Care Home: The Thimbles

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What the care home does well The Thimbles is currently home for two people who are supported to be as independent as possible within a clear risk assessment framework. The home is well furnished and maintained with a garden that people use in good weather. People living in the home take a pride in their environment and help to keep the home clean and the garden well stocked. The small team of staff know people well and the care needs of the people living in the home are documented in detailed in person centred care plans that are kept under review. People`s goals and wishes are taken account of and their views are listened to in the development of the service. Staff feel well supported by the management team and are given a thorough induction and ongoing training programme. People living in the home are involved in the appointment of new staff. There are quality assurance systems in place and Regulation 26 visits are carried out every month and a written report provided. The following comments were made by people who returned surveys: `I like going out with staff and I want to post this letter on my own. I like that my friend can come and see me`, `Nice to live here, good support and nice staff. I am free to choose what I want to do`, `I am very pleased with the way the service is looking after X`, `Without this service X would not be able to survive. X is well cared for in an environment that suits the needs`, `Provides a friendly supportive environment`, `Relaxed atmosphere, person-centred, good quality staff who support people well`, `If I had anyone related to me (or even myself) I know they would be in good care there` and `The home provides a personal touch and kindness given to the residents`. What has improved since the last inspection? The home has responded to people`s individual requests, for example one person now has a friend to visit two evenings a week. The service user guide has been updated. Risk assessments have been provided in a clearer format. A new cooker has been purchased and one bedroom has been redecorated. The lounge has been redesigned with a new flat screen television. The garden has also been redesigned with new borders and plants. The use of agency staff has been reduced following a recruitment drive. What the care home could do better: Healthcare records should be better organised so that full and up to date information about people`s physical care needs are readily available and clear. Risk assessments for people who are able to self medicate should be more detailed and kept under review. Key inspection report Care homes for adults (18-65 years) Name: Address: The Thimbles 80 Barnham Road Barnham Bognor Regis West Sussex PO22 0ES     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: Annette Campbell-Currie     Date: 2 2 0 6 2 0 0 9 This is a review of 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 2 1 0 stars - excellent stars - good star - adequate 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. that people have said are important to them: They reflect the things 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 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 29 Information about the care home Name of care home: Address: The Thimbles 80 Barnham Road Barnham Bognor Regis West Sussex PO22 0ES 01243555808 F/P01243555808 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: None United Response care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 3. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Date of last inspection Brief description of the care home The Thimbles is a care home registered to provide accommodation and personal care for up to three younger adults who have a learning disability. The home is a detached cottage located in the village of Barnham, near to local amenities and public transport. People living in the home share a lounge, kitchen and dining room. There are three single rooms on the first floor, one with en-suite toilet and shower acilities. All areas of the home are accessible to residents including the small courtyard garden. 3 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 29 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 peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 star. This means that people who use the service experience excellent quality outcomes. The previous key unannounced inspection took place on 26th June 2007 and an annual service review (ASR) was carried out on 18th July 2008. We (the Commission) carried out the site visit over three and a half hours. The member of staff on duty assisted with the inspection. Mr Jones, the manager was available by telephone and the area manager called in to provide advice and support. Most of the information and documents we needed to help to make an assessment of the service were available. There were two people living in the home at the time and one person was staying as part of a planned admission to the home. The manager completed an annual quality assurance assessment form (AQAA) before Care Homes for Adults (18-65 years) Page 5 of 29 the inspection. The AQAA was detailed and provided evidence of how the home achieves good outcomes for people living at The Thimbles. The information was used to help plan the site visit. We sent out surveys to find out what people think about the home. The two people living in the home returned surveys they had completed with assistance, their relatives returned surveys, five staff and four health or social care professionals also returned surveys. The comments have been used to help make an assessment of the service. Both people living in the home were spoken with also the member of staff on duty. We saw the communal areas of the home and one persons bedroom. The following documents were read: the case records for both people living in the home, the preassessