Care Home: The Old Vicarage (Notts)

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What the care home does well There are good pre-admission procedures to allow plenty of time for people to get used to the move and make a decision about whether they will be happy there.The staff are good at giving people choices about what they do and there are lots of fun activities every day.Staff are good at understanding how people need to communicate to get their views across. They also know what care people need.Staff get on well with people who live in the home, this makes them feel safe. Two people told our expert by experience that `they felt safe in the home`. What has improved since the last inspection? New paperwork means that staff can record more about how they are helping people move into the home.Staff are doing quality surveys so that people have more of a say in how the service is run.Staff are getting more training so they can do their jobs better and support people more.New risk assessment forms have been introduced to reduce the potential for things going wrong. Behaviour rating scores have been put on graphs so that staff can predict times when people might need more support with their feelings and to feel safe. What the care home could do better: The manager could introduce better checks on peoples` money to reduce the potential for financial discrepancies.The manager needs to ensure she checks records of medication each month to make sure staff are recording what they are giving correctly.The process for recruiting staff needs to make sure all safeguards are in place so people are better protected from unsuitable workers. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Old Vicarage (Notts) The Old Vicarage Bullock Lane Ironville Nottinghamshire NG16 5NP The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Helen Macukiewicz Date: 1 1 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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 Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 37 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 Vicarage (Notts) The Old Vicarage Bullock Lane Ironville Nottinghamshire NG16 5NP 01773541254 01159631844 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) : Creative Care (East Midlands) Ltd care home 4 Number of places (if applicable): Under 65 Over 65 4 0 learning disability Additional conditions: The registered provider may provide the following categories of service only: Care Home Only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home fall within the following categories: Learning Disability - Code LD (16-25 years) Only service users between the ages of 16-25 to reside at the home. The maximum number of service users who can be accommodated is: 4 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 37 A bit about the care home The home is a big house for 4 people to share. There is enough space to be alone if people want to be. There is a big, safe garden outside. There is a bus stop near the home. This means that the people who live at the home can get around easily. The home also has a car, and the staff support people that live there to go out in the car. Everybody who lives at the home has their own bedroom and bathroom. Nobody has to share. Care Homes for Adults (18-65 years) Page 5 of 37 The current weekly fees range from £ 2231.21 to £ 4121.18 per week. The weekly fees include all activities. Copies of the previous Inspection report are kept in the manager’s office. Care Homes for Adults (18-65 years) Page 6 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 7 of 37 How we did our inspection: This is what the inspector did when they were at the care home We visited the home on 11 May 2009 at 9am. We looked at how well people were being looked after. We did this by talking to people who live there, staff and the manager. And by watching what people were doing. We asked for the views of parents and social workers in questionnaires. We looked at some of the policies and procedures in the office. Policies are rules about how to do things. Procedures tell people how to follow the rules. Care Homes for Adults (18-65 years) Page 8 of 37 We took an expert by experience with us. An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. They stayed for 2 hours and spoke as much as possible with all the people living in the home and the staff. His findings are written in the report. What the care home does well There are good pre-admission procedures to allow plenty of time for people to get used to the move and make a decision about whether they will be happy there. Care Homes for Adults (18-65 years) Page 9 of 37 The staff are good at giving people choices about what they do and there are lots of fun activities every day. Staff are good at understanding how people need to communicate to get their views across. They also know what care people need. Staff get on well with people who live in the home, this makes them feel safe. Two people told our expert by experience that they felt safe in the home. Care Homes for Adults (18-65 years) Page 10 of 37 What has got better from the last inspection New paperwork means that staff can record more about how they are helping people move into the home. Staff are doing quality surveys so that people have more of a say in how the service is run. Staff are getting more training so they can do their jobs better and support people more. Care Homes for Adults (18-65 years) Page 11 of 37 New risk assessment forms have been introduced to reduce the potential for things going wrong. Behaviour rating scores have been put on graphs so that staff can predict times when people might need more support with their feelings and to feel safe. What the care home could do better The manager could introduce better checks on peoples money to reduce the potential for financial discrepancies. Care Homes for Adults (18-65 years) Page 12 of 37 The manager needs to ensure she checks records of medication each month to make sure staff are recording what they are giving correctly. The process for recruiting staff needs to make sure all safeguards are in place so people are better protected from unsuitable workers. 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 Helen Macukiewicz 33 Greycoat Street London SW1P 2QF 02079792000 Care Homes for Adults (18-65 years) Page 13 of 37 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 14 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 15 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 . People have the information they need to choose a home that is suited to their needs. Pre-admission procedures ensure that people are not admitted inappropriately. Evidence: People can get information about the home by reading two documents known as the Statement of Purpose and Service Users Guide. Both of these provided people with the information they needed to make a decision about whether to move in. One was written in symbol form to assist people who use that method of communication. The manager told us they were also considering putting the information on to a DVD as not everyone who uses their service can understand symbols. In her completed pre-inspection self-assessment the manager told us before admission any prospective service user is subject to a Pre Admission Assessment which covers family involvement, mental health assessment, maintaining a safe environment, social and spiritual care, communication, eating and drinking, mobility and medical history. This is then considered and the placement deemed suitable or otherwise. This depends on us being able to cater for the individuals appropriately and also how the individuals needs may impact the other service users living in the home. Care Homes for Adults (18-65 years) Page 16 of 37 Evidence: When admission is agreed by all parties a transition period is agreed, this varies according to the individual and their needs. During this time the service user and family/carers (if appropriate) spend time at the home, including overnight and tea visits and also, if possible a full day. During this time the other service users are involved so they can also get to know the individual before moving in. We saw evidence in pre-admission documentation that this process was followed through in practice. In their completed pre-inspection surveys one person living in the home told us they could remember visiting the home to see if they like it. A pre assessment tool had been implemented since we last visited, although the process was the same as before, it was now documented. We saw this had been used for recent admissions and that it gave staff a good idea about the needs of the person being admitted and whether the home could meet their needs. Although the manager told us she considered any risks to existing service users before a new person was admitted, this was not written down to support the decision making process. Care Homes for Adults (18-65 years) Page 17 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 . People receive individualised packages of care and are allowed to take risks in order to achieve a fulfilling lifestyle of their choosing. Evidence: We saw that all people had a plan of care to meet their needs. Due to peoples communication difficulties staff encouraged an all about me document, which was included in the care plans. This was in simple format to enable people living in the home to contribute to their care package. We saw that peoples preferred form of communication was used in care planning so they could get more involved in planning their care. Wherever possible, people living in the home had signed that they had contributed to the records. Peoples care had been reviewed and updated at regular intervals. One visiting therapist wrote in their pre-inspection survey each service user is very much treated as an individual and all aspects of their care is tailored to them. In their completed pre-inspection surveys, people who live at the home told us they Care Homes for Adults (18-65 years) Page 18 of 37 Evidence: could make decisions about what they did each day. In her completed pre-inspection self-assessment the manager wrote all of the service users are given choices daily about activities they wish to take part in and choices of meals, decor of the home etc. The service users with little or no verbal communication are provided with symbols and social stories to enable them to communicate their wants and needs to staff. Two people living in the home told our expert by experience they could choose when to get up and when to go to bed. We saw that staff asked people what they wanted to do throughout the day of our visit. The manager told us that she was considering starting residents meetings as the group of people currently living in the home were more able to participate in this type of forum, than in previous months. Although two people living in the home told our expert by experience that they already attend house meetings to put their ideas and grumbles across. The staff were supporting people to learn the value of money and how to handle their own finances safely. Staff checked peoples money to ensure they had the correct amount each week. We saw that one debit was not accompanied by a receipt, which meant that a small amount of their money was unaccounted for. Two people living in the home told our expert by experience that they could choose what to spend their money on and they needed help with their money. New risk assessment forms were being used, and we saw that people had these in their files. Three staff assess risks, so all peoples perspectives on risk are captured and scores reflect what everyone thinks. The manager told us they had a missing person protocol, and that she had spoken to the police to arrange some specific arrangements to keep one person who lived at the home, safe. Two people told our expert by experience that they felt safe in the