Care Home: The Padova

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What the care home does well The Padova provides accommodation of the highest standards. People have rooms which they have personalised to reflect their interests and lifestyles. People were observed being supported to make decisions about their day to day lives. They said they enjoy going to social clubs and were looking forward to a trip to the theatre. They lead full and inclusive lifestyles making good use of local facilities and nearby towns.Staff have access to a robust training programme which reflects people`s needs. Over half of the staff team have a National Vocational Qualification in Health and Social Care. People have accessible information around their home produced in formats using symbols and pictures. What has improved since the last inspection? Staff have had access to training specific to people`s needs including Epilepsy, Ageing and Nutrition.Recruitment and selection procedures are robust and staff are not employed until their Criminal Records Bureau check has been received. People and visitors are involved in the quality assurance process. What the care home could do better: No requirements were made as a result of this visit. Some recommendations have been made to make sure records and documents are consistent and robust. Key inspection report Care homes for adults (18-65 years) Name: Address: The Padova 88 Bristol Road Quedgeley Gloucester Glos GL2 4NA The quality rating for this care home is: Three star excellent 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: Lynne Bennett Date: 0 8 0 4 2 0 1 0 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 36 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: The Padova 88 Bristol Road Quedgeley Gloucester Glos GL2 4NA 01452883764 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Miss Deborah Bayliss Name of registered manager (if applicable) Miss Deborah Bayliss Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 7 2 care home 9 learning disability Additional conditions: Date of last inspection 1 4 0 5 2 0 0 7 Care Homes for Adults (18-65 years) Page 4 of 36 A bit about the care home The Padova is an extended detached house in Quedgeley near Gloucester that provides accommodation for up to nine adults with Learning Disabilities. The older part of the house has a ground and first floor. The new extension is single storey and meets current environmental standards with all rooms having en-suite facilities. The home is staffed twenty-four hours a day and the Registered Manager is in day-to-day charge of the home. Fee levels are available upon application to the home. Care Homes for Adults (18-65 years) Page 5 of 36 People have access to a copy of the Statement of Purpose. Additional fees to people include paying towards staffs expenses costs when supporting people on activities. Care Homes for Adults (18-65 years) Page 6 of 36 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: three star excellent 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 36 How we did our inspection: This is what the inspector did when they were at the care home This inspection took place in April 2010 by one inspector over one day. The registered manager completed an AQAA (Annual Quality Assurance Assessment) as part of the inspection, providing considerable information about the service and plans for further improvement. It also provided numerical information about the service (DataSet). The registered manager was present during our visit. Care Homes for Adults (18-65 years) Page 8 of 36 We received surveys from 10 people and 7 staff prior to the inspection. We talked to 3 people using the service, and asked staff about those peoples needs. We also looked at the care plans, medical records and daily notes for these people. This is called case tracking. We also had a tour of the home and some people took us into their rooms. We examined a range of documents including quality assurance records, staff files and health and safety systems. We observed people and staff during our visit and had lunch with people. Care Homes for Adults (18-65 years) Page 9 of 36 What the care home does well The Padova provides accommodation of the highest standards. People have rooms which they have personalised to reflect their interests and lifestyles. People were observed being supported to make decisions about their day to day lives. They said they enjoy going to social clubs and were looking forward to a trip to the theatre. They lead full and inclusive lifestyles making good use of local facilities and nearby towns. Care Homes for Adults (18-65 years) Page 10 of 36 Staff have access to a robust training programme which reflects peoples needs. Over half of the staff team have a National Vocational Qualification in Health and Social Care. People have accessible information around their home produced in formats using symbols and pictures. Care Homes for Adults (18-65 years) Page 11 of 36 What has got better from the last inspection Staff have had access to training specific to peoples needs including Epilepsy, Ageing and Nutrition. Recruitment and selection procedures are robust and staff are not employed until their Criminal Records Bureau check has been received. People and visitors are involved in the quality assurance process. Care Homes for Adults (18-65 years) Page 12 of 36 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 Care Homes for Adults (18-65 years) Page 13 of 36 If you want to speak to the inspector please contact Lynne Bennett CQC South West Citygate, Gallowgate Newcastle upon Tyne NE1 4PA 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 14 of 36 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 36 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. Satisfactory admission arrangements are in place that includes an assessment of peoples needs. Accessible information is available to people living in the home describing the service they will receive. Evidence: The Statement of Purpose and Service User Guide were reviewed this year and were displayed in the entrance hall. These had been produced in an accessible format