Care Home: The Old Vicarage

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What the care home does well +1The people in charge of The Old Vicarage are making it better for everybody.The people in charge of The Old Vicarage 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 at the home 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 treatthem with respect.The manager at the home does a good job.The home has been made a nicer place to live in by improvements to rooms the areas that everybody uses. People living at the home have said what they want changed about the building. What has improved since the last inspection? The people who run the home have done everything they were asked to at the last inspection and the way they run it has been improved. The home is better place to live and this includes the improvements to the building.Staff have had more training which hashelped them do their jobs better and some have achieved an approved qualification. What the care home could do better: No statutory requirements have been made as a result of this inspection. Everything is going well at the home and the people who run it don`t have to do too much more to improve things. Key inspection report Care homes for adults (18-65 years) Name: Address: The Old Vicarage Market Place Riddings Alfreton Derbyshire DE55 4BQ two star good service The quality rating for this care home is: 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: Brian Marks Date: 0 9 0 6 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 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 Information about the care home Name of care home: Address: The Old Vicarage Market Place Riddings Alfreton Derbyshire DE55 4BQ (01773)607479 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Raymond Miles,Mrs Pauline Ann Miles care home 10 Number of places (if applicable): Under 65 Over 65 10 0 learning disability Additional conditions: Date of last inspection A bit about the care home The Home can look after 10 people. RIDDINGS The Old Vicarage is in Riddings village centre. X2 The Home has bathroom and toilet facilities on both floors and is run on domestic lines. People are encouraged to use community facilities, including day centres. People pay to live at the home. 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 How we did our inspection: This is what the inspector did when they were at the care home X We came to the home without telling the manager before we came and spent part of a 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. X1 We spoke to the staff who was working during the time we were at the home. X5 We spoke to five people who live at the home about their rooms and how much they enjoy living there. We walked around the home and saw how it had been improved. This is the first inspection of this home since 26 June 2007 - two years ago. What the care home does well 1 The people in charge of The Old Vicarage are making it better for everybody. The people in charge of The Old Vicarage 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 at the home 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. The manager at the home does a good job. The home has been made a nicer place to live in by improvements to rooms the areas that everybody uses. People living at the home have said what they want changed about the building. What has got better from the last inspection The people who run the home have done everything they were asked to at the last inspection and the way they run it has been improved. The home is better place to live and this includes the improvements to the building. Staff have had more training which has helped them do their jobs better and some have achieved an approved qualification. 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 Brian Marks CPC1 Capital Park Fulbourn Cambridge Cambridgeshire CB21 5XE 01223771300 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 http:/www.cqc.org.uk/. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. 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 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. Although no new people have come to live at the home recently, in the past the support and care needs of individuals have been properly identified before they moved in. They were sure that the home was right for them and that their wishes and needs were properly planned for. Evidence: In the AQAA we were told how the home has not admitted any new people for some time but that when they have in the past they have worked hard to make the transition right, using visits, involving significant others, establishing compatibility and working with other key professionals. We were also told that the homes Statement of Purpose has been amended to indicate the sort of people they are right for the home and the inappropriateness of emergency admissions. From looking at records and talking to the manager we established that there have been no new people at the home for over six years and because of this the manager has not yet devised any paperwork that would be used for initial assessment purposes and completing the admission process, but is aware of the need to do so. In the two care files seen during the inspection, the care documents indicated that an annual reviewing process had been carried out and the needs and progress of the people involved had gone through a reassessment, completed with the assigned care manager from the Councils Adult Services Department. These reviews are taking place annually which indicates that the homes staff may not be working with up to date information. When we spoke to the parents of one of the people living at the home, who were visiting, they described how their daughter had visited her friends already living there and decided Evidence: that she wanted to move in when a vacancy became available. They described the preparations that had been made at the time for her to leave the family home and how everything had gone well and she had become settled there: She chose to come here rather than us and has enjoyed every minute of her time here. All of the people living at the home have a longstanding acquaintance through attendance at the Councils day services and have maintained this through living at the home. 