Care Home: The Sycamores

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What the care home does well People live in a home which is clean, tidy, comfortably furnished and meets their needs.They each have their own room and can choose how it is arranged.People are able to practice their skills so that they can increase their independence. Staff supports them to do this.There is a wide range of leisure, work and social opportunities, which people can choose to do and people can go on holiday if they wish to different places of their choice.They have regular meetings when all the people who live in the home can get together to talk about any changes they may like and raise any matters of concern.People`s health care and wellbeing is checked through regular appointments with a range of health professionals.They get on well with staff. People told us staff listened to their comments and acted on them.Staff are well trained so that their knowledge and skills are kept up to date and there have been few staff changes. People told us there are enough staff to enable them to do the things they want to.They can have visitors when they want and they can visit other people such as family and friends.People said they felt safe and liked living in the home.The home is well managed. What has improved since the last inspection? There have been improvements made to the environment. For example, the redecoration and refurbishment of the kitchen and some bedrooms.We saw they have obtained better facilities for making sure peoples belongings such as medicines and money are kept safe.They now have wakeful staff on duty at night. Staff are well trained and people told us they were kind and friendly. What the care home could do better: The manager said she would make sure care plans showed more clearly that people`s capacity to make choices and decisions had been considered.We have not raised any matters over a number of inspections now. They continue to operate to high standards. Key inspection report Care homes for adults (18-65 years) Name: Address: The Sycamores 45 South Street Alford Lincs. LN13 9AN 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: Sue Hayward Date: 1 1 0 8 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 39 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 39 Information about the care home Name of care home: Address: The Sycamores 45 South Street Alford Lincs. LN13 9AN 01507462971 diane.johnson@linkage.org.uk www.linkage.org.uk 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) : Linkage Community Trust care home 8 Number of places (if applicable): Under 65 Over 65 8 0 learning disability Additional conditions: Date of last inspection 2 4 0 4 2 0 0 6 A bit about the care home Care Homes for Adults (18-65 years) Page 4 of 39 8 men and women over the age of eighteen live in the home. Everyone who lives in the home has their own bedroom. No one has to share a room. Everyone is given information telling him or her what they can expect if they live there. Care Homes for Adults (18-65 years) Page 5 of 39 Some information and photographs are on display in the home showing the different things that happen. There are a range of social, leisure and work opportunities that people can choose to participate in. Some are operated by Linkage Community Trust and others in the local community. Care Homes for Adults (18-65 years) Page 6 of 39 The manager told us that the current cost per week for someone to live there ranges from £547.95 £665.83 per week. A copy of this inspection report is kept on display in the home or can be obtained from the manager. Care Homes for Adults (18-65 years) Page 7 of 39 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 8 of 39 How we did our inspection: This is what the inspector did when they were at the care home. Throughout this report the terms we and us refer to the Care Quality Commission (CQC). Prior to the visit the manager had completed a questionnaire. This gave us some important information about their own assessment of how well they are meeting standards and how they plan to improve the service. Care Homes for Adults (18-65 years) Page 9 of 39 We followed the care of three people and checked their records. We spoke to three people who live at the home. Three people showed us their bedrooms. Care Homes for Adults (18-65 years) Page 10 of 39 We talked to a staff member who was on duty. General discussion was held with the manager about the outcomes at the end of the inspection. What the care home does well Care Homes for Adults (18-65 years) Page 11 of 39 People live in a home which is clean, tidy, comfortably furnished and meets their needs. They each have their own room and can choose how it is arranged. People are able to practice their skills so that they can increase their independence. Staff supports them to do this. Care Homes for Adults (18-65 years) Page 12 of 39 There is a wide range of leisure, work and social opportunities, which people can choose to do and people can go on holiday if they wish to different places of their choice. They have regular meetings when all the people who live in the home can get together to talk about any changes they may like and raise any matters of concern. People’s health care and wellbeing is checked through regular appointments with a range of health professionals. Care Homes for Adults (18-65 years) Page 13 of 39 They get on well with staff. People told us staff listened to their comments and acted on them. Staff are well trained so that their knowledge and skills are kept up to date and there have been few staff changes. People told us there are enough staff to enable them to do the things they want to. They can have visitors when they want and they can visit other people such as family and friends. Care Homes for Adults (18-65 years) Page 14 of 39 People said they felt safe and liked living in the home. The home is well managed. What has got better from the last inspection Care Homes for Adults (18-65 years) Page 15 of 39 