Care Home: The Old Manse

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What the care home does well Staff spend time sitting talking to the person living in the home so that they feel valued. Staff use communication methods that the person knows.Plans that explain how to care for the person living there are well written so that staff know how to support individuals.The person living there goes out and does things they enjoy with staff that know them well.The person has a Health Action Plan. This is a personal plan about what a person can do and what health care services they need to use to stay healthy. This helps staff toknow how to support them to meet their heath needs.Staff have training to help them understand how to protect people from harm and understand how to help them keep well.Staff help people to develop their skills and experience new things so improving their quality of life.The home is well decorated and furnished making it homely and comfortable for people to live in.The person has their own bedroom that is decorated in the way they want it to be. They have the space in their bedroom to keep their personal things there.There are enough staff on duty so that the person living there does not have to wait for staff support.Equipment in the home is often tested to make sure it is working and safe to use.There is a choice of healthy food so that the person living there is supported in their diet to keep well. What has improved since the last inspection? This is the homes first inspection. What the care home could do better: Update the service user guide with information about how much it costs to live at the home. This will help to ensure people have the information they need to make a decision about if they want to live there.Improve the records for administering medication to make sure people get the medication they need safely.Check all the staff files to make sure they contain all the required records to show that good recruitment procedures have been followed.Improve the frequency of staff meetings and supervisions to help ensure that staff are well supported in their role.Consideration needs to be given to fitting a device to the office door that will keep it open but releases the door should a fire occur. This would help to stop the spread of smoke and fire in the home and help to keep people safe. Key inspection report Care homes for adults (18-65 years) Name: Address: The Old Manse 2 Compton Road W Midlands B24 8QA 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: Kerry Coulter Date: 0 7 0 9 2 0 0 9 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 37 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 37 Information about the care home Name of care home: Address: The Old Manse 2 Compton Road W Midlands B24 8QA 01213865494 01213865494 theoldmanse@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Optimum Care Services Name of registered manager (if applicable) Mrs Heidi Cox Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 3 0 care home 3 learning disability Additional conditions: The maximum number of service users to be accommodated is 3 The registered person may provide he following category of service only: Care home only ((PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Learning disability (LD) Date of last inspection N/A Care Homes for Adults (18-65 years) Page 4 of 37 A bit about the care home The home is located close to the centre of Erdington. There are local bus routes near by. The home does not have any off road parking but there is ample on road parking available next to the home. The home is new and opened in March 2009. The home is allowed to accommodate up to three people who have a learning disability, but when we visited only one person was living there. Care Homes for Adults (18-65 years) Page 5 of 37 Bedrooms are located on the first floor and so people living there need to be able to use the stairs. All bedrooms are single and have an ensuite shower room. There is also a communal bathroom so that people can choose to have a bath if they want to. The home has a large kitchen, dining room and lounge. The laundry is situated on the first floor. The home has a large rear garden. A copy of the service user guide is available in the home, this tells people about the home. The actual range of fees was not stated in the current Care Homes for Adults (18-65 years) Page 6 of 37 service users guide so people would need to contact the home for fee information. Care Homes for Adults (18-65 years) Page 7 of 37 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 8 of 37 How we did our inspection: This is what the inspector did when they were at the care home This inspection was carried out over one day, the home did not know we were going to visit. Before we visited we asked the manager to send us information about the home, this is called an AQAA. We briefly met with the person using the service but they did not want to spend a long time talking with us. We therefore asked staff about this persons needs. Care Homes for Adults (18-65 years) Page 9 of 37 We also looked at the care plans, medical records and daily notes for this person. This is called case tracking. We also looked at all parts of the home, staff and health and safety records. Surveys were sent to six staff, four were returned. We sent four surveys to health professionals, none of these were returned to us. What the care home does well Care Homes for Adults (18-65 years) Page 10 of 37 Staff spend time sitting talking to the person living in the home so that they feel valued. Staff use communication methods that the person knows. Plans that explain how to care for the person living there are well written so that staff know how to support individuals. The person living there goes out and does things they enjoy with staff that know them well. The person has a Health Action Plan. This is a personal plan about what a person can do and what health care services they need to use to stay healthy. This helps staff to Care Homes for Adults (18-65 