Care Home: The Manor House Residential Home

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What the care home does well Those in charge of The Manor are always listening to the people who live there, and have changed things in the ways that they want. People from outside, such as doctors, nurses and social workers, are regular visitors to the home and they have helpedstaff to look after people properly and to be healthy. Staff at the home work well to give people a good life and they get regular training to help them do things even better. Staff look after people properly and treat them with respect. People are supported to go to college and go out to the shops, pubs and other places that they enjoy. The new manager at the home does a good job. People can talk about the service they receive with an advocate who visits the service regularly. What has improved since the last inspection? people now have a care plan in place, which told the staff how they want to be supported. The plans covered all of peoples needs, and were reviewed regularly to make sure they were up to date. The manager ensures she checks all of the information she received for all new staff to make sure they are suitable to work with the people who live in this service. Systems are now in place to ensure people, their representatives, staff andexternal people are asked about the service and any ways it can be improved. What the care home could do better: No statutory requirements have been made as a result of this inspection. We have made some good practice recommendations which should be implemented. Key inspection report Care homes for adults (18-65 years) Name: Address: The Manor House Residential Home 137 Manor Road Littleover Derby DE23 6BU 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: Claire Williams Date: 2 6 0 1 2 0 1 0 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 34 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2010) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: The Manor House Residential Home 137 Manor Road Littleover Derby DE23 6BU 01332372358 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): the_manor_house@hotmail.co.uk Livlife (UK) Ltd Name of registered manager (if applicable) Mrs Bronja Mary Williams Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 11 11 0 0 care home 11 learning disability sensory impairment Additional conditions: The maximum number of service users who can be accommodated is: 11. The provider may provide the following category of service only: Care Home - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD Sensory Impairment - Code SI. Date of last inspection 3 0 0 3 2 0 0 9 Care Homes for Adults (18-65 years) Page 4 of 34 A bit about the care home The Manor House was registered on 30th October 2007. The building used to be a domestic dwelling that has been renovated and extended to meet the requirements of a residential care home. The service is registered to provide personal care and accommodation for eleven people of either sex aged 18 and over with sensory impairment and learning disabilities. The physical environment of the home includes 8 single bedrooms on the ground floor and 3 large bedrooms on the first floor. Access to the first floor is by stairs only. All rooms have en-suite facilities, and emergency call systems. The service has a sensory room, which is located on the ground floor in the conservatory. There is an accessible landscaped garden and patio areas. In addition to the en-suite facilities there is a communal bathroom with a jet spa bath equipped with an electronic ceiling hoist. The service provides people with a combined Statement of purpose and Service user guide. Information provided by the service stated that the current fees ranged from £650 to £950 per week. Information is provided in the Statement of purpose/Service user guide of the services that are included in these fees. Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 34 How we did our inspection: This is what the inspector did when they were at the care home We came to the home without telling the manager before we came and spent one day there. We had received a lot of information about the home from the manager, the staff and people living at the home before we came.The information we received before we came helped us plan what we would do when we arrived. At the home we spoke to the manager who told how things had changed since we last came. We looked at a lot of papers and documents in the office that told us about the home. We spoke to staff who were working during the time we were at the home. We spoke to five people who live at the home about their rooms and how much what it is like living there. We walked around the home to ensure it was a safe place for people to live in. What the care home does well Those in charge of The Manor are always listening to the people who live there, and have changed things in the ways that they want. People from outside, such as doctors, nurses and social workers, are regular visitors to the home and they have helped Care Homes for Adults (18-65 years) Page 7 of 34 staff to look after people properly and to be healthy. Staff at the home work well to give people a good life and they get regular training to help them do things even better. Staff look after people properly and treat them with respect. People are supported to go to college and go out to the shops, pubs and other places that they enjoy. The new manager at the home does a good job. People can talk about the service they receive with an advocate who visits the service regularly. What has got better from the last inspection people now have a care plan in place, which told the staff how they want to be supported. The plans covered all of peoples needs, and were reviewed regularly to make sure they were up to date. The manager ensures she checks all of the information she received for all new staff to make sure they are suitable to work with the people who live in this service. Systems are now in place to ensure people, their representatives, staff and Care Homes for Adults (18-65 years) Page 8 of 34 external people are asked about the service and any ways it can be improved. What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Claire Williams CPC1 Capital Park Fulbourn Cambridge Cambridgeshire CB21 5XE 01223771300 Care Homes for Adults (18-65 years) Page 9 of 34 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 34 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 11 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The support and care needs of people are properly identified before they move to the home; this ensures that the home is right for them and that their wishes and needs are properly planned for. Evidence: In the information supplied about the service the manager told us; they provide prospective people with as much information as possible to assist them to make a decision about moving into this service. This includes an accessible Service Users Guide and Statement of purpose. People we spoke to told us they had received a copy of the guide, which they had in their rooms. They also told us they had enough information to enable them to make a decision, about using this service. The manager told us in the information provided; that each person is fully assessed, and based on this information a judgement is then made on whether the service is able to meet the persons needs & aspirations. They told us they encourage trial visits to enable people to make an informed decision about the service, and to enable them to meet staff and the other people that use the service. Page 12 of 34 Care Homes for Adults (18-65 years) Evidence: We looked at the care records for two people, one of whom was the last admission to the service. The records confirmed that detailed assessments of need had been carried out before both people came to live here. These included a personal profile and descriptions of needs and any associated issues. The records demonstrated that all of the important people in their lives had been involved in the assessment and planning process. Documents were in place from this service as well as professionals from relevant health and social care services. There was evidence that reviews had been undertaken a couple of days after the persons admission and then 6 weeks later. This ensures people have an opportunity to talk about the service and to reflect on their decision to remain here on a permanent basis. We had the opportunity to speak to a Care manager who has placed people in this service. He said; The staff team and manager have been very responsive and worked with me to arrange transistions in accordance with people needs and preferences. The staff have a genuine caring attitude, and seem to have the required skills to support people. All of the people I have placed here, tell me they are happy, and want to remain living here. We spoke to some of the people during our visit and they told us: I enjoy living here and moving in was good. I like it here and want to stay it is good fun. In the written feedback we received on behalf of those who couldnt speak out for themselves, general satisfaction was expressed that the home was able to meet their needs and keep them safe. Care Homes for Adults (18-65 years) Page 13 of 34 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. Peoples care needs have been assessed, risk factors identified and care planned in ways that reflect their individual preferences and abilities. Evidence: In the information provided about the service the manager told us; people are encouraged to lead an independent life style, and their right to take managed risks is promoted. People are consulted about any actions that have to be taken in order to minimised any risks to them. They told us each person has a care plan in place with is regularly reviewed in consultation with people and their representatives. We looked at 2 care files more closely and found that detailed support plans were in place for both people. These were individualised to the person concerned and provided staff with the required information in all key areas of the persons life. They included the communication needs of the individual and their preferences on how support was provided, and any aids they may use, such as symbols and photographs. A support plan was not in place for either person in respect of decision making and any identified limitations imposed by the recently introduced Mental Capacity Act. Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: The support plans had been completed with information provided in both written and an easy read picture style. This enables people to understand and gain insight into particular aspects of their support. Risk assessments were seen and referenced to the appropriate care plans they related to. The risk assessments informed staff of the support each person required to enable them to stay as independent as possible. There was evidence that the people concerned and their representative had been involved in the process of creating plans for care and support. In all the records we looked at the involvement of outside professionals was also identified as well as personal profiles, agreements and consent forms signed by, or on behalf of, the individual concerned. The care documentation indicated that staff were working with up to date information and in ways that put the person at the centre of their care. We spoke to people were willing and able to meet with us and they all said how happy they were at the home and how they all get on really well together, and that staff are really good too. Staff were all observed interacting in a relaxed and friendly manner with people throughout our visit. Feedback in the surveys, completed by peoples representatives, confirmed that peoples needs were met in a dignified and respectful way, and observations supported this. Care Homes for Adults (18-65 years) Page 15 of 34 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 enjoy a wide range of social, educational and leisure activities of their choice. Their independence and decision making are encouraged and they enjoy as many opportunities as possible. Evidence: In the information provided about the service the manager told us; all people are encouraged to have the opportunity for personal development, and staff support them to continue to develop the skills they have. People are supported to participant in a particular hobby, or learn daily living skills. They told us people are also supported to fulfill their spiritual beliefs. Discussion with staff and observations made during the visit confirmed that the daily routines of the service continue to be flexible. People we spoke to told us I can do whatever I like when I like. I go to bed when I want to and get up when I want to, which is good there are no rules. Although observations supported that the routines are lead by people, there was limited information in peoples files concerning their preferred Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: routines. This would enable the staff to work in a consistent way when supporting peoples needs. Information was seen in the support plans to demonstrate the activities that were undertaken. This is an improvement from our last visit. Evidence was in place to support what opportunities people had and these included a timetable that demonstrated the daily routines, activities and community access and social inclusion. People told us they are