There have been improvements made to the environment. For example, the redecoration and refurbishment of the kitchen and some bedrooms. We saw they have obtained better facilities for making sure peoples belongings such as medicines and money are kept safe. They now have wakeful staff on duty at night. Staff are well trained and people told us they were kind and friendly. Care Homes for Adults (18-65 years) Page 16 of 39 What the care home could do better The manager said she would make sure care plans showed more clearly that people’s capacity to make choices and decisions had been considered. We have not raised any matters over a number of inspections now. They continue to operate to high standards. Care Homes for Adults (18-65 years) Page 17 of 39 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 Sue Hayward Operations Directorate Care Quality Commission East Midlands Citygate Gallowgate Newcastle upon Tyne NE1 4PA Tel. 013000 616161 Email enquiries@cqc.org.uk Care Homes for Adults (18-65 years) Page 18 of 39 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 19 of 39 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 20 of 39 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. There is a thorough assessment process which makes sure peoples needs can be met before they are admitted to the service and they have sufficient information so that they know what to expect. Evidence: We checked the records of three people the service supports and included someone who had been admitted within the past year. We saw that there were records in place which showed that peoples individual needs had been assessed such as their cultural, religious and relationship needs. Where any risks had been identified, we saw there were assessments in place to show the action needed to minimise them whilst enabling people to be as independent as possible. Staff said that risk assessment was part of their training. People told us that they knew about and had been involved in the assessment and planning of their care. They showed us their personal files and the information contained in them. The comments we received from people who use the service about their needs and how they are met, matched the information we saw in peoples care plans, for example whether they were allergic to any particular medicines and information about their daily living routines and lifestyles. Staff comments showed that they were Care Homes for Adults (18-65 years) Page 21 of 39 Evidence: also aware of peoples needs. We saw that the assessment procedure also included obtaining information from other professionals involved with people who use the service such as social workers. People told us they had been able to visit the home and look around it before deciding to stay and felt that they had been given all the information they needed. We saw that people had been given their own copies of information which tells them about the home and what they can expect from the service. We saw important information is made available to people in other forms such as audio tape, digital video disk and in larger print. People told us that they liked living at the Sycamores. One person told us he had been living at the home a long time and liked it because it was in a small town where he preferred to be. Care Homes for Adults (18-65 years) Page 22 of 39 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 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 in the way they want them to be and they have choice and control over their daily lives. Care plans are detailed and person centred and reflect peoples individual needs and wishes. Evidence: We checked the care plans of two people who said we could. They both contained detailed information about their needs such as their leisure interests, daily living needs, medication, financial management and vocational needs. All people we spoke to were aware of the records that are held about them and two showed us their care plans and the person centred care plans that have been developed with them. They were detailed and included information such as their individual likes and dislikes and goals and wishes for the future. For example, people told us that they hoped eventually to move on to more independent living and we saw that they had been supported to complete housing applications. People told us that they were able to travel to certain places using public transport, could stay in the house for short periods on their own and took part in household duties such as preparing meals and cleaning their rooms for example. All areas Care Homes for Adults (18-65 years) Page 23 of 39 Evidence: which help to promote peoples independence. Staff had a good knowledge of the needs of people and people told us that they thought their needs were met at the home. They made comments which indicated that they are supported to be as independent as possible. Where necessary we saw that risk assessments had been carried out to enable risks to be reduced for activities that people may be involved with for example, accessing the community independently, staying in the house unaccompanied and taking responsibility for looking after their own medication. We saw that care plans are reviewed regularly and that people who use the service are able to invite who they wish to attend, for example their parents and other professionals. We saw from the records kept of reviews that peoples views are actively responded and listened too. For example, one person had asked for the record of the review to be provided to him in large print and a copy we saw showed this had been done. We saw that people had health action plans in words and pictures and hospital passports which contained detailed information about people’s specific medical and health needs. These are designed to assist other professionals, for example they contain information about ways in which people communicate. People told us that they were supported to make their own decisions and this is reflected in their