years) Page 11 of 37 know how to support them to meet their heath needs. Staff have training to help them understand how to protect people from harm and understand how to help them keep well. Staff help people to develop their skills and experience new things so improving their quality of life. The home is well decorated and furnished making it homely and comfortable for people to live in. The person has their own bedroom that is decorated in the way they want it to be. They have the space in their bedroom to keep their personal things there. Care Homes for Adults (18-65 years) Page 12 of 37 There are enough staff on duty so that the person living there does not have to wait for staff support. Equipment in the home is often tested to make sure it is working and safe to use. There is a choice of healthy food so that the person living there is supported in their diet to keep well. What has got better from the last inspection This is the homes first inspection. Care Homes for Adults (18-65 years) Page 13 of 37 What the care home could do better Update the service user guide with information about how much it costs to live at the home. This will help to ensure people have the information they need to make a decision about if they want to live there. Improve the records for administering medication to make sure people get the medication they need safely. Care Homes for Adults (18-65 years) Page 14 of 37 Check all the staff files to make sure they contain all the required records to show that good recruitment procedures have been followed. Improve the frequency of staff meetings and supervisions to help ensure that staff are well supported in their role. Consideration needs to be given to fitting a device to the office door that will keep it open but releases the door should a fire occur. This would help to stop the spread of smoke and fire in the home and help to keep people safe. Care Homes for Adults (18-65 years) Page 15 of 37 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 Kerry Coulter West Midlands Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA Tel 0300 616161 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 16 of 37 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 17 of 37 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. Arrangements in place should ensure that people can be confident their needs will be met on admission. Evidence: The service users guide was readily available and gave information about the home. It included photographs and was written in an easy read format making it easier for people to understand. The person living at the home has information about how much it costs to live there, however the range of fees needs to be included in the guide. This will help people thinking of moving to the home to make a decision about if they want to live there. The home had been open for less than six months when we visited and only one person has so far moved into the home. Records and discussions with staff show that a full assessment of the persons needs had been completed before they moved in. The person also had the opportunity to visit the home to undertake activities and have meals there. This helped them get used to the home before moving in. Several staff members had worked at the persons previous home and this helped to ensure staff were aware of the persons needs. Discussion with staff indicates that the person has settled well into their Care Homes for Adults (18-65 years) Page 18 of 37 Evidence: new home. Records sampled included an individual contract between the home and the person. This stated the terms and conditions of their stay including their rights and responsibilities. Care Homes for Adults (18-65 years) Page 19 of 37 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. Staff have the information they need so they can support individuals to meet their needs safely so ensuring their well being. Evidence: We looked at the care records of the person living at the home. These included an individual care plan that detailed how staff are to support the person to meet their needs. The plan centred on the person and how they would prefer to be supported. They detailed the things important to the person, how they should be supported, the things they like and the things they do not like. There were some good details included in the care plans about the persons preferred daily routines and these were seen to be followed. Care plans had been reviewed and updated if the persons needs had changed. The persons care file contained a vast amount of information, some of which was more about the homes general procedures than being specific to the person. This made it time consuming to locate more important information such as the persons care plans. Staff meet monthly with the person to review their care and make sure they are happy. Care Homes for Adults (18-65 years) Page 20 of 37 Evidence: Minutes of these meetings showed that what the person has been doing is discussed and what can be done to make things better if things have not worked well. The person living at the home had complex communication needs and their care plan gave staff details of how they should communicate with the person to ensure they understood as much as possible. Records and discussions with staff showed that the person is given choices about what they do. Staff gave examples of how the person is supported to make choices through the use of signs and picture cards. The observations made throughout the day clearly showed staff knew the needs of the person living in the home and that they consulted with them on an ongoing basis. Records included risk assessments for activities such as bathing, cooking, travel, shaving and using the stairs. Where the persons needs had changed the assessments had been updated. This helps to ensure that the person is supported to take risks in their daily lives whilst being as safe as possible. Care Homes for Adults (18-65 years) Page 21 of 37 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. Arrangements help to ensure that people experience a meaningful lifestyle that meets their individual needs. Evidence: Sampled records show that the person has opportunities to take part in varied activities both inside and outside of the home. Activities on offer include bowling, foot spas, meals out, walks, music and art. The person is also encouraged to do tasks around the home to make them more independent, this includes helping keep their bedroom clean and cooking. The person living at the home has a daily plan of activities that is based on the things they enjoy doing. The plan is in a picture format so that the person knows what they will be doing. On the day we visited the home the person went out with staff to buy a newspaper, went out shopping and for lunch and later went out to post a letter. These activities matched the planner for the day. Care Homes for Adults (18-65 years) Page 22 of 37 Evidence: The home has the use of their own vehicle but use is also made of public transport. Staff told us that the person often uses the bus as this is something they like to do. The home has open visiting hours. Records showed that the person is supported to keep in contact with their friends by letter and in person. On the day of our visit staff supported them to write and post a letter to a friend. The manager told us that as the person has no contact with relatives a referral has been made on their behalf for advocacy and befriending services. Training records show that staff have received training on healthy eating so that they can support the person to have a healthy diet. Food records sampled showed that the person has a varied and nutritious diet that includes fruit and vegetables. They are given opportunities to try foods from different cultures, to have take away meals, go for meals out and on picnics. This gives the person the chance to try lots of different types of food. Staff told us that meals are planned on a weekly basis but that the person living at the home will often choose what they want to eat on a day by day basis. Staff said that the person is offered choice of food by looking in the fridge and freezer to see what they would like and also at pictures of food. Staff said that they also support the person to go shopping for food where they choose the foods they like. The manager said that they are currently taking photographs of the meals to use as an alternative communication tool. Care Homes for Adults (18-65 years) Page 23 of 37 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. Arrangements ensure that individuals personal care and health needs are met so ensuring their well being. Evidence: The person living there was well dressed in an appropriate style to their age, gender, cultural background and the activities they were doing. Attention had been paid to their personal care indicating that they had the support they needed so ensuring they felt good about themselves. Their care plan was very detailed as to how to support the individual with personal care and included how to encourage the person to be as independent as possible. The ongoing health care needs of the person living in the home were detailed in their care plans. This included an individual health action plan. This is a personal plan about what support the person needs to meet their health needs and what healthcare services they need to use. These included pictures making them easier to understand. Records showed that since moving to the home the person had been registered with a local GP and had a health check with the practice nurse. Files showed the person had contact with a variety of health care professionals such as the psychiatrist, optician and chiropodist. Staff told us that arrangements were underway for the person to have a Care Homes for Adults (18-65 years) Page 24 of 37 Evidence: check up with a dentist. It was clear that where there were specific concerns referrals had been made to the appropriate professionals. Some staff have had training in the persons specific health needs and for staff who have not yet had the training this has already been arranged. Medication was stored securely. Certificates were available to show that staff who administer medication had received training to do so. Information is available to staff about what medication the person is prescribed, what it is for and side effects that staff need to look out for. Copies of the most recent prescriptions were available for staff to refer to if needed. Medication records had been signed by staff when medication had been administered, but some improvements to these records were needed. One medication was prescribed on a variable dose of one or two tablets. When staff sign the record of administration they need to record how many tablets were given. Two medications were not being given in line with the frequency stated on the administration record. The manager said this was on the instructions of the GP. This needs to be recorded and the directions on the administration record need to reflect the GP instructions to make sure the person receives their medication as prescribed. Care Homes for Adults (18-65 years) Page 25 of 37 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. Arrangements help to ensure that the views of the people living there are listened to and they are protected from abuse and harm so ensuring their well being. Evidence: The home have not received any complaints since they opened and we have not received any complaints about the service provided there. The staff surveys that were returned to us indicated that staff knew what to do should anyone lodge a complaint at the home. The home has a complaints procedure that is in a format that makes it easier for people living in the home to understand. However the person living at the home does have communication difficulties. Staff spoken with were able to tell us how they would know if the person currently living at the home was unhappy by their gestures and behaviour. It would be useful if this information was recorded in care plans so that staff had