using symbols. The Service User Guide contained a statement of terms and conditions which includes any additional costs to people living in the home. At present this does not make reference to the funding of staff expenses when supporting people on activities. The registered manager stated that people kept their full Disability Living Allowance entitlement and were not asked to contribute towards transport costs. There had been no new admissions to the home since the last inspection. The changing needs of people due to age were being monitored and staff were receiving training in how to support people with a learning disability as they age. Files examined contained information supplied with people at their admission which included a full assessment of need and an assessment and care plan from the placing authority. Care Homes for Adults (18-65 years) Page 16 of 36 Care Homes for Adults (18-65 years) Page 17 of 36 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. Care plans reflect peoples assessed needs and there is evidence that people are being supported to make choices about their lifestyles. Care plans could be more accessible to people providing them with a personalised summary of their needs. Risk assessments are in place safeguarding people from possible harm. Evidence: We case tracked 3 people living at the home examining all records and documents relating to them. The home uses the Standex system of care planning which provides a holistic assessment of each persons needs from which care plans and risk assessments had been developed. We noted some inconsistencies in these records where changes in need had been identified but care plans had not been updated to reflect this. This included references to the reason for use of a communication diary for one person which were no longer relevant and likewise references to the use of as necessary medication when other records indicated they were no longer used. The Standex system of care planning is not produced in an accessible format for people living in the home although some had signed records on their files. We discussed with the registered manager formats which would be accessible to people and promote a personalised approach to Care Homes for Adults (18-65 years) Page 18 of 36 Evidence: care. The home were implementing Health Action Plans which would promote person centred care. We observed people being supported in line with their care plans such as offering them choice of activity or supporting them when anxious. Staff spoken with had a good understanding of peoples needs and the support they needed. The registered manager said that everyone had an annual review which included attendance from their placing authority in 2009. Two people had copies of the assessment of need and care plans produced as a result from the placing authority. The third persons had not yet been received by the home. The AQAA stated, We have copies of social services assessments and care plans to ensure that we can meet the needs of the service user. We discussed with the registered manager some restrictions which were observed to be in place such as the use of lap belts on people using wheelchairs and the use of a standing frame. The reasons for these were to safeguard people from possible harm and to promote their wellbeing. They were being used after consultation with other health care professionals. This should be recorded in peoples files including the rationale for this, in line with recommendations of the Mental Capacity Act. People were being supported to make decisions and choices about their day to day lives. This was recorded in their care records and observed during our visit. For instance people were asked what they would like to wear, drink and eat and offered informed choice about a range of activities. Records indicated that people had the opportunity each month to attend a house meeting to discuss issues, activities, meal choices and whether they had any concerns. Minutes for one meeting had been produced in an accessible format using symbols. People had signed to indicate they agreed with the content of the minutes. Peoples communication needs were identified in their care plans and in their Health Action Plans. We discussed with the registered manager how staff interpreted peoples non verbal behaviour and the guidance provided in care plans. Observation of staff and discussion with them confirmed they had a good understanding of the way in which people communicated their needs. Staff were observed using gestures and objects of reference to communicate with people and said they also used photographs or pictures. Good use was made of photographs around the home. Communication diaries were in place providing a description of what people had done each day and illustrated with photographs of key events. Some documents had been produced using symbols and pictures making them more accessible to people. A section on the personal profile provided information about each persons physical description and photographs were in place. Risk assessments had been produced to minimise hazards allowing people to take risks as safely as possible. Staff had completed training in risk assessment. All records were being reviewed annually or sooner if changes in need had occurred. Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: Care Homes for Adults (18-65 years) Page 20 of 36 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 who use the service are able to take part in appropriate activities inside and outside of the home, have links with the local community and pursue a range of leisure interests in order to enhance their lifestyle. A healthy and nutritional diet is offered promoting peoples wellbeing. Evidence: Peoples surveys said they had opportunities to participate in indoor and outside activities, including the cinema, theatre, pantomime, pub and evening classes. Relatives confirmed that people were taken out frequently. One staff survey indicated that sometimes there were too many activities and that people liked to relax at home occasionally. Whilst another stated that people were part of their local community and were able to do interesting things like day activities and art and craft in the home. Daily records were kept evidencing what people had done each day and the choices they had made. Where people had refused opportunities to go out this had been noted. People were observed during our visit going out to a local shop for a coffee, going to the theatre, helping in the kitchen to prepare lunch, listening to music in their room or the lounge and Care Homes for Adults (18-65 years) Page 21 of 36 Evidence: doing arts and crafts. Some people were attending a local day centre. In addition to this people regularly went swimming, riding for disabled people, to a gardening club and to a farm. The registered manager stated that older people living in the home were supported to attend a senior citizen day centre offering exercise classes for older people as well as a social club. Improvements over the past twelve months included a themed entertainer coming to the home. People had access to a range of holidays and day trips. When at home people had the opportunity for intensive therapies including use of the jacuzzi bath, massage, manicures and pedicures. Daily records and care plans evidenced the support people needed to keep in touch with relatives and friends. Some were supported to visit, make telephone calls or were visited in their home. People had the opportunity to meet with friends at social clubs and were looking forward to attending one on the evening of our visit. House meetings were being held each month and records were kept of these. One meeting had been recorded using symbols and text. All people had been asked to sign as an indication that they agreed with the minutes, which they had either read or staff had dictated to them. Staff were observed offering people choices about how to spend their time and with whom. One person chose to listen to music in their room and another did some colouring. One person had a key to their room and other people had access to keys if they wished. People living at the home had several pets including a cat, fish and a rabbit. Menus had been produced in a format using pictures and reflected peoples choices, likes and dislikes. Where people were offered alternatives to the main meal or occasionally refused food this was noted in their daily records. Some people needed a soft diet and support from staff and this was observed being offered during lunch. Staff had completed training in nutrition and health and a healthy diet was promoted. Environmental Health had awarded the home 5 stars. Care Homes for Adults (18-65 years) Page 22 of 36 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal care support is offered in a way that responds to peoples needs and preferences, promoting peoples dignity. Updating some records used in the administration of medication will continue to safeguard people from the risk of error or possible harm. People have been supported to express their wishes in relation to ageing or death. Evidence: The way in which people would like to be supported with their personal and health care needs were clearly recorded in care plans. Their likes and dislikes were also noted. The needs of older people were promoted by access to appropriate activities and support around their home with respect to their gender, age, disability and religious beliefs. The AQAA stated, our staff deliver high quality personal care as per each individual care plan. Any changes noticed by staff whilst performing personal care duties are reported and acted upon. Surveys from staff said that there is a very high standard of care, we understand what the clients needs are, and all staff are working towards the wellbeing clients. Relatives of people living in the home said, staff provide ..... with adequate support to meet his personal needs. The AQAA also said that during induction new staff are taught ways in which they can promote and respect the privacy and dignity of people. Our observations during the visit confirmed this. Care Homes for Adults (18-65 years) Page 23 of 36 Evidence: Moving and handling plans and risk assessments were in place for people needing support with transfers and the use of hoists/slings and bath chairs. Staff had received training in moving and handling and equipment was being serviced. Records indicated that people had access to support from the local Community Learning Disability Team (CLDT) when needed. Robust records were being maintained of outcomes of appointments with a range of health care professionals. People were having appointments with their General Practitioner and referred for outpatient appointments when needed. Routine appointments with their Dentist, Optician and Chiropodist were being monitored with dates identified for future appointments. This is good practice. When people were admitted to hospital staff and people living in the home visited them. Information was provided to the hospital about peoples likes, dislikes and needs. This section of the Health Action Plan had been completed by the home. The full Health Action Plan was being put in place for all people and the registered manager had received training in how to implement this. Annual health checks were being arranged for people with their General Practitioner. We examined the homes systems for the administration of medication and found them to be mostly satisfactory. Staff had completed training in the safe administration of medication. The AQAA stated that the registered manager ensures that this is adhered to. Medication audits were in place. Medication administration records were satisfactory. We suggested that where as necessary medication is given in line with the protocol, staff record this and the reasons for administration on the back of the medication record. Protocols were in place for the use of as necessary medication although it appeared one had not been drawn up for the use of Diazepam oral solution. Confirmation of the use of homely remedies as agreed with the GP was in place, although this was dated 2003. We suggested this should be reviewed. The home had copies of the British National Formula although these were out of date. We