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. Residents care needs have been assessed, risk factors identified and care planned in ways that reflect their individual preferences and abilities. Evidence: In the AQAA we were told how the homes staff are very committed to treating everybody living there as an individual and how, through their long experience of working at the home, they are committed to them leading full, eventful and ambitious lives. We were also told that each person living at the home has an individual care plan, which are currently being replaced by a more user friendly Person Centred Plan which will be much easier for everybody to understand. These have involved active participation from everybody involved. We were also told that people living at the home are consulted on aspects of life at The Old Vicarage and this occurs through both formal and informal meetings. The two care records we looked at in detail had comprehensive personal care plans, which were prepared from the annual review meeting held with the assigned care manager from the Councils Adult Services Department. These included actions for staff to take in all key areas such as accommodation, personal support, culture and faith, social and recreational, mobility, communication, community skills and general and specific healthcare needs. The person living in the home signs them to indicate their involvement in their care and they accurately described the care provided by staff and the care needs of the person. Additionally there are a number of records such as weight charts, daily routines and logs, and of the involvement of outside professionals and attendance at any healthcare services and clinics. There were also a range of risk assessments in place to support safe working along with agreements and consent forms Evidence: signed by the individual concerned. Beyond the annual review process there were no records that indicated any evaluations of staff support taking place more regularly. For some of the people living at the home the manager has started to prepare new care records that are very different from the earlier versions. They are written in the first person and in a style more likely to include the involvement of the person concerned. These are called the Personal Planning Book and reflect a more modern approach to the way that the home supports people and how it is moving towards a more person centred style. We spoke to five of the people living at the home and received nine written replies to our surveys; everybody said that they were very happy at the home and they were all good friends, like a great big happy family. They told us that they please themselves how they live at the home and that staff help them do things we want to. When we spoke to the manager and members of staff they told us that they were committed to help them lead the lives that they want; they were all observed interacting together in a relaxed and friendly manner. There is a varied degree of independence amongst the current group of people living at the home but nobody usually requires anything more than supervision with personal care. They are also encouraged to help with domestic activities around the home and one told us that he enjoys helping in the garden and we grow loads of tomatoes in the greenhouse. 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 living at the home have continued to enjoy social and leisure activities of their choice, so that independence and decision making are encouraged and they enjoy as many opportunities as possible. Evidence: In the AQAA we were told about a range of activities enjoyed by people living at the home, and how staff encourage them to live the life they want and to achieve their ambitions and aspirations. We were also told about the meal arrangements at the home, and how visitors are made welcome and how they are encouraged to take part within the home. Staff are clear that they treat people with dignity and respect at all times and also to respect their rights to participate in the wider community. Discussion with staff and observations made during the visit confirmed that the daily routines of the home continue to be flexible, and residents were seen in the communal rooms and in their bedrooms. Nine people spend most their week at structured day services, operated by the Councils Adult Social Services and one of these works at the Parkwood Car Wash which is a work programme now well established in the local community. It is through this network that they had become acquainted and all are good friends because of this long term contact. The particular activities that people enjoy are described in their care plans and outside professionals have, in some cases, been involved in making arrangements. Informal leisure activities are well supported and people have continued to enjoy activities within the wider community with staff support, including church attendance. The manager reported that a number of formal social clubs that previously operated successfully throughout Amber Valley are no longer in existence Evidence: due to funding problems. They told us that visits to local shops, pub, and restaurants are regular and we were told about arrangements for holidays this year, which include a group going to Spain the day after the inspection and another group going to Skegness when they return. All but one person has retained contact with their families and one told us how she sees her parents weekly. The latter visited later in the inspection and told us how the staff are very nice and we know them all and that there is a warmth that wraps around the place. Another told us that she can visit casually, just pop in, as I live locally. I always get a good welcome and they always let me know if anything is happening. The catering arrangements at the home are very domestic and flexible in style and we were told how the weekly menu is chosen from a previously selected list by each person in turn. The main meal of the day is in the evening and those going to day services take a packed lunch with them. The feedback received was positive about the meals provided and we were told that the food is good and I like it al and we get spicy food, pizza and proper Sunday lunch. The staff on duty told us that the menu is sometimes changed on the day if the group say they want something else, and we were also told that individuals can change their choice as well. She also told us that home cooking and healthy eating are the principle they try to work to; fresh fruit and vegetables were seen in the kitchen. She also told us about arrangements for people who need softened diets and how these were properly done. The owner does a weekly shop at a wholesaler as well as at a local supermarket, and people living at the home sometimes help out with this. Overall food stocks seen in the kitchen and storage areas were satisfactory. In the AQAA we were told how the regular meetings with the people living at the home influence decisions around menu planning and mealtime, and also how they choose the arrangements for special occasions such as birthdays. 