access to this at all times. The home have documents entitled Are You Happy and Listen to Me. These were completed with the person living in the home on a regular a basis to help establish if they are happy living there. There had been no safeguarding issues raised with us or directly with the home. There were appropriate policies and procedures on site for staff to follow should any issues arise. Staff receive training on how to protect people and staff spoken with satisfactorily described the actions they would take to keep people safe if they suspected they were being abused. Care Homes for Adults (18-65 years) Page 26 of 37 Evidence: There were robust systems in place for managing money on behalf of the people living in the home, where necessary, to ensure they were safeguarded. The records for the system in place were sampled and found to be appropriate. All income and expenditure was recorded and receipts were available for expenditure made on behalf of the person. The system was regularly audited by a senior manager to ensure it was managed appropriately. The manager has received training to enable her to deliver training in the Mental Capacity Act and Deprivation of Liberty Safeguards legislation. This requires an assessment of the persons capacity to be completed when making a decision about their welfare if there is any doubt that they lack capacity and helps to ensure that people who live in a care home are not being cared for in a way that deprives them of their liberty. The manager told us that she would be arranging for staff to have this training in the near future. One staff spoken with had a basic understanding about this new legislation and told us that the manager had given them information about this in preparation for future training. Care Homes for Adults (18-65 years) Page 27 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe, homely and comfortable environment that meets their individual needs. Evidence: The home has been open for less than six months and so accordingly the decor and furnishings are in very good order. Decor is modern but homely in style. The home has a large lounge and dining area that has ample room to accommodate the number of people the home is registered for. Each person who lives at the home will have their own bedroom. We looked at the bedroom of the person currently living at the home. It was decorated and furnished to suit the tastes and interests of the individual. Staff told us that since moving to the home the person had started to take a real pride in their bedroom and enjoyed being supported by staff to keep it looking nice. Two bedrooms have their own en suite shower room, the third bedroom has an allocated shower room adjacent to their bedroom. This helps to promote peoples privacy and independence. The person living at the home has had some falls recently, including two on the stairs. We saw that the design of the stairs incorporates a turn at the bottom. The colour of the carpet is also similar to the colour of the hallway floor covering. Discussion with the manager indicates that a referral to an occupational therapist has been made to look at Care Homes for Adults (18-65 years) Page 28 of 37 Evidence: the persons needs and this will include the design of the stairs. Hygiene and infection control measures were in place. Standards of cleanliness were good and there were no unpleasant odours ensuring a pleasant environment for people living in the home. The environmental health officer had visited the home and inspected the kitchen. The report from this visit was positive stating that the home has very good practices in place. The laundry is situated on the first floor of the home. The manger told us that as peoples bedrooms are also located on the first floor laundering of clothing is done during the day rather than at night. This means that people will not be disturbed at night by the noise from the washing machine. Care Homes for Adults (18-65 years) Page 29 of 37 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 arrangements for staffing, their support and development usually help to ensure that the needs of the people living there are met. Evidence: The homes annual quality assurance assessment told us that all but one of the staff has a National Vocational Qualification in care, either at level two or three. This exceeds the standard that at least 50 of staff have achieved this qualification ensuring they have the skills and knowledge to meet the needs of the people living there. Although the home has been open for under six months some of the staff have worked for the organisation for several years and have previously worked with the person who lives at the home. This means that the person is supported by staff who they know well. Staff skills and knowledge about the person they were supporting was evident throughout observations during the inspection. As there is currently only one person living at the home they always have support from at least one member of staff, sometimes there are two staff on duty. This means that current staffing arrangements meets the persons needs. The manager said that once more people move into the home staffing arrangements will be reviewed but that the current person will continue to receive one to one support. The home does not use agency staff to cover for gaps in staffing, staff work extra hours or the organisations own bank staff are used so that the person is supported by staff they know. Care Homes for Adults (18-65 years) Page 30 of 37 Evidence: The records of four of the staff who work there were looked at. These generally included the required recruitment records including evidence that a Criminal Records Bureau (CRB) check had been completed to ensure that suitable people are employed to work with the people living there. One staff who had worked for the organisation for several years only had one reference in their staff file. The manager said she would ensure the reason for this was established. Records sampled showed that when staff start working