supported to attend activities of their choice. For example one person is supported to put a bet on the horses, which they like to do. Another person told us one of their aspirations when they first came to live in this service, was to get a job. They said the staff and manager have helped them to achieve this and the person nows works two days a week and said. I love my new job it is great and I get paid which is very good. The staff were very good, especially the manager who helped me to get this job. Now I can buy myself lots of new things. During our visit we observed people participating in art and craft activities, and some people helped to bake some cakes. People told us they enjoyed these activities. People also have the opportunity to use the sensory room that is on site and fitted with various sensory aids and equipment. We looked at a photo album which demonstrated the parties that people had attended or had for their birthday. The places they had visited such as Skegness, Matlock and various parks. People are also supported to go horse riding and photos of previous trips were seen. We was told a trip had been planned for the cinema and some people told us they had been seen the local panto. People told us We have lots of fun things to do and we are always busy. People told us they are supported to maintain contact with their friends and family and evidence in their files demonstrated this. We spoke to a relative who said; I regularly go and visit my family member and the staff are always welcoming and keep me informed of their well being. I am happy about the care they receive and they go out more which is very good. My family member always seems happy when I visit. The catering arrangements at the service are domestic and flexible in style. A menu is in place, and this demonstrated that choices are available. The menus are in a written format only, but a large pictorial menu would be beneficial to enable people to make choices regarding meal preferences. We joined people for their lunchtime meal, which was relaxed and people had their preferred choice of meal. People that required aids in order to be self managing had these provided, and people were supported to eat their meal in a respectful manner. In the files of the two people case tracked there was limited records in place regarding their likes and dislikes with regard to food and drinks. Staff spoken with demonstrated that they knew the people they supported well and this included their dietary preferences and needs. Page 17 of 34 Care Homes for Adults (18-65 years) Evidence: The feedback received was positive about the meals provided and we were told that; The food is nice and I enjoy my meal everyday. We always have choices and we sometimes have takeaways which are really nice. Feedback in the surveys completed on behalf of people also demonstrated peoples satisfaction with the activities, life experiences and the food provided. We received this comment from a professional who we spoke to during their visit to the service; I think the staff work in a respectful way and I always see them interacting with people which I think is very good. People are never left to sit on their own. Care Homes for Adults (18-65 years) Page 18 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal support from staff in a way they prefer and want. The staff team support people to take medication safely. Evidence: The pre inspection information said that the staff support all people with their personal care to the highest standard, and promote privacy, dignity and independence at all times. The staff support people to make daily choices about the clothes they want to wear and they assist people to attend any health appointments. Medication is only administered by staff who have received the appropriate training, and audits are undertaken to ensure people receive their medication as prescribed. The records we looked at, and the feedback from the surveys demonstrated that, people receive support with their personal and health care in the way they liked. Care records indicated that the people living at the home require differing levels of personal care support or prompting with self care. Those individuals who require a wheelchair to mobilise, need two people to assist them with personal care tasks. The information in the support plans informed the staff of the individuals preferred method of support with their personal care needs. These plans linked to risk assessments to ensure people were supported in a safe way and enabled them to stay as independent as possible. Evidence was seen within the support plans that demonstrated that healthcare needs were monitored on a regular basis to ensure peoples needs were met. However although healthcare records were completed following Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: the intervention from healthcare professionals such as GP, and Chiropodist, any identified changes in the persons needs was not then transferred to the persons care plan. For example, one person had a sore eye and another person had infected feet. This information had not been updated and reflected in their care plan although these plans had been reviewed regularly. This action is required to ensure staff are aware of these changes. Each person has a pictorial health action file in place that is used to support them in understanding their health care needs. This enables them to take ownership of their own health care. We looked at the medication and the records for the two people case tracked. This demonstrated that people receive their medication as prescribed by their GP. The medication was stored securely within a Monitored Dosage System, and entries in the written records had been made properly. The records seen, and discussions with staff members confirmed that the staff involved in medicines administration had all received accredited training. The manager told us she is currently in the process of undertaking an assessment of competency to ensure staff follow safe practices when administering medication. A recent pharmacist inspection confirmed that standards in place were good and met the current regulations. Care Homes for Adults (18-65 years) Page 20 of 34 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. A competent staff team that follow the correct procedures safeguards people using the service. Evidence: The pre inspection information told us the service have a complaints procedure in place which is easy read, and that all people are aware of who they can complain to if they have any issues. People have advocacy meetings every three months to enable them to discuss any issues which can then be brought to the mangers attention to action. Staff follow the safeguarding procedures in