are supported by two managers who know their needs well and who support them with the meeting of these. What has improved since the last inspection? This is the first inspection of this service under its current registration. Consequently there are no previous requirements to meet. What the care home could do better: Staff could be trained in the completing of assessments. This would reduce the chance of these being completed incorrectly and in turn peoples needs not being fully known. Records should be kept of all monies received by each person and managed by the home. This allows for a clear audit trail to help ensure no errors occur. A report and action plan should be completed from the information obtained in the quality assurance that would help in the ongoing development of the home. Portable appliance and electrical system checks must be undertaken in the home to ensure that these systems are safe and do not pose a risk to the people in the home. Key inspection report Care homes for adults (18-65 years) Name: Address: The Lombrand Limited 52-54 Tennyson Avenue Bridlington N Humberside YO15 2EP     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: Sarah Rodmell     Date: 1 6 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: The Lombrand Limited 52-54 Tennyson Avenue Bridlington N Humberside YO15 2EP 01262677149 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): jpbirdsall@aol.com The Lombrand Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who may be accommodated: 21 The Registered person may provide personal care(excluding nursing) and accommodation to service users of both sexes whose primary care needs on admission to the home are within the following category: Mental Disorder, excluding Learning Disability or Dementia (CodeMD) Date of last inspection Brief description of the care home 21 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means that the people who use the service experience good quality outcomes. This inspection report is based on information received by the Care Quality Commission (CQC) since the last key inspection on 2 October 2008 including information gathered during a site visit to the home. The unannounced visit was undertaken over one day by one inspector. It began at 9:15 am and finished at 4:00 pm. On the day of the visit the inspector spoke with people who live in the home, and the two managers, who were the staff on duty. Inspection of the premises and close examination of a range of documentation, including three care plans, were also undertaken. The manager confirmed the information sent in the Annual Quality Assurance Assessment form (AQAA) to the CQC Care Homes for Adults (18-65 years) Page 5 of 30 from the home. The AQAA is a self assessment tool that focuses on how well outcomes are being met for people who use the service. The managers told us that the current fee for living in the home is £339.60 and that there are no additional charges for items such as chiropody, hairdressing or newspapers. At the end of this visit, feedback was given to the managers on our findings, including any requirements and recommendations that may be in the key inspection report. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Adults (18-65 years) Page 6 of 30 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at standard 2. People are assessed before they move into the home so that they and the staff can be sure that their needs can be met. Evidence: Information recorded in the AQAA included, Everyone admitted has a full care plan and risk assessment done. We examined the care files of three of the people who live in the home, this included the records for someone who had moved into the home since the last visit. All of the files included a full assessment of need for the individual. The assessments included a copy of the Local Authority assessment and an assessment completed in the home and or information provided from other specialists. It also included assessments undertaken from Mental Health Services, as necessary. The information was then used to develop an individual plan of care, which included risk assessments. Care Homes for Adults (18-65 years) Page 9 of 30 Evidence: This information helps to make sure that the staff in the home are aware of the latest needs of the individual and how these are to be met. Information recorded in the surveys included that the majority of people were involved in the decision to move into the home and that they felt they received enough information before they moved into the home, so that they could decide if it was the right place for them. Care Homes for Adults (18-65 years) Page 10 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at standards 6, 7 & 9. People are supported through a care planning process to take risks and live their lives as they choose. Evidence: Information recorded in the AQAA included, We identify the individuals needs and choices through care approach forms that are filled in with the service user and keyworker. Keyworker skills are considered and matched with service user needs. We looked at the care files for three of the people who live in the home. These all included a plan of care that had been developed from previous assessments. The care plans covered a variety of areas and included: Mental Health, Diet, Personal Care, Health , Medication, Independent living skills, relationships and activities. They included long and short term goals for people, and their individual preferences on their Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: daily lives. Key workers were also identified and some records were kept of the time spent with the individual in the home. However these were more of an assessment than record of actual activity and the managers are to amend this. When we spoke to people they told us that they knew they had plans of care and were happy with the content and the support that they receive. An internal review form is used by the home and we saw that when possible the individual concerned had signed to confirm that they were happy with their review and had participated. Information in the AQAA recorded that, Annual reviews are held including multi agency & family as well as 6 monthly in house reviews. Throughout the day we saw that people could make their own choices and decisions. People were observed to choose how to spend their time, either at home or out for differing periods of time and spending time alone or with others. Information was available on advocacy services to assist people in making decisions and records reflected that people spent their day as they wished.People responded positively in surveys reflecting that they made the decisions about what they did each day, on evenings and weekends. Details of restrictions on peoples lives both through the care planning approach and risk assessments were held in peoples files. We observed that one person was able to leave the home early in the day and choose when they would return, this would often be late in the evening after tea. Risk assessments were in place to support this person to undertake this activity of their choice whilst maintaining as much safety as possible. Other risk assessments were also in peoples files and these covered a variety of areas, for example, to hold a key to their room, not to smoke in individual rooms but to use the smoking room, and mental health with associated behaviours. Care Homes for Adults (18-65 years) Page 12 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at standards 12,13,15,16 & 17. People are supported to live their lives and maintain important relationships as they choose. Evidence: Information recorded in the AQAA included,Service users are aware of the local drop in centres , encouraged to make use of these services, and Our local Mind offer several different activities and these are displayed in the home, the local college have a gardening programme which service users can attend as well as other suitable courses. The staff told us that people choose not to attend local clubs and spend the majority of their time in the local town or in the home. Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: We observed that people came and went from the home as they chose. Some people enjoyed a horse race game and then watched a movie. When we spoke to people they told us that they were happy in the home and felt that they had enough to do. Comments included, I do as I want , I go out all day and make my own meals, I go out when I want and I go out on my bike and go to church. Peoples responses in surveys included, Entertainment in the home is excellent with 2 TV lounges and parties sometimes during the year for birthdays.Also Have parties and arrange days out. Peoples care files contained details of the things that people do each day. For example, one person chose to spend most of their time in their room one day and then out all morning another day. Information in the AQAA recorded that, Friends and family are welcome and can use their own bedrooms for privacy. One of the care files we examined identified the maintaining of a relationship as a need and identified how to support this person with this. Staff had a good knowledge of this and discussed some of the difficulties for the person concerned. Details in peoples daily notes included reference to relationships, for example, when someone phoned their relatives. The routine of the home supports people to do as they wish. People were observed to leave and enter the home at different times of the day. We saw that people were able to have a key to their room and that staff respected peoples privacy knocking on doors before entering a room. People are able to use the communal areas of the home as they wish, this includes a smoking room and information about smoking is included in peoples risk assessments. We saw that the relationships between the staff and the people who live in the home were good. Conversations were appropriate and staff reflected a good, up to date knowledge of the needs of each individual and what was happening in their lives. Peoples care files included a nutritional assessment of each person and monthly weights are recorded as a means of monitoring. There are planned 4 weekly menus in place with a deviation record kept. Individuals are able to prepare their own food if they wish and peoples care plans identified independent living skills as areas for development. We observed the lunch time meal and people told us that they liked the food and that it was good. Responses in the surveys included, Choice of meals and drinks is very good. Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: Information in the AQAA included, Menus discussed at residents meetings - options for daily menus are given, and Service users are encouraged to shop for themselves. Their opinions are actively sought. Care Homes for Adults (18-65 years) Page 15 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at standards 18,19 & 20. People are supported as far as possible to have their personal , health and medication needs met. Evidence: When we spoke to the managers they told us that all but one of the people who live in the home manage their own personal care. We observed that this is respected by the home and that peoples appearances reflect their individual personality. Peoples care files included their needs regarding personal care. This was detailed in their care plans, for example taking a shower was identified as a goal under independent living skills. One response in a survey included that Foot hygiene was something that the home does well. Information in the AQAA recorded that all of the people who live in the home have a key worker and that time is set aside each shift for 1:1 time. Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: When we talked to the managers they told us that one of the biggest problems they had had to deal with recently was access to mental health services. They told us that it has at times taken them weeks to get a GP appointment or mental health assessment and they felt that people were suffering due to the amount of time that this takes. They told us how one persons mental health had deteriorated but that it still was 3 weeks before they could access specialist support. Additionally they recorded in the AQAA, Our biggest barrier this year is help from the NHS. We have found it extremely difficult to make appointments for service users to access G.Ps and dentists. We do, however have two very good CPNs but otherwise have found it difficult to access help and intervention from the CMHT. Separately they told us about someone else who had received excellent support from MacMillan specialist nurses and the district nurses and that they had supported both the individual and the staff team in meeting this persons needs. Information recorded in the AQAA states that, All service users are registered with a GP and dentist as available. Information in individual files included details of both mental and physical health needs. Assessments included moving and handling, continence and nutrition . However the moving and handling assessments had not been fully or correctly completed and the managers were advised as to the need for this. Notes detailed appointments with professionals, for example the Community Psychiatric Nurse and social worker . With notes for medical treatment, for example, receiving an immunisation, were recorded in peoples daily files. Information recorded in the AQAA included, Staff have been trained in the administering of medication and only senior care assistants take this responsibility. Medication is only administered by well trained senior staff,self medicating service users will sign to say they want to self medicate and are supported by staff to do so.We keep good records on all aspects of the above, most of which are updated daily. We observed the administration of the lunchtime medication. Medication is stored in a locked medication trolley that is then stored in a locked cupboard. People were offered their medication and a drink to take this with. Records were kept of the receipt, administration and disposal of all medicines. The managers told us that there were no medicines that would be described as controlled and that there were no medicines that required to be kept cool. The managers also told us that currently there is no-one Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: who self medicates. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at standards 22 & 23. People receive support to raise concerns and are protected from harm. Evidence: Information in the AQAA recorded, We have policies and procedures covering all aspects with concerns, complaints and protection. We listen and take every complaint seriously, Management respond to complaints within 28 days.We keep good accurate records which are kept in accordance with data protection. Responses in surveys included that everyone knew who to speak to if they were not happy and the majority of people knew how to make a complaint. However some people did not know how to make a complaint if they needed to. Additionally there was not a copy of the complaints procedure on display inthe home for people to easily access. Having a complaints procedure on display could help people to understand the complaints procedure and to use this should they feel the need. Information in the staff surveys included that staff knew what to do should someone raise a complaint about the home. People we spoke with all told us that they were happy in the home. The CQC has not received any complaints regarding the home, although information in Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: the AQAA recorded that one complaint had been received by the home. Records are kept of complaints received, however these were not individual and the managers were advised as to this. Staff records for training included that people had attended training regarding Abuse in a care home. Information recorded in the AQAA included that there is a policy to support people in the home should an allegation of harm occur and that there had been one referral to the Safeguarding Adults team. We looked at the finances for people who live in the home. Records are kept of expenditure and people sign to confirm receipt of their money. However no records are kept of the amounts of money that people receive and the managers said that peoples money is topped up as necessary. Without clear records it is not possible to have a clear audit trail to support people and make sure that they have claimed any benefits they may be entitled to and are in receipt of all their monies. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at standards 24 & 30. People live in a clean and comfortable home. Evidence: During our visit the managers showed us around the home. Externally there is a small patio area and the home has CCTV to help keep people safe. There are two lounges, a dining room and a smoking area downstairs. A new bedroom and office area have been added to the downstairs of the home. The new bedroom benefits from en-suite facilities. Upstairs there are a variety of bedrooms and one bedroom that is a large bed /sitting room that has also recently been added to the home. We saw that the home was comfortably furnished, clean and warm throughout. People had been able to individualise their room and reflect their own personalities and tastes with this. There were not any window opening restrictors in place in the home and an Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: assessment as to the necessity of these must be undertaken. This should include guidance form the Local Environmental Health and Fire Safety departments to make sure that the latest legislation and safety requirements are met. Additionally no checks and records are made of the hot water temperatures for outlets that people who live in the home have access to. These checks and records must be complete. Also risk assessments must be completed to reflect whether there is a need to restrict the hot water temperatures that would in turn reduce the risks of scalding. Any highlighted areas of concern must be addressed to help to keep people safe. Information in the AQAA recorded, The home is friendly and welcoming. Service users are encouraged to personalise their rooms. The home is in good decorative order. Laundry is done daily. Service users have choice of seating in dining room/communal areas. Information in the AQAA also included, The home is kept well cleaned all communal areas are cleaned nightly. Comments in surveys included, Very well furnished and kept warm in the winter months. All of the responses wabout the cleanliness of the home were positive. There is a seperate laundry area, with commercial style washing machines. We examined the fire safety records kept in the home. These included that there were regular fire drills signed by the people who participate. Also that there were fire alarm, emergency lighting and fire extinguisher maintenance checks to make sure that this equipment was in good working order, should they need to be used. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at standards 32, 34 & 35. People are supported by well recruited and trained staff. Evidence: Information in the AQAA included that, All staff undertake CRB checks. We looked at the files for three of the people who work in the home, this included their recruitment and training records. Information in these recorded that each person had completed an application form and had the necessary checks undertaken prior to employment. Checks included a Criminal Records Bureau Check (CRB) and references; these are used to help make sure that the person does not hold a criminal conviction that may prevent them from working with vulnerable people and that they are suitable for the role. In addition one person had commenced in post with a POVA first check, this check shows whether the person is listed in the Protection of Vulnerable Adults List and that they should not work with vulnerable people. As this person did not have a full CRB Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: check the manager confirmed that they were only working as a supernumerary member of staff who is supervised, until their full check is received. This helps to make sure that people remain protected until all the persons details are verified. Of the five staff surveys received all confirmed that their employer carried out checks, such as a CRB prior to them starting work. Information in the AQAA also included, After completion of successful induction, staff are encouraged to commence NVQ training. and Also they must complete a three months induction programme to TOPPS standard. We saw that people had records of their induction packages in their files, with some people still undertaking this training. Information in the staff surveys included that staff felt that their induction had covered everything they needed to know before they started their job either, very well or mostly. Information in the AQAA also included We now meet more than the standard 32.6 re NVQ training.All staff have qualified or are working towards gaining NVQ levels 2/3, Courses completed this year are: Managing challenging behaviour, Food hygiene, Abuse in the care home, Moving and handling, Health and safety, Mental capacity act, Mental health awareness. and In addition 2 staff have completed Managers awareness for safeguarding and the training for trainers for safeguarding and have gained or are working towards RMA or leadership in management. We looked at the training records in peoples files. The records included details that staff had been trained in Moving and Handling, Food Hygiene, Health and safety and Challenging Behaviour. Responses in staff surveys included that staff felt that they are given training relevant to their role and to meet peoples needs and help keep them up to date. The managers told us that they had undertaken training specific to their role and attended courses regarding Mental Health accessed via Mind. Additionally they have continued to complete their management training. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at standards 37, 39 & 42. People live in a home were they are supported by competent managers and they are able to raise concerns and be involved in decisions. However management systems must be kept up to date to ensure that peoples needs are continued to be met. Evidence: The two staff on duty at the time of the visit are the two managers of the home. They told us that they are hoping to both become the registered manager and to share this role. The managers have both worked in the home for a period of time now and both are completing an NVQ level 4 in management. The information in the AQAA recorded that the present owners of the home have run the business for 24 years. The managers showed us the Quality Assurance system currently in use in the home. Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: Questionnaires included housekeeping, and catering. Responses had been received from people who live in the home, however this had not been compiled into a report with an action plan. Records are kept of staff meetings and meetings for people who live in the home. We examined some of the maintenance records in the home. This included a British Gas homecare checklist to show that the gas systems in the home were safe, and Portable appliance testing that was due for renewal November 2009. There was not an electrical wiring certificate to confirm that the electricity systems in the home were safe and this is to be forwarded to the Commission. Records are kept of accidents and incidents in the home ,with incidents being reported to the CQC as necessary. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 23 17 A record should be kept of all monies received by each service user and managed by the home. Clear records help in the auditing of records and reduce the risk of errors occurring. 08/01/2010 2 42 13 Portable appliance testing must be kept up to date. This will help to make sure that equipment in use in the home does not pose a risk to the safety of people in the home. 08/01/2010 3 42 13 Checks of the electrical systems in the home must be undertaken to ensure that they are safe. This will help to make sure that people are not at risk of harm from these systems. 08/01/2010 Care Homes for Adults (18-65 years) Page 28 of 30 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 19 Staff should be trained in the completing of assessments so that they are fully aware and competent in doing so and that the assessment is then correct. Information received as part of the quality assurance systems should be used to complete a report and action plan for the development of the home. 2 39 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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