personal records. For example, they go on holidays of their choosing and take part in vocational and leisure activities of their choice. People also told us that they opened their own mail and could vote if they wanted to. We saw that they are made aware of advocacy services and an advocate from a voluntary organisation sits on a committee consisting of people from a range of Linkage services. People told us the ways in which they are involved in the running of the home. For example there are regular house meetings held where people who live in the home can make their views known. Everyone we spoke to was aware of the current plans to build social housing on land to the rear of the property. Other comments indicated that they had been consulted about the refurbishment of the kitchen. Staff told us that information about the Mental Capacity Act 2005 and peoples rights to make choices and decisions had been covered in a staff meeting. In addition we saw from training records that the manager and deputy had attended a training session about deprivation of liberties. It was clear from comments and records we saw that people who live in the home are consulted about significant matters and involved in making decisions and choices. The manager agreed to make sure care plans reflected peoples wishes should they not have capacity to make significant decisions. Care Homes for Adults (18-65 years) Page 24 of 39 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 enjoy the wide range of social, leisure and vocational opportunities which they can choose to participate in within the home and community. People like the meals, which are well balanced and promote healthy eating. Evidence: We saw that care records contained information to show peoples food preferences and dislikes and any special dietary requirements and needs they may have. We saw that people are consulted about the choice of meals and we were told that, as well as a four weekly menu plan people who use the service are able to develop their own cookery skills. We were told people who live in the home have specific days when they are given an allowance and they can budget plan and prepare their own meals for the day. One person we spoke to showed us photographs of meals she had made and said she liked helping to prepare them. Records are kept of the meals provided and we saw that they were well balanced and healthy, for example the evening meal consisted of chicken breasts, potatoes and two vegetables followed by yogurt. We also saw that fresh fruit Care Homes for Adults (18-65 years) Page 25 of 39 Evidence: was available for people to have if they wished. We saw records to show staff have had basic food hygiene training, and the kitchen was clean and tidy. We were told it had been refurbished since out last visit. We saw the most recent report from an environmental health officer who had visited on 5th September 2008 and awarded the service a three star/excellent food hygiene rating with a comment made that all was satisfactory. People who live in the home told us about a wide range of activities that they can participate in if they choose. For example one person said that they worked at the local hairdressers, attended college and went bowling for example. Another said he had chosen to have a holiday in Great Yarmouth although he could have gone to Spain if he wanted. We were told that five people who live in the home had gone to stay with their relatives. People told us they could have visitors when they wished and could go out to visit friends and relatives. We noticed that people returned on the day of the inspection from a visit to a local animal park and that staff were also trying to arrange another visit to a local leisure park. People told us that they were able to go out when they wished but had also been through an assessment process to make sure that they were able and safe to do so alone. If not, staff supported them to access facilities, working toward people who live in the home increasing their independence skills. Lots of photographs were seen on display showing the various leisure activities people who use the service had taken part in. Care Homes for Adults (18-65 years) Page 26 of 39 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 are happy with the support they receive for their personal and health care needs and their independence in these areas is promoted. Evidence: We saw there were satisfactory arrangements in place for storing medication and they have told us that they have policies and procedures in place for staff to refer to if needed. People who use the service told us they looked after their own medicines and we saw that they had been provided with satisfactory storage facilities to enable them to keep them securely, although we saw they are currently in the process of changing these to make them more safe. We saw that there are good systems in place to check that people who are administering their own medicines are doing so safely, for example they have been risk assessed and keep a record which they sign to show when they have taken it. There are also satisfactory systems in place to enable staff to check that medication is being taken regularly. We saw that records kept to show when medication had been administered were well maintained. The service has a contract with a pharmacist who visits the service periodically and offers advice and guidance on the systems in place. We saw the most recent report which occurred on 12th June 2009. No issues were noted and the comments made were, maintaining a good standard in all medication issues. Staff told us and records showed that they have training about the safe administration of Care Homes for Adults (18-65 years) Page 27 of 39 Evidence: medication. Care records we checked contained detailed information about peoples medical and health needs. They have an individual health action plan and hospital passport which includes important information about peoples health and medication, which can