home. Care Homes for Adults (18-65 years) Page 19 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People are able to lead an active lifestyle of their choosing and are supported to reach their potential. Evidence: People were supported to participate in learning life skills such as shopping, cooking and cleaning. One person told our expert by experience that they helped with chores in the home, another said they helped with washing up and hoovering. In their completed pre-inspection surveys, people who live at the home told us they go home at the weekend and one said this is what they like to do. We saw from care files that most people regularly went home for one or two days each weekend. Staff surveys told us that they offer people lots of activities. One wrote the service offers so many activities...we always have petty cash available for expenses. If staff see something that we think service users would enjoy or we need to buy something Care Homes for Adults (18-65 years) Page 20 of 37 Evidence: for the home, funding is always available. A visiting therapist wrote variety of activities as a whole group and for individuals to meet their independent needs. In her completed pre-inspection self-assessment the manager wrote before booking any activity the service users are consulted and once the activity is organised the service users are not obliged to take part if they do not wish to. Our daily activities are tailored to suit the service users individual interests and abilities. Instead of doing group activities daily, we cater for the service users own choices and our staffing levels mean that we can provide individual activity plans. She also told us as a company we do our best to maintain community links and social inclusion. We believe that our service users should have the same opportunities in the community as anyone else and our staffing levels enable the service users to access the community with adequate support. We access public sessions such as swimming and aqua aerobics and access our own community using the local GP surgery, dentist etc instead of getting home visits or specialist services. Due to the individuals we cater for having complex behavioural issues, school placements have broken down before the individual comes into the service. We have maintained contact with one of the schools who provide a home education package for the staff to implement with guidance from the school. This enables the individual to continue with the education they are entitled to but would otherwise have missed. We saw that people were supported to occupy their time, both through leisure activity and education. One persons educational packages were seen. Sentence strips had been used to assist them to learn. The Educational establishment that they were accessing had interpreted books into symbol format to make them easier to read with staff support. Peoples all about me files showed pictures of them doing various activities they enjoyed and care files showed daily records written by caseworkers of what activity they had participated in that day, including trampolining, walk around a reservoir, painting and drawing. All people attended a disco on a Wednesday run by another care home to allow them to engage with their peers in the community. The manager said that there had been a gardening group started on Thursdays as some of the people like manual work. Some people who lived in other homes attended and the manager said it was a good social event. One person showed us the garden area and said they enjoyed gardening. People told our expert by experience that they did go out to social clubs and one said they went to the pub and disco. Although none of the people were practicing their religion, two told the expert that they could go to their place of worship if they wanted. People went for a walk around a reservoir and swimming on the day of the visit and they said they liked going. Two people went food shopping in the afternoon. One of those people said they liked going shopping and told me what they were going to buy. One person said they had a Wii and liked playing the sport games. Another person was relaxing with staff, watching a DVD during the afternoon. The manager said that Care Homes for Adults (18-65 years) Page 21 of 37 Evidence: everyone was going to Wales for a holiday in September, they had been asked where they wanted to go and had said the seaside. Peoples favourite foods were listed in their all about me book and all about me section of their care file. The weekly diet record showed a varied diet with hot meals, which included some of the things that they said they liked in their care plans. The manager said she has menu plans but as people help to make it themselves, they do vary from day to day. She also said that a two sitting service was now in operation as she noticed the people needed more space and had different dietary needs. Care Homes for Adults (18-65 years) Page 22 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 . People have their health needs met although gaps in recording medication given has the potential to adversely affect wellbeing. Evidence: In her completed pre-inspection self-assessment the manager told us all of the service users are registered with the local GP and are encouraged to access the surgery rather than get home visits. The service users (if able) can remain with their current health care providers if they wish i.e. specialist dentists etc. All specialist appointments are documented and the service user supported to attend by staff, who provide information needed. Care files showed that peoples health needs were being met and that people were attending hospital check ups. Daily caseworker notes recorded what personal care people had completed such as cleaning teeth, washing hair as well as what their health was like more generally. Peoples weight was also being monitored regularly. One person told our expert by experience that they do