Care Home: The Old Court House

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What the care home does well People living at The Old Court House are part of an active family household and have lifestyles that reflect this. They have a social network and enjoy a lot of shared and individual activities in the wider community. The meal arrangements are flexible, with an emphasis on healthy eating and the use of fresh produce. People`s personal and healthcare needs are being met by the support provided within the home and from outside professionals. They receive support which ensures that their medication is well managed and administered correctly. People live in a large family house, which provides them with a very comfortable and interesting home environment. The individual accommodation is meeting people`s needs and reflects their personal preferences. The home looks clean, tidy and to have been well maintained. Overall, people benefit from a well run home and from the individual attention that they receive. What has improved since the last inspection? People have been able to develop their interests and talents, for example by attending courses in fine art and stone carving. We saw some of their art work when we visited The Old Court House, and were told that people`s work has also been displayed in local art exhibitions. Trips and activities have been arranged which have provided people with new experiences. This has included going camping in Devon and in the Cotswolds, and visiting museums and exhibitions. Work has taken place at the home to create some new features and areas of interest for people. A small, but very productive kitchen garden has been established. We also saw the chickens which now live in the grounds and provide the home with a regular supply of organic eggs. We were told about other work that has taken place, such as creating a new patio and barbecue area, and redecoration within the home. What the care home could do better: Information for family members should be produced in different formats, which will meet their individual needs. This is to ensure that the information they are given can be easily understood. People`s individual plans should also include their own views about their support and individual goals. This is so that they reflect a more person centred approach. We have also made recommendations about some of the home`s procedures and the way in which records are kept. This is to ensure that they promote people`s best interests and rights. Key inspection report Care homes for adults (18-65 years) Name: Address: The Old Court House Broad Street Kings Stanley Nr Stroud Glos GL10 3PN     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: Malcolm Kippax     Date: 1 7 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 29 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 29 Information about the care home Name of care home: Address: The Old Court House Broad Street Kings Stanley Nr Stroud Glos GL10 3PN 01453791548 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Rachel@innes70.fsnet.co.uk Mr Stuart Innes,Mrs Rachel Claire Innes care home 2 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home The Old Court House is a period property in the village of Kings Stanley, near Stroud. Although registered as a care home, The Old Court House is essentially a family residence for both the provider and for the other people who live there. The registered provider, Mrs Innes, employs one person from outside The Old Court House to help support people with their care and with going out. Mrs Innes husband also assists with the day to day routines. There was no set range of fees; the fee received for the people who currently receive care at The Old Court House were based upon their individual circumstances. They would not necessarily be a guide to the fee levels that would apply to other people in the future. Further information about The Old Court House is available in a Statement of Purpose. Copies of inspection reports can be seen on the Commissions website at www.cqc.org.uk 2 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 29 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: Before visiting The Old Court House, we asked the provider to complete an Annual Quality Assurance Assessment (known as the AQAA). This was their own assessment of how they were performing. We also sent surveys to The Old Court House, so that these could be given out to the people who receive care at the home, and to the people who support them. We had surveys back from the two people who receive care, and from a support worker. We looked at all the information that we have received about The Old Court House since the last inspection. This helped us to decide what we should focus on when we visited on 17th July 2009. During the visit we talked with the people who live at The Old Court House, and with a support worker. We went around the accommodation and looked at some records. Care Homes for Adults (18-65 years) Page 5 of 29 The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visit. The previous inspection of The Old Court House was on 11th July 2006. In the evidence sections of this report, the two people who were receiving care at The Old Court House are referred to as family members. This is at the request of the people who live at The Old Court House, and reflects the actual relationship between the provider and the other people who live there. Care Homes for Adults (18-65 years) Page 6 of 29 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 Care Homes for Adults (18-65 years) Page 7 of 29 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 8 of 29 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 9 of 29 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. Good information is available about The Old Court House and how it is run. However, this is mostly in a written format, which means that some people will find it difficult to understand. There is an admissions procedure, although