discussed how people take medication away from the home when on social leave. The registered manager confirmed that they take the medication as dispensed by the pharmacy and that no secondary dispensing of medication takes place. We suggested that the temperature of the medication cabinet is monitored and recorded so that medication is stored at below 25 degrees centigrade. Most handwritten entries on the medication record had been countersigned and most liquids and creams had been labelled with the date of opening. The registered manager said that no one in the home had been assessed as able to self medicate but they would be supported to do this if applicable. End of life plans had been developed with people and were on their files indicating their preferences for support if they became unwell and funeral service. Next of kin had been involved in this process. Where people are admitted to hospital any changes in their condition are monitored closely and staff receive the appropriate training delegated from District Nurses to ensure that the home can continue to meet their needs. Care Homes for Adults (18-65 years) Page 24 of 36 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. Systems are in place that enable complaints and concerns to be raised by people using the service or on their behalf. Processes are in place which should safeguard people from possible harm or abuse. Evidence: The AQAA stated, The home has a clear and accessible complaints procedure, illustrating timescales and how complaints are dealt with. This was displayed in the entrance hall. We discussed with the registered manager copies of the complaints procedure in various forms on peoples files which were out of date. She said these would be removed and that people would have access to the new procedure. People had the opportunity to discuss concerns at house meetings. Of the 10 surveys returned to us, 1 person did not know how to make a complaint. The home keeps a complaints log which indicated that no complaints had been received by the home since our last inspection. The AQAA confirmed that staff had access to training in the protection of adults providing them with knowledge about the local procedures. Copies of the alerters guide, including a pictorial version were available in the home. The AQAA stated, staff ensure that service users of aware of this and it is displayed. Staff spoken with were confident that the registered manager would not tolerate poor practice and would deal with any concerns appropriately. The home has a copy of No Secrets. Some peoples files contained historical guidelines about the way in which they were to be supported when angry or upset. Staff confirmed that they effectively supported people Care Homes for Adults (18-65 years) Page 25 of 36 Evidence: by using diversion techniques and were able to distract people and enable them to remain calm. This was observed during our visits. Care plans reflected how staff should support people. Staff confirmed that physical intervention is not used. People needed support to manage their finances and this was clearly indicated in their care plans and risk assessments. Records were kept of income and expenditure. Receipts could be cross referenced with expenditures. These were checked by the registered manager and a senior team member. We discussed how these audits could be made more robust by the registered manager of the sister home Pembury checking financial records at least annually. Inventories were in place for all people and they were being updated. Care Homes for Adults (18-65 years) Page 26 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is safe, clean and well maintained which recognises their diverse needs creating an environment that matches their personal requirements. Specialist equipment is provided to those people who need it. Evidence: The Padova provides accommodation of the highest standards. People have spacious rooms some with en suite facilities. Some people showed us their rooms which were decorated to reflect their lifestyle choices and hobbies. One had a sensory environment making good use of lighting and mobiles and another had specialist adaptations which were discreetly stored. Communal areas were pleasantly decorated, spacious, clean, well lit and accessible to people using wheelchairs. Where people needed specialist equipment this was provided including chairs and tables. The grounds around the home were well maintained and accessible providing a patio area with tables and seating and a lawned area. The home has access to a maintenance person who ensures the high standards of accommodation are maintained and day to day wear and tear resolved quickly. The home has a small laundry which is managed well and was tidy and clean during our visit. Staff had completed infection control training and were supplied with personal protective equipment. Hazardous products were stored securely and information data sheets were in place. Daily cleaning records were being maintained and issues discussed Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: at staff meetings. Care Homes for Adults (18-65 years) Page 28 of 36 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. Peoples needs are met by a competent staff team, who have access to a comprehensive training programme that provides staff with the opportunity to gain knowledge about the diverse needs of people living at the home. Robust recruitment and selection procedures are in place which should safeguard people from possible harm. Evidence: The AQAA stated, We recruit in a fair and open way ensuring that we recruit the right people. Comments from relatives included, staff appear to be very caring, and from health care professionals, very professionally run home. We observed people being treated with dignity, respect and sensitivity. The registered manager said that the home was almost fully staffed with staff covering additional hours to make sure staffing levels were maintained. Staff said levels were sufficient to meet peoples needs. A maintenance person also helped with driving duties and a cleaner had been employed. New staff confirmed