be taken with them should they need to attend hospital. People who live in the home told us that they were able to see the doctor whenever they wished and that they had a choice of whether they attended alone or with staff. One person told us that staff stopped with them if they needed to stay in hospital. We saw from the records we checked that peoples health is promoted and monitored in different ways for example people attend well person clinics annually, the organisation employs a physiotherapist and people told us and records confirmed that both people who have a visual impairment are supported by workers from the Lincolnshire Visual Impairment service to enable them greater independence. We noticed that people looked well cared for. We saw records in place to show that people’s weight is monitored regularly and if necessary advice and guidance is sought from other professionals as to how best any challenging behaviour can be managed. We saw and people’s comments confirmed that they can see people such as doctors, dentists and chiropodists when they wish. They told us that their privacy was well respected by staff and that there are both male and female staff employed. This enables opportunities for people to have some choice of carer. Care Homes for Adults (18-65 years) Page 28 of 39 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. Satisfactory processes are in place, which help to make sure people feel safe, know how and feel comfortable to raise concerns. Evidence: People told us they knew what to do if they were unhappy or wanted to make a complaint. They said they would tell staff and thought action would be taken to resolve any matters. They knew they had been given a copy of the complaints procedure and that a copy was kept on their individual files. We saw that records are kept of any complaints or concerns. Three have been made in the past year. They recorded the action taken to resolve them and the outcomes. People told us they liked living at the home, liked the staff and felt safe. We saw that the manager, staff and people who live in the home had a good rapport. There are various systems in place for people to raise concerns for example through individual discussions, reviews and house meetings. The records we saw of the latter showed that people are asked if they wish to rise any complaints. Records showed that safe guarding vulnerable adults training is part of the staff training programme and leaflets were on display with information about the local authority’s procedures. They have told us they have policies and procedures about safeguarding vulnerable adults. They have referred two matters appropriately. The manager confirmed that both matters were now closed although they had not received any minutes from either local authority who was involved to demonstrate this. We asked people whether Care Homes for Adults (18-65 years) Page 29 of 39 Evidence: they felt safe and they told us they did. The manager said she had attended training about legislation referring to people’s rights and freedom. The staff recruitment procedure was checked through the records kept of this process. We saw they contained information to show that checks such as protection of vulnerable adults (POVA), criminal records bureau (CRB) and references were taken up as part of the procedure. Care Homes for Adults (18-65 years) Page 30 of 39 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 who use the service benefit from comfortable and personalised private rooms and well maintained communal areas, which is meeting their needs. Evidence: The manager showed us that work had commenced to build some social housing on land owned by Linkage behind the home. She also said planning permission had been obtained to convert the stable block into flats which will become part of the home and is aware that this will necessitate an application to vary their terms and conditions of registration. All people we spoke to indicated they knew about the building of the flats and they had completed housing application forms as they wished eventually to move on to more independent living. We saw that bedrooms had been arranged, decorated and furnished to each person’s particular tastes and are lockable with people being given their own room key. The communal areas of the home are well maintained, decorated and comfortably furnished. Since the last inspection the kitchen has been refurbished and redecorated. People who live in the home told us they had been consulted about this. There is a lounge, computer lounge and conservatory, large kitchen/dining room and laundry. There are bathrooms and toilets on both floors and both people with visual impairments have rooms on the ground floor. There are large well maintained gardens to the front and rear Care Homes for Adults (18-65 years) Page 31 of 39 Evidence: of the premises and car parking to the side. One person we spoke said he enjoyed helping to look after the garden. We saw that people who live in the home had choice over where they received visitors and are able to have pets if they wish. For example one person has a rabbit which lives in an outhouse. We saw that risk assessments of the environment are in place and had been reviewed this year. We noticed that things like radiators were guarded and the house was tidy and not presenting any obvious hazards. People told us that they are able to do their own laundry and staff support them where needed. There is a separate laundry room with domestic style appliances. Staff told us that they had training about infection control and that equipment was available for them to use to maintain good hygiene standards such as gloves and aprons. There is also antiseptic hand gel available and staff were seen to use this and a polite reminder is on display for visitors about this as well. People told us they felt safe in the home. Care Homes for Adults (18-65 years) Page 32 of 39 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 protected by a well trained