exercise to stay healthy. We found that the storage of medicines was within guidelines, and that all medicines had been given as needed. However, not all administration was properly documented. Care Homes for Adults (18-65 years) Page 23 of 37 Evidence: Where a prescription for cream was still live but the cream was not required, the medication chart had not been updated to state that this prescription was still current, but that none had been delivered. Staff were also using one medication chart to document administration of medicines over more than one month. We found that the manager was not auditing records to pick up on recording errors. The owner of the home told us that he did have an audit tool available and that he would ensure it was given to the manager for her to start checks immediately. The manager told us that BOOTS have done training for staff in the past and that in-house training covered medication, but that she was planning for BOOTS to come in again as it was more comprehensive. Care Homes for Adults (18-65 years) Page 24 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 . People are kept safe in the home and have their rights upheld. Evidence: In their completed pre-inspection surveys people who live at the home told us there were people around them that they could talk to if they had a complaint. One said they would tell somebody, another said they would moan to the manager. In her completed pre-inspection self-assessment the manager told us I and the staff also have very regular contact with the service users families who offer another voice for the service users. We have in the past used an Advocacy Service although the service didnt feel this was needed at the time. The service is kept on file should we feel it necessary to use in the future. We saw evidence in one persons file that they had been visited by the National Youth Advocacy Service. All people went home for one or two days a week. None of the people living in the home had a mobile phone due to their limited ability, but had access to a mobile handset at the home for private calls. Two people told our expert by experience that they could make and receive personal telephone calls. There had been one safeguarding referral and one complaint made about the home since we last Inspected. The manager worked co-operatively with social services and us throughout, making appropriate referrals to keep people living in the home safe. These issues were satisfactorily resolved, but complaints records did not always fully Care Homes for Adults (18-65 years) Page 25 of 37 Evidence: describe the action staff took. There was use of a behaviour management programme, mostly a star chart system and reward system, but these were not mandatory for all. All staff had received training in behaviour management so that they could keep people safe within legal guidelines. Sanctions and incident books detailed incidents of restraints, the manager had signed them off and incidents of restraint were logged to legal requirements. One person told our expert by experience that staff did tell them their rights. One person was going to have a mental capacity assessment to see how much they could participate in making decisions for themselves and to uphold their rights. The manager told us that some staff had undertaken training in this area. All staff had received safeguarding training. Care Homes for Adults (18-65 years) Page 26 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 well-maintained environment that is suited to their needs and fulfilling the aims and purpose of the home. Evidence: In her completed pre-inspection self-assessment the manager wrote the service users have control over the decor and content of their own bedrooms, any communal area in the home is decorated and furnished with the service users involvement, where appropriate. The service users bedrooms within the home are treated as their space. Where appropriate the service users are given a key to their bedrooms and permission sought before any staff have access. One person told our expert by experience that they could use all of the home. Two people said they did not have a front door key, but a member of staff said that this was necessary to keep people safe. Only one person had a key to their bedroom, but all bedrooms could be locked from the inside for privacy. The home was well maintained and a handyman was present for part of the inspection to make improvements to one persons bedroom. One person showed us around the gardens, these were well maintained. The person showed us the things they were growing and the swings they had helped to make. Care Homes for Adults (18-65 years) Page 27 of 37 Evidence: A brief walk around the home showed that all rooms were personalised with a good standard of decor, cleanliness and maintenance, pictures made by people using the service were on display. People had access to a laundry room where they were assisted to wash their clothes. Care Homes for Adults (18-65 years) Page 28 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 . People are cared for by sufficient numbers of competent staff. Gaps in recruitment checks may leave people exposed to unsuitable workers. Evidence: We saw from staffing rotas that there were sufficient numbers of staff on each shift to enable people to have one to one support and to ensure no staff worked alone. People living in the home who completed pre-inspection surveys told us that staff treated them well. A visiting therapist in their survey wrote staff are excellent, approachable, caring and supportive. On the day of this visit, people told our expert by experience that male and female members of staff attend to them, that they knew all the staff and that the staff were friendly. Two people told us they got on well with staff and other people in the home. Staff who completed pre-inspection surveys for us said that they received an adequate induction and that training was relevant to their