they had completed an induction programme and shadowed staff initially. Copies of the homes induction were on their file. They also receive a personal copy of the homes employee handbook. The registered manager said staff were also registered with Learn Direct to complete an induction equivalent to the Skills for Care Common Induction Standards and would then progress onto a National Vocational Qualification (NVQ) Award. The DataSet indicated that over 55 per cent of staff had a NVQ in Health and Social Care and that all staff had completed the Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: induction. We looked at recruitment and selection files for three new members of staff. All had completed an application form. Where there were gaps in employment history this had been investigated and evidence recorded to provide a full employment history. Evidence of identity had been provided with a current photograph. We advised the registered manager not to keep copies of birth certificates in line with Data Protection recommendations. There was evidence that at least 2 references were being obtained prior to appointment. Where people had previously worked in care the reason why they left this employment had been queried with the employer. People were not being appointed before their Criminal Records Bureau (CRB) check was received. An Independent Safeguarding Authority (ISA) Adult First check was being completed. Staff confirmed they had access to training and refresher training when needed. Individual training records confirmed this. Staff were keeping up to date with mandatory training as well as training specific to peoples needs such as autism, learning disability, epilepsy and diabetes. Staff will have the opportunity to attend courses in palliative care and people with a learning disability and supporting people with learning disabilities with loss and bereavement. Copies of certificates were kept on staff files. Care Homes for Adults (18-65 years) Page 30 of 36 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on openness and respect. Effective quality assurance systems are in place involving people who live at the home. Systems are in place to maintain and monitor the health, safety and welfare of people. Evidence: The registered manager has considerable experience supporting people with a learning disability. She has the Registered Managers Award and a NVQ Level 4. She has continued her professional developement completing training in the Mental Capacity Act and Deprivation of Liberty Safeguards. Staff said she was open and accessible and provided hands on support. The AQAA stated, an open and honest approach to all aspects of the running of the home is encouraged, and we believe in investing in our team members with training and development as well as putting service users at the centre of everything we do and delivering quality care. A quality assurance process is in place which involves obtaining feedback from people living in the home and their relatives and other visitors. We examined surveys returned in March this year comments included, the happy residents say it all, excellent home, and provides the highest standards of care. Comments from health care professionals Care Homes for Adults (18-65 years) Page 31 of 36 Evidence: included, staff appear to be very caring and very professionally run. Other monthly audits were also in place monitoring medication and the environment. The registered manager said she also monitors quality through the AQAA she produces annually for us and uses this as the improvement plan for the home. Service improvements over the past twelve months included, accessing training in Dementia, Epilepsy and Nutrition. Managers attended a workshop run by the Health Protection Agency and cascading practice around the home in promoting good infection control. Care plans also make reference to the mental capacity act and any best interests issues. Management had received training in the Mental Capacity Act and Deprivation of Liberty Safeguards and staff were scheduled to complete this training. The necessary assessments and records were being completed by the home. No one in the home was subject to a Deprivation of Liberty Safeguard at the time of the inspection. Systems for the monitoring of health and safety around the home were in place. Records were examined confirming checks were in place for fire systems, water temperatures, fridge and freezer and hot food temperatures as well as portable appliance tests. A fire risk assessment was in place which had been reviewed in June 2009 and the registered manager had completed fire training which would be cascaded to staff. We discussed putting individual fire risk assessments in place particularly for people with mobility or sensory concerns. Care Homes for Adults (18-65 years) Page 32 of 36 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 36 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 5 Peoples individual contracts or statement of terms and conditions should include reference to the funding of staff when supporting people on activities. Person centred plans which are accessible to people should be put in place. Where there are restrictions in place the rationale for this should be recorded indicating that these are in place to promote the best interests of people. The temperature of the medication cabinet should be monitored and recorded. Some records should be reviewed or replaced such as the agreement for the use of homely remedies and the BNF. When as necessary medication is given this should be recorded on the rear of the medication administration record with the reasons why is was given. 2 3 6 7 4 5 6 20 20 20 Care Homes for Adults (18-65 years) Page 34 of 36 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 7 8 34 42 Copies of birth certificates should not be kept. Individual fire risk assessments should be deveoped for people living in the home particularly for people with mobility or sensory concerns. Care Homes for Adults (18-65 years) Page 35 of 36 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. 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