staff team and a satisfactory staff recruitment procedure. Evidence: We saw the records of three staff including someone who had been employed within the past year. We saw that the recruitment process included application forms being completed, obtaining proof of identity, criminal records bureau (CRB), protection of vulnerable adults (POVA) and reference checks for each person. Notes are kept of interviews and they have told us that they have policies and procedures about equal opportunities and employment. No new employees were on duty to speak to, but the staff member we saw confirmed this as the process and said she was involved in interviewing prospective staff along with the manager. She confirmed, as did records we saw, that staff follow an induction process and have training which is updated on a regular basis about some matters such as manual handling, fire safety and the protection of vulnerable adults and training which is more specific such as autism and Aspergers syndromes. In addition some staff have achieved a nationally recognised vocational qualification in care at various levels. A staff member said that if they felt they needed any training it was identified and arranged, for example the speech and language therapist had attended a staff meeting. Staff also said they felt well supported and valued and confirmed that there is an appraisal system in place as well as regular individual Care Homes for Adults (18-65 years) Page 33 of 39 Evidence: supervision sessions for staff. People who live in the home made positive comments about their relationships with staff and were noticed to have a good rapport with the staff present on the day of the inspection. They said they would feel comfortable to talk to them about any problems and that they were kind. As there were only three people staying at the home on the day of the visit, one person was on duty. However, people who use the service and staff confirmed when it is fully occupied there are two staff on duty. This does not include the manager who works additionally to the staff rota. We saw that the organisation also have a management on call system for staff to contact if necessary and this was on display in the office. They have told us as that the night staffing arrangements have changed since the last inspection to fit in with the European Working Time Directives and there is now a wakeful staff member on duty during the night instead of sleeping in. Care Homes for Adults (18-65 years) Page 34 of 39 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. People benefit from a well managed service, which promotes their health, welfare and safety and where their views are sought to contribute to its development. Evidence: There has been no change to the management arrangements of the home. The manager has a lot of experience working with adults with learning disabilities. She has a management certificate and is an NVQ assessor. She is also responsible for managing another home in Alford and divides her time flexibly between the two services. Records we checked showed that the manager participates in regular training to help keep her knowledge and skills up to date. Discussion with people who use the service showed they were aware of who was in charge and felt comfortable to raise any matters with any of the staff or manager on an individual basis, through house meetings or at their individual review meetings and they thought that action would be taken to resolve any issues. A staff member said they felt valued and supported by the manager and staff meetings, supervision and appraisal sessions were held regularly where they had opportunities to raise any matters. The manager said she welcomed our visit and discussion with her showed she was open to ways to improve the service. She gave examples of some Care Homes for Adults (18-65 years) Page 35 of 39 Evidence: changes which had been made to make sure people were kept safer, for example in relation to the medication arrangements. There are a range of systems in place to monitor the quality of the service such as the pointers committee which is run by and for people who use the organisations range of services. A representative from the Sycamores attends these meetings. There are also regular visits from a senior manager who assesses areas such as staffing, complaints, social and community issues and building and maintenance issues. We saw that as well as keeping records of any complaints they also keep records to show when they have received compliments and praise. We noticed a card which said thanks for looking after X so well. A staff member also told us that the organisation are planning to set up a suggestion box via the internet for anyone with an interest in the service to make comments. They have told us they have a range of organisational policies and procedures in place to promote the safety and welfare of people who use the service. Some are on display such as the procedure to be followed in the event of a fire occurring. Staff told us they regularly carry out fire drills and include people who live in the home to make sure they understand what to do to keep safe if they hear the fire alarm. There are also risk assessments in place relating to the environment. Staff confirmed as did records, that they have training about health and safety matters. They have also confirmed in writing that regular checks are carried out to make sure that equipment is in good working order, for example fire fighting equipment was last serviced in April 2009, portable electrical appliances and the central heating system in January 2009. People told us they liked living at the home and felt safe. Care Homes for Adults (18-65 years) Page 36 of 39 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 37 of 39 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 Care Homes for Adults (18-65 years) Page 38 of 39 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 39 of 39 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!