the provider does not intend to provide care to other people in the future. Evidence: A copy of a Statement of Purpose for The Old Court House was kept at the home, and could be made available to interested parties. The Statement of Purpose had been updated in June 2009 and included appropriate information about The Old Court House. There was also information that had been produced for the family members, including a Service Users guide. This included relevant information about The Old Court House and about the role of outside agencies. However the information was mainly in printed text, which meant that it was not in a format that would be easily understood by Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: everybody. Mrs Innes told us that the family members received a personal allowance, and that this was their money to spend as they wished, as all the services and activities were paid for out of the fees. There was information available about fee levels, although the Service Users guide did not give information about the financial arrangements, and who paid for what. Mrs Innes told us that this information would now be included. The family members had lived together at The Old Court House since 1991. Review meetings had taken place in 2008, when it was decided that the home was meeting the family members needs. An admissions procedure had been produced, although the current policy was that there would be no new admissions in the future. Care Homes for Adults (18-65 years) Page 11 of 29 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 have individual plans which provide good information about their day to day needs, but do not reflect a person centred approach. People receive support so that they can make informed choices about their daily routines and activities. Risks are assessed in most areas of peoples lives, which helps to ensure that they are safe when doing the things they want to. Evidence: Each family member had a care plan, which had last been reviewed in April 2009. The plans included information about peoples individual routines and how each person should be supported in order to meet their needs. Each family member also had an Individual Learning Plan, which described the aims in providing support, such as to keep happy, mentally stable and occupied in such a way that you are not caused unnecessary stress. One family member told us about the local slimming club that they attended, and how this had helped them. They also Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: enjoyed going to a gym and felt that this was very good for them. In the survey for staff, we asked whether they were given up to date information for example in the care plan about the needs of the people who they supported or cared for. The support worker responded Always to this question. Although the plans were informative about peoples needs, they were not produced in a user friendly format. Peoples own views about their support and individual goals were not highlighted, which meant that they lacked a person centred approach. The family members had signed their plans, which Mrs Innes said was intended to be a way of involving them in the care planning process. We discussed this with Mrs Innes, who acknowledged that the written format of the plans meant that the contents would not be easily understood by the family members. The family members personal records also included information about risks to them in the home and when out in the community. Guidance had been produced which would help to ensure that people were safe when participating in their daily routines and activities. For example, there was guidance about travelling safely in the homes vehicle. We talked to Mrs Innes about the risk assessment process, and agreed that it would be worthwhile to include some other activities within this process. These were in relation to certain activities that one person undertook without support or supervision. The risk assessment process would help to ensure that the appropriate safety measures were in place and kept under review. Meetings were being held regularly at The Old Court House when the family members talked with other people about their day to day life at the home and made plans for the future. Minutes of the meetings were displayed on a notice board in the one of the communal areas. Family members told us that at the meetings they talked about new places that they would like to go. In their surveys, the family members confirmed that they made decisions about what to do each day. When we asked in the staff survey about what the home did well, the support worker commented The home is run with all the family in mind and everyone gets involved with activities, whether jobs or hobbies etc in and out of the house. Care Homes for Adults (18-65 years) Page 13 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at The Old Court House are part of an active family household and have lifestyles that reflect this. There is an emphasis on healthy eating and using fresh produce in the preparation of meals. People have a social network and enjoy a variety of shared and individual activities in the wider community. Evidence: The family members told us about the different things that they did during the week. This included a mix of regular activities, and other outings and events that were arranged on the day. Family members had activities in the community such as attending clubs, art courses and gym sessions, which reflected their individual interests. Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: There was information in the personal records about the family members faith, and the importance of this to them in their lives. They received support to attend a church each week, and other church based activities as and when they arose. People went out socially as a family household. We heard about cinema trips, visits to museums, camping holidays, and visits to relatives and friends that the family members had enjoyed. The support worker had access to a car at all times, so that there was always the option of being able to support the family members with going out. Family members contributed to the day to day running of the home, for example by helping out with the shopping and doing jobs around the house and grounds. There were fields nearby where the familys pet dog could be exercised. Work had taken place since the last inspection to create some new features and areas of interest for people. A small, but very productive kitchen garden had been established. One of the family members showed us the chickens which now lived in the grounds. The organic eggs and home grown vegetables were used to provide family members with freshly prepared meals. The family members told us that they liked the meals at the home and that they also ate out on some occasions. They received advice about healthy eating and were supported with a lot of sporting and outside activities that helped with keeping fit. Within the home, there were communal areas where people could watch television, listen to music and play games. There was a pool table in one of the communal rooms. Each family member had their own room. They showed us their rooms, which had been well personalised and contained possessions that they had collected over the years. One person liked to construct things and they had space in their bedroom to keep their models. Another family member had their artwork on display and they had collected various art books. Care Homes for Adults (18-65 years) Page 15 of 29 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 personal and healthcare needs are being met through the support provided within the home and from outside professionals. People receive support which ensures that their medication is well managed and administered correctly. Evidence: Mrs Innes took the lead in ensuring that family members received the care that they needed. A support worker assisted with the practical arrangements at the home and when out in the community. They told us that this included accompanying family members when they had appointments with healthcare professionals. Mrs Innes told us that the family members were in good health and there were no concerns about their welfare. The family members looked well supported with their personal appearance. Specialist services were available when needed, including support from a consultant psychiatrist. The family members care plans included details of their health and care needs. There Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: was information about peoples individual preferences, which showed an awareness of the need to support people with dignity and respect. Family members were encouraged to be independent in some areas of personal care and support. The support worker told us that the condition of peoples nails was checked, but one person was able to manage their own nail cutting. As reported in the Lifestyle section, there was an emphasis on healthy eating and outdoor activity, which promoted good health and helped people to keep fit. Details of appointments and some care related notes were being recorded on the back of their care plans. We were also told about a diary that was being used to record information before it was written onto the care plans. This system raised issues about the security and confidentiality of personal information, which we discussed with Mrs Innes. The family members records did not include Health Action Plans, or a summary of health and personal care needs, which would be useful if a family member had to be admitted to hospital at short notice. Mrs Innes said that Health Action Plans had recently been discussed with her, and that she was keen for the family members to have these in place. The family members were registered with local GPs. A consultant psychiatrist was also available to advise on medication and to carry out reviews. Family members received support within the home to ensure that their medication was well managed and administered correctly. Their medication was received in the form of a monitored dosage system and kept in a lockable facility. The pharmacist had provided training in the use of the monitored dosage system. The support worker had also attended an accredited course in the safe handling of medicines. Care Homes for Adults (18-65 years) Page 17 of 29 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 listened to and there are arrangements in place which help to ensure that people are protected from harm. Evidence: Mrs Innes had produced a complaints procedure, which described the different stages of making a complaint. A complaints procedure had also beein given to family members with their Service Users guides. As with some other information, the procedure was not available in a format that would be easily understood by everyone. Mrs Innes told us that the procedure had been well explained to family members and to staff. In their surveys, the family members confirmed that they knew who to speak to if not happy with something. The support worker told us that they knew what to do if somebody had concerns about the home. People met together regularly when they could raise issues and talk about their day to day business. This helped to ensure that any concerns could be discussed and dealt with at an early stage. We were told in the AQAA that during the last year there had been no complaints made, and no safeguarding referrals made, for example when an allegation of abuse Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: has been made. The people working at The Old Court House had received information about abuse awareness and protecting people from harm. The support worker was attending a Protection of Vulnerable Adults course at a local college during the morning of our visit. The homes written procedure about safeguarding vulnerable adults had been obtained from the family members funding authority; a copy of the local Gloucestershire procedure was not available at the home. Mrs