at the home they complete an induction so they know how to meet the needs of the people living there. One staff told us that they had received a good induction that included shadowing the other staff on duty. Discussion with staff and records sampled showed that staff receive the training they need to be able to meet the needs of the people living there. The surveys staff returned to us indicated they were generally satisfied with the training they received. Training includes health and safety, fire, first aid, manual handling, healthy eating, safeguarding people from abuse and infection control. Training has also been booked for peoples specific needs, for example in autism. Staff meetings are held and staff have formal supervision with their manager but this has not always been regular. The frequency of this needs to be improved to help ensure staff are well supported in their role. Care Homes for Adults (18-65 years) Page 31 of 37 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management arrangements help to ensure that the home is well run so the health, safety and welfare of the people living there is promoted and protected ensuring their well being. Evidence: The home has a manager in place who has successfully completed their registration with us. The manager is well qualified having completed an NVQ 4 in care, the registered managers award and a diploma in working with people who have autism. This helps to ensure that the manager has the skills and knowledge to manage the home in the interests of the people who live there. Throughout the course of the inspection she demonstrated knowledge of the needs of the person living in the home and was enthusiastic about making improvements at the home. One staff told us that the manager is very approachable, you can talk to her, say what you want. The manager completed and returned the annual quality assurance assessment for the home when we asked for it. This told us about the homes plans for future improvements. The home has quality monitoring systems in place. However due to the home only having Care Homes for Adults (18-65 years) Page 32 of 37 Evidence: been open for a short time some of the systems have yet to be fully utilized. This will include sending satisfaction surveys to families, visiting professionals and staff in the future. Currently a senior manager from the organisation undertakes monthly visits to the home and produces reports on the conduct of the care home. The person living in the home is also assisted by staff to complete the Are You Happy survey. The health and safety of the people living in the home and the staff were well managed. Staff had received training in safe working practices and knew what action to take in order to keep individuals safe from harm. Where staff needed training in first aid this has been arranged. The AQAA indicated that the equipment in home was regularly serviced. The in house checks on the fire system were sampled and found to be up to date. Fire drills were taking place regularly and records were being kept of these. An external company had recently carried out a health and safety audit of the home, their report did not detail any high risk areas. Where improvements were identified as needed there was evidence that these are being actioned. Staff test the water temperatures to make sure they are not too hot which could put people at risk of being scalded. Records showed that these were within the correct temperatures so that people were not at risk. During our visit we saw that the office door was propped open with a chair, this could pose a risk should a fire occur in the home. We brought this to the attention of the manager who immediately removed the chair. The manager told us that the person at the home likes the office door to be open and they prop it open, not the staff. After the manager removed the chair the person later came back to the office and propped the door open again. Consideration therefore needs to be given to fitting a device to the office door that will keep it open but releases the door should a fire occur. As stated earlier in this report the person at the home has had some recently falls. Where medical attention has been needed the home have appropriately notified us of this. A risk assessment has been completed and measures are in place to try and reduce the risk to the person. Referrals have also been made to other health professionals for advice on how the falls can be reduced. Care Homes for Adults (18-65 years) Page 33 of 37 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 34 of 37 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 20 13 Medication administration records must accurately reflect the prescription and Gps instructions and record the amount of medication administered. 16/10/2009 To help ensure people have the medication they need in a safe manner. 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 Update the service user guide with information about the range of fees at the home. This will help to ensure people have the information they need to make a decision about if they want to live there. Complete an audit of all staff files to make sure they contain all the required records to show that robust recruitment procedures have been followed. Where references are missing this should be obtained or a risk Page 35 of 37 2 34 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 assessment completed to make sure staff are safe to work at the home. 3 4 36 42 Improve the frequency of staff meetings and supervisions to help ensure that staff are well supported in their role. Consideration needs to be given to fitting a device to the office door that will keep it open but releases the door should a fire occur. This would help to stop the spread of smoke and fire in the home and help to keep people safe. Care Homes for Adults (18-65 years) Page 36 of 37 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 © (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. 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