role. They also told us that they met regularly with the manager who gave them support. One wrote my manager is always available to discuss any issues even if she is not working. I have even contacted the company director on many occasions and he has helped. Staff we spoke to on the day confirmed that they had attended training in areas such as restraint and safeguarding adults. Staff files contained certificates for training Care Homes for Adults (18-65 years) Page 29 of 37 Evidence: course such as infection control and National Vocational Qualifications. Induction records were kept and showed that people received a probationary review and supervision, which supported that people were trained and supported to do their job. Most staff had either completed or were undertaking National Vocational Qualifications to level 3. The owner proprietor said he was planning autism and behaviour training for staff, he had put a pack together with the aim to help staff observe and record behaviours better. Staff recruitment files showed that people were having police checks before they started work but there were some gaps in employment history and reasons why they had ceased previous employment working with children or vulnerable adults. Care Homes for Adults (18-65 years) Page 30 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 home is effectively managed in peoples best interests, to ensure the general safety and wellbeing of people. Evidence: The manager of the home had registered with the Commission for Social Care Inspection. She had an NVQ 4 in care and had completed the registered managers award. She had nine years experience of working with people with challenging behaviour and attended regular training updates and managers meetings. The manager had returned to us a completed a self-assessment of the service. This is known as an Annual Quality Assurance Assessment or AQAA. We have referred to this as a pre-inspection self-assessment throughout this report. This was completed well and gave us a good picture of what the service does well and what needs to improve. It showed us that staff know what needs to be done, and had plans in place to address these areas. It showed that staff have an awareness of equality and diversity issues that impact on the needs of people who live at the home. In her completed pre-inspection self-assessment the manager told us as at least two Care Homes for Adults (18-65 years) Page 31 of 37 Evidence: of the service users have improved significantly in their communication skills, I plan to implement weekly service user meetings to gain views and choices of the people living in the home. We saw that quality monitoring within the home took place. Daily behaviour ratings were undertaken on people and this information was fed into management for them to audit and analyse to look for behavioural patterns and trends. Using the principles of Nottinghamshire County Councils Care Quality Tree, the proprietor said he kept in regular touch with families and people who used the service for feedback. He had sourced some pro-formas to assist with this and was trialling them in another home. The provider was in day to day control of the service so felt he did not need to do monthly monitoring visits, the manager supported that this was the case. Records relating to servicing of equipment and fire safety checks, plus risk assessments of the home supported that a safe environment was being maintained. health and safety was covered within the staff induction programme. Care Homes for Adults (18-65 years) Page 32 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 33 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 7 16 30/06/2009 2)l)The manager must double check records of peoples financial transactions as part of her monthly audits, to ensure peoples money is all accounted for. This is to ensure people are fully protected from financial abuse. 2 20 13 2) The amount of tablets 30/06/2009 coming into the home must be recorded to ensure the exact amount of medicines stored in the home is known. A new medication chart must be started each month for when required medication to enable clearer record keeping. This is to ensure better safeguards for people living Care Homes for Adults (18-65 years) Page 34 of 37 in the home. 3 34 19 30/06/2009 and Schedule 2) A full employment history must be obtained and written reasons why the person left previous employment working with children or vulnerable adults must be sought. This is to ensure people are not exposed to unsuitable workers. 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 3 Staff should record in pre-admission documentation how they considered the risks to existing service users preadmission. The manager must double check records of peoples financial transactions as part of her monthly audits, to ensure peoples money is all accounted for. Old medication charts should be filed away so staff only have one point of reference for medicines. This will reduce the potential for medication errors. Hand written entires on the medication record should be signed and dated so a point of reference can be sought in case of future queries. Audits of medication should be commenced to ensure better safeguards for people. Topical creams that are not being used should be discarded and a new prescription obtained when needed, to avoid old stocks of medication being kept and to keep medication record charts up to date. 2 7 3 20 4 20 Staff should record how many they give each time of variable dose medicines. Care Homes for Adults (18-65 years) Page 35 of 37 5 22 Complaints records should detail the action taken by staff to resolve the issue. This would demonstrate the homes responsiveness to issues raised. Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 03000 616161 or Textphone : 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) Commission for Social Care Inspection (CSCI). 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