Innes confirmed that she would obtain a copy of this. This is important because any safegurding referrals would need to be made in accordance with the local procedures, rather than those of another authority. The family members received support with managing their financial affairs, both in terms of their allowances and also with their day to day expenditures. The support worker told us that they supported people with shopping, and always kept an account of what had been spent, with receipts obtained. This helps to ensure that there is a clear record of how people have been supported with spending their money, to show that it has not been used inappropriately. Mrs Innes told us that she was in the role of appointee to the family members. The appointee role is often undertaken by somebody who is independent of the service, as this helps to ensure that there can be no conflict of interests. Mrs Innes said that the arrangements had been agreed and were being kept under review with the family members funding authority. Care Homes for Adults (18-65 years) Page 19 of 29 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 excellent 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 large family house, which provides them with a very comfortable and interesting home environment. They have individual accommodation which is meeting their needs and which reflects their individual preferences. The home looks clean, tidy and to have been well maintained. Evidence: The Old Court House is a period property in the village of Kings Stanley, near Stroud. The Old Court House is essentially a large family residence for both the registered provider and for the other people who live there. The facilities and accommodation reflected this. There was a mix of old features and modern facilities, which added interest to the home environment. Overall, the decoration and furnishings were of a high standard. Family members shared the communal rooms, which included a large and well furnished lounge. Another room had a games area and another sitting area with comfortable sofas. There was a good sized domestic type kitchen with a dining area where people could eat together. There was a separate utility area where the laundry was done. Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: One of the family members showed us the grounds, which included a parking area and space for different recreational activities. As reported under the Lifestyle section, parts of the grounds were also used for growing vegetables and for keeping chickens. Family members appeared to be at home in the surroundings. They had their own rooms on the first floor, which were individual in character and large enough for peoples personal possessions. There was a bathroom close to the family members rooms, which was for their exclusive use. There had been discussion at the last inspection about the need for aids or adaptations. We discussed this again with Mrs Innes, who said that family members did not currently have any mobility difficulties, but was aware of the need to keep the need for aids under review. The accommodation that we saw looked well maintained and clean. Care Homes for Adults (18-65 years) Page 21 of 29 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. Care and support is being provided by competent people who receive relevant training. Evidence: The registered provider and manager, Mrs Innes, was the main person providing care to the family members. One person was employed from outside The Old Court House to help support people with their care and with going out. We met with this support worker, who had a full-time role and had been supporting the family members for over 14 years. The support worker had undertaken a range of relevant training courses over the years and achieved a National Vocational Qualification in care at level 2. They spoke positively about their role and appeared to be knowledgeable about the family members needs. The support worker had a training plan for the year. This included attending a course about the Mental Capacity Act. Training in infection control was also to be arranged. We talked to Mrs Innes about developing the training plan to include new subjects which would increase knowledge of peoples health and diverse needs. Mrs Innes has had limited experience of recruiting staff. Mrs Innes said that her husband was not initially involved as staff, but had had a practical role at the home Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: since early 2008. At that point, a Criminal Records Bureau disclosure was obtained, and a check made of the POVA (Protection of Vulnerable Adults) list. These are two of the most important checks that need to be made to ensure that somebody is suitable to work with vulnerable adults. Mrs Innes acknowledged that this did not demonstrate evidence of a full recruitment process. However, Mrs Innes confirmed that she was aware of the need, in normal circumstances, for a new staff member to be recruited on the basis of an application form, references and additional checks in relation to their fitness. Mrs Innes husband had a role which initially started with maintenance, but was developing to include assistance with the day to day routines, including the cooking of meals. Training was being undertaken which reflected this developing role. This had included the protection of vulnerable adults; food hygiene; first aid; health and safety; and an Introduction to Autism course. Care Homes for Adults (18-65 years) Page 23 of 29 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. People live in a well run home that is meeting their needs. Policies and procedures generally safeguard peoples rights and best interests, although there are areas that would benefit from further attention. Evidence: Mrs Innes has been in a caring role with the family members for many years and they have shared family life together for a longer period of time. Since being involved in a formal capacity, Mrs Innes has obtained