place and peoples finances are audited on a regular basis. The records we looked and discussions with people and staff confirmed this information. People told us they have been provided with an accessible complaints procedure and a copy of this is displayed in the service. People told us If I am unhappy about anything I would just go straight to the manager and she will sort it, she is good like that, but I am fine and happy here. The service have not received any complaints since our last visit and we have not referred any issues to the service. Discussions with staff members and the training records seen confirmed that staff members have received training in how to respond to any safeguarding issues. The staff members spoken to demonstrated their knowledge and their responsibilities in relation to this and to responding to any complaints. The service have not received any safeguarding incidents since our last visit and we have not referred any issues to the service. The Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: service intend to obtain accessible information about safeguarding, to enable people to understand what constitutes as abuse. We looked at the systems in place for managing peoples finances and looked at the records for the two people we case tracked. We found these systems to be satisfactory. People we spoke to told us; I can access my money whenever I want to, and the staff help me when I want to buy things. One person told us the staff have helped them to open a bank account and they said. I have a bank account for the first time in my life, and I am very happy about this. Care Homes for Adults (18-65 years) Page 22 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the service have continued to benefit from a homely domestic style environment that is equipped to meet their needs. Evidence: The pre inspection information told us people live in a safe, and comfortable environment, which people are supported to maintain. People have access to a jet spa and each bedroom is fitted with a walk in shower. It said all furnishings in the home are of good quality and fit for purpose. We made a brief tour of the building and found it to be clean, tidy and offering domestic style accommodation, which people occupy in single rooms with all the required facilities. Good standards of decoration have been maintained throughout and any repairs are undertaken in a timely manner. People have access to a sensory room which is fitted with various sensory aids. People told us I like going into this room it is very relaxing. People showed us their bedrooms which have been personalised to reflect their personal style and preferences. One person told us I like my room, but I think I might be moving to a bigger room as I have so many things, and I am running out of space. People told us they have access to the required aids and equipment to assist them to Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: mobilise or to move around the building. People have access to a garden, which is regularly used by one person who enjoys Going for a walk and getting some fresh air. Staff are mainly responsible for cleaning and domestic arrangements around the building, but they are helped by people tidying their own rooms. The laundry is domestic in style and people who are able to are supported to wash their clothes. Records demonstrated that all the staff have undertaken infection control training which ensures safe practices within the service. Care Homes for Adults (18-65 years) Page 24 of 34 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. The service has good systems for recruiting, training and supporting its staff, so that the interests of the people in their care are protected and their overall welfare is promoted. Evidence: The pre inspection information told us all of the staff team have a National Vocational Qualification Level 2 and Level 3 or they are working towards these. It said some staff are also working towards a Leadership and management in care Level 4 qualification. The records seen confirmed this and discussions with staff members demonstrated their motivation to training to ensure they are skilled and competent. The manager told us in the information provided that the staff members work in a person centred way and have a good knowledge of peoples support needs. Our observations of the staff practices and interactions during our visit confirmed this. The rotas demonstrated that there was a good staff skill mix within the service. This consisted of six team leaders , and seven support workers. The rotas told us that their are a minimum of three staff that work on the morning shift and two staff on the evening shift supporting 11 people. As mentioned previously one of the people that live in this service requires two people for support with their personal care. This means that when the staff members re supporting this person, there is no other staff to supervise or support the other 10 people. Discussions with the manager and provider indicated that Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: this is an issue they are already aware of. Therefore an additional member of staff is currently being recruited to work on a evening. The staffing levels also mean that people who require support, are unable to access community facilities during the evening time. However we was informed that extra staff do work when activities have been planned to accommodate this. People we spoke to told us the staffing levels met their needs, and they were enabled to go out when they pleased. Discussions with staff members and the feedback provided in the surveys told us that generally the staffing levels were satisfactory. Six out of the seven staff who completed a survey told us They always had enough staff, and one said They usually did. Both the relative and the Care manager we spoke to, told us they thought the staffing levels were sufficient and did not restrict peoples lives. We received positive comments about the staff team from all of those consulted. Some of these included: The staff team have the skills and a good knowledge about this client group. They support people well. The staff keep me informed about my relatives well-being and I think they provide good care. They are receptive to my relatives well- being, and I am happy they are in this service. The staff are very good and friendly and I like them. Staff members spoken with demonstrated a good understanding of their roles and responsibilities, and insight into the needs of the people they support. They told us they felt supported and was committed to ensuring people received a good standard of care. There was evidence in the files to support that staff receive supervision on a regular basis and