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. The personal and health needs of people at the home are dealt with in a satisfactory way, so that they have access to local services like everybody else. Evidence: In the AQAA we were told about the range of activities that support the good health of the people living at the home and how people are encouraged to have their say about the way they want things done. We were told about the variety of specialist and generic healthcare professionals that they work with, and about how people are supported in any visits to clinics and hospitals. We were also told how the home manages medication on behalf of some of the people living there and how staff are trained to make sure this is done properly. Care plans indicated that most of the people living at the home require nothing more than supervision and low level support or prompting with personal care; the ones we spoke to described the daily help they receive and how it was done carefully and properly. Care plans confirmed regular involvement of local Learning Disability Services professionals, including community nurse, psychiatrist, psychologist, speech and language therapist and physiotherapist. They have advised on specific interventions for staff to follow and this has included the management of difficult behaviors which the manager said a small number of people living at the home occasionally demonstrate. The care plans described specific techniques for staff to follow to ensure everybodys safety and the manager has revised the policy guidance in the homes manuals to underline the general principles allowed within the home. People also have routine access to general healthcare services such as GP as well as specialist clinics for neurology, X ray and sight impairment. The manager confirmed they were generally all in good health, apart from one who has a number of long-term issues that are well managed by local doctors and which do not affect his lifestyle too adversely. Written risk assessments on care files cover areas such as fire safety, independent travel, holidays abroad and the risk of falls. Evidence: Some of these were more than two years old and had not been subject to review or updating. There were regular monitoring checks taking place on weight and personal care activities. We saw from written records that everybody receiving prescribed medication requires staff help with its management although only four people were in receipt of any at the time of the inspection. Examination of the records for the receipt, storage and administration of medicines indicated that these are generally satisfactory although discontinued medication prescriptions had not been removed from the printed Medication Administration Record as had been recommended at the last inspection. The manager had spoken with the dispensing pharmacist to get these items removed, and agreed to do so again. The latter had recently visited the home to carry out a regular audit and the report was satisfactory. Medication is stored securely and the home uses a Monitored Dosage System for the dispensing of most of the medicines in use; entries in the written records had been made properly. Staff training in the good management of medicines has occurred regularly, and a new course been arranged with the pharmacist in July 2009. 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 living at the home are protected by having their rights to complain upheld and by staff who understand their responsibility to report concerns and to safeguard vulnerable people from harm. Evidence: In the AQAA we were told that staff at the home have pride in the homes open atmosphere, which gives confidence to the people living there to speak out for themselves without fear of discrimination. We were told that the same applies to relationships with families involved with the home, and that they are reassured that any concerns will be be swiftly and competently dealt with. The home has a comprehensive complaints policy and procedure that is on display in the foyer, although the residents meetings are the most appropriate method for people who live at the home to raise their concerns, worries and opinions about the service they receive. The manager reported that there had been no formal complaints made by anyone since the last inspection but the size of the home is small and the manager or owner are in the home most days so that concerns and problems are usually dealt with immediately and informally as they arise. The home has a copy of the statutory safeguarding procedures and other national guidance, and records indicated that all staff have attended training provided by the Council; this helps them understand their responsibilities to safeguard the people they support. There have been no incidents at the home which have resulted in an investigation under these procedures. People living at the home previously enjoyed the support of a befriender who acted as an advocate in individual circumstances, but contact with this person has lapsed. The manager has improved the arrangements for the management of peoples finances, and one showed us his record book and storage box which he keeps locked away until needed. 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 living at the home have continued to benefit from a homely domestic style environment that is equipped to meet their needs and offers high levels of facility and comfort. Evidence: In the AQAA we were how the homes owners have aimed to provide a homely environment and to keep the premises in a good state of repair focusing on the health, safety and welfare of the people living there. We were also told about the extensive improvements that have been made to the home during the past twelve months. We made a brief tour of the building and found it clean, tidy and offering domestic style accommodation which people occupy in eight single rooms and one shared room, with all the required facilities. The manager pointed out the improvements that had been recently made: New flooring and sofas in the quiet lounge, New carpet, sofas and large television in the main lounge, New carpets and redecoration in the hallway, stairs and corridors, New walk in shower room downstairs, New furniture in the shared and some of the single bedrooms, Newly refurbished upstairs bathroom, Recently redecorated kitchen, Landscaping and furniture improvements in the garden, Partial repainting of outside paintwork. The recent visits by the Fire and Environmental Health Officers were satisfactory. All the bedrooms are very much to each occupants individual style and furnishing, and all have televisions and other electric equipment. They are personalised with pictures, Evidence: personal mementoes and photographs. The manager described a continuous programme of redecoration, and also improvements in the greenhouse to allow people to take part in growing plants and vegetables. Staff are mainly responsible for cleaning and domestic arrangements around the building, but are helped by people tidying their own rooms. The laundry is domestic in style and capacity and clothes are laundered daily or as needed. Standards of cleanliness and hygiene were high and everybodys clothes were clean and appropriate. As mentioned in previous reports the home would not be suitable for people with substantial physical disabilities. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has established 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: In the AQAA we were told how the home provides a very stable experienced staff group, who look after the residents with compassion and understanding. We were also told that the staff team is very flexible and work their hours to fit in with the needs of residents. We were also told about staff training, induction and deployment and how the manager had recruited the first new staff for some years during 2008. The home employs eight part time support workers, one of whom is employed in a senior capacity and who shares supervisory duties with the manager. The staffing level during the day is for two staff to be on duty, with three usually in the evenings to support leisure activities. At night there is one person on sleep-in duties throughout the week. We looked at the recruitment file of the last worker to be employed during 2008, and this indicated that the manager had developed a systematic approach and that all the proper references and checks were obtained. We looked at the training records for staff and some of the certificates that had been received by the manager and these indicated that good standards of training had been maintained. The new staff member was assisted to work her way through a nationally approved induction programme as she started work at the home, and was working through a National Vocational Qualification (NVQ) level 2 at the time of the inspection; the majority of the other staff have achieved at least this level, which is in excess of the standard and is to be commended. Records did not indicate that the staff had received any awareness training about the needs of people with a learning disability that could help further develop skills, and the manager told us that she had only recently become aware of the need to create a staff training programme that has been structured under Evidence: nationally approved protocols. Broad achievements in staff training has been good with a refresher programme in the key subjects carried out in 2008 through a training agency. Instruction for staff in managing infections was a shortfall but this will be addressed later in 2009. Other subjects planned for 2009 include safe eating, downs syndrome and aging, and the manager will be completing a course with the Council about key new legislation, the Mental Capacity and Deprivation of Liberty Acts, which she will pass onto the staff group. The manager and staff on duty described how the staff team is very stable and how everybody supports one another to work for the people living at the home; staff morale was said to be high. They told us how they had built up a lot of knowledge about the people at the home and described how they had come to understand and interpret those who had difficult communication skills. The staff member on duty told us how working at the home is like being in one big family and that is the approach we adopt with the people living here. She also said that if I have any problems there is always someone to go to to help out. During our discussions with the people living at the home they told us that the staff are like our friends. J is my special staff and I would go to her if I had a problem. She would sort things out. Whilst the staff work quite independently for a lot of the time, we were told that they have access to good support from the manager. We looked at the records for formal meetings with staff (supervision) and these indicated that they had had three or four such meetings in the past 12 months, which is in line with their part time status. 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: In the AQAA we were told how the homes owners regularly visit the home to make sure that everybody is happy and that there are no concerns or issues. It is a stated aim of the home to promote dignity, self worth and independence. During the inspection, the manager confirmed that she had completed the Registered Managers Award qualification at NVQ level 4 and that she has continued to take up training opportunities with the other staff as they have been arranged. As reported above she is supported by a staff team that enjoys considerable stability, and the resulting consistency has allowed for the family homely environment to be established. There was a relaxed atmosphere at the home and the people spoken to were equally positive about the manager as they were about the other staff. The manager described methods by which people involved with the home give feedback, and we saw a number of stakeholder surveys completed by relatives and others which were all very positive about standards. One said that we are very satisfied and the home cares for all their needs. Feedback from people living at the home is mostly informal, but an irregular meeting has been used for them to speak out as group, and generally they are very vocal about levels pf satisfaction with their lives and lifestyles. One of the people living at the home confirmed this and the member of staff we spoke to also told us that they meet as a group irregularly. The manager has developed methods for forward planning about how the home is going to develop and uses the AQAA documentation as the basis for this activity. This allows her to highlight the key areas that need to be addressed in order to maintain a good standard of service. Evidence: The manager told us about standards of health and safety activity and regular servicing of equipment at the home in the AQAA, and observations made around the building and a sample of safety and servicing records indicated that the home was hazard free at the time of the inspection. We did note however that the regular check on portable electrical appliances was overdue. 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 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 2 Assessments of the needs of people living at the home should be reviewed every six months so that staff can be sure they are working with up to date information. The care plans of people living at the home should be reviewed every six months so that staff can be sure they are working with up to date information. The manager of the home should continue to adopt the Personal planning Book for everybody living at the home so that a more person centred style of care can be developed. Records relating to discontinued medications should be removed from Medication Administration Records to ensure records are clear and ensure the safety of service users. The people at the home should have access to local advocacy services so that somebody independent of the home is able to help them speak out more freely. Staff working at the home should receive training that is in 2 6 3 6 4 20 5 22 6 35 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 line with nationally approved protocols, so that they are exposed to modern thinking about the best ways to help the people they support. 7 42 The electrical appliances in use around the home should be subject to regular inspection so that is not people living there are not exposed to unsafe equipment. 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