a management qualification and undertaken a range of training which is relevant to her role. The family members appeared well settled, and they spoke positively about their day to day routines and activities. The support worker also told us that they felt well supported. We saw records of individual meetings that were taking place to discuss peoples needs. The relationships between people at The Old Court House, and their day to day contact, meant that views could be shared and discussed on regular basis. We would Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: not necessarily expect the home to operate a formal quality assurance system, although it was agreed with Mrs Innes that it would be useful to have a written policy in place. This would describe the homes own approach to quality assurance and show how improvements were being made in the light of peoples comments, including those received from outside agencies. We would have liked to have been given more details in the AQAA about how the home was developing and about the improvements that were being planned. The AQAA is an opportunity, through self-assessment for homes to tell us about how they are responding to change and about their performance in general. We talked to Mrs Innes about a number of developments that have taken place since the last inspection in relation to care practice and learning disability services. Some developments are reflected in the recommendations that we have made in this report, for example about producing information in a way which is person centred. The home looked well maintained and cared for, which together with the routine servicing of domestic appliances and facilities, appeared to be providing people with a safe environment. Risk assessments were also being undertaken in relation to some of the family members activities. A fire procedure was displayed and there was also information on a notice board about keeping healthy. Some of the other usual indications of health and safety in a care home, such as signs and labels on plugs, were not present. Mrs Innes said that she would check whether anything further should be done, for example in relation to portable appliance testing. We also talked about the use of a simple health and safety checklist, which would give an overview of the arrangements being made. A fire officer had visited The Old Court House in 2008 and given advice about the fire precautions. Mrs Innes said that the homes boiler had been upgraded as a result of this, and torches were being kept to use in an emergency. The fire officer had also talked to Mrs Innes about completing a fire risk assessment. This assessment had not been formally recorded at the time of our visit, but soon after Mrs Innes confirmed with us that this had been done. Care Homes for Adults (18-65 years) Page 25 of 29 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 26 of 29 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 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 1 That the information for family members is produced in different formats which will meet their individual needs. This is to ensure that the information they are given can be easily understood. That information is included in the Service Users guide about what the fees cover and the use of personal allowances. This is so that there is good information about the financial arrangements, which will help to ensure that there are no misunderstandings about how things are being paid for and by whom. That the individual plans reflect peoples own views about their support and individual goals, as part of a person centred approach. The plans should also be produced in formats which will meet peoples individual needs. This is to ensure that the family members are fully involved in the care planning process, and so that there is good information about the support that they will receive with achieving their goals. That the risk assessment process is extended to include the activities which one person undertakes without support or supervision. The risk assessment process will help to Page 27 of 29 2 1 3 6 4 9 Care Homes for Adults (18-65 years) 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 ensure that the appropriate safety measures are in place and are kept under review. 5 19 That the family members receive support with the completion of Health Action Plans. This is so that they each have a living plan in a suitable format, which explains their health needs and which can be updated as their needs change. It can be used as the health section of a Person Centred Plan. That all personal and health care matters are recorded on appropriate forms for each person. This is to help ensure that individual records are kept in a way which maintains confidentiality. It should also make it easier to keep an overview of health related activities, and to provide a chronological record of the support that people have received. That the complaints procedure is produced in different formats which will meet the family members individual needs. This is to ensure that the information about how to make a complaint can be easily understood. That the training plans are expanded to include a greater range of subjects. This is to ensure that the people who provide care and support are developing their skills and knowledge, for example in relation to health needs and to equality and diversity issues. That a policy and procedure for quality assurance is produced. This is in order to show the homes own approach to quality assurance and how improvements are being made in the light of peoples comments, including those received from outside agencies. That a health and safety checklist is maintained. This is to provide an overview of the arrangements being made for health and safety and to show that appropriate checks and servicing are being undertaken on a regular basis. 6 19 7 22 8 35 9 39 10 42 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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