staff members did confirm this during discussions. Feedback provided from the staff surveys also confirmed this and comments made include; We give good care and we are dedicated to all of the people that live at this service. All the staff give 100 . We have good training and development opportunities. The staff team work well together. We support people respectfully, and have a good understanding of each individuals needs. We looked at the recruitment files of the last two workers to be employed at the home and these indicated that all of the required checks had been completed. One of these staff had declared a past minor criminal offence, but the records of the assessment of Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: this were not clearly recorded. However this was addressed and records completed the day after our visit. Care Homes for Adults (18-65 years) Page 27 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is a well-managed and safe environment in which to live and work. Evidence: The manager told us in the self assessment how they aim to maintain a high standard in the running of the home. She said they do this by making sure that all staff are aware of the policies and procedures, have regular supervisions, staff meetings, and access to training. Records seen during our visit confirmed that all of the staff have completed all of the required training to ensure they work in a safe way. During our visit, the manager confirmed that she had completed the Registered Managers Award qualification at NVQ level 4 in management, and she told us about other qualifications she has achieved and is currently completing. Records indicated that she has continued to take up training opportunities with the other staff as they have been arranged. The manager has just completed the registration process with the Commission and has wide experience of managing services for people with a learning disability. The manager has made many changes and improvements to the service since our last visit, and the staff team told us Things are managed much better now. There was a Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: relaxed atmosphere at the service throughout our visit and everybody spoken to was positive about the impact the manager has made on improving things. Comments we received include: The management are very supportive and understanding. I feel very at ease to be able to discuss anything with my manager. I feel that over the months there have been changes for the better. Things are much better now and we are all well supported. I cannot think of any improvements as everything is done. I think the service is managed well, and the manager is always very helpful and receptive to us and keeps us informed of our relatives well being. We do not have any cause to complain and we are happy with the care our relative receives. This is a nice service to visit. There is always a good atmosphere here and the manager is always very welcoming. I think she manages the service well and provides good leadership to the staff. The service have also received some compliments from families and comments made include: Thank you staff for a lovely day, and making a lovely birthday party for my relative. Just a note to thank everyone who made my relatives birthday such a wonderful day everyone was so happy. Thanks for the lovely buffet, and all that you did we really appreciate it. The service has a range of quality assurance activities in place in order to gain feedback from people, their representatives, the staff team and external professionals. This includes regular meetings with people and their advocates, annual quality assurance questionnaires and reviews. The service completed a quality assurance exercises in the summer of 2009. The report from this told us that people were positive and complimentary about the service that people received. Some comments were made about improvements, and the report told us about these and what action they would take to address them. This demonstrates that the service listens to people and is pro-active about improving the service provided to them. The provider is a regular visitor to this service, and he was there during our visit. He now works on shift, and records confirmed that he has completed all of the mandatory training. He continues to complete unannounced visits and a report based on his findings. Those seen demonstrated that the service was meeting the required standards and peoples needs. Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: In the information provided about the service the manager told us about standards of health and safety and regular servicing of equipment at the service. Observations made around the building indicated that the building was hazard free at the time of our inspection. Care Homes for Adults (18-65 years) Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 31 of 34 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 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 6 People should have information recorded in their files about their Life history. This will enable the staff to be aware of their past before they moved into this service. Information should be recorded in peoples files about their ability to make decisions in their daily lives. Information about peoples preferred routines should be recorded in their files. This will assist the staff to meet individual needs in accordance with their preferences. Information about peoples likes and dislikes in respect of food and drink should be recorded in their files. This is to ensure the staff team are aware of their preferences. A pictorial menu should be devised to assist people to make a choice at meal times. Any changes to a persons healthcare needs should be updated within their care plan. This is to ensure staff are 2 3 7 16 4 17 5 6 17 19 Care Homes for Adults (18-65 years) Page 32 of 34 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 aware of these changes. 7 20 All staff that administer medication should have an assessment of their practice undertaken. This is to ensure they are competent in undertaking these tasks. The records should demonstrate that a full employment history is obtained and all gaps have been explored. This is to ensure new staff are vetted appropriately. Clear records of declared criminal offences, and their evaluation, made by staff as part of recruitment should be made to allow for better management monitoring All new staff should complete a structured induction within 6 weeks of appointment. 8 34 9 34 10 35 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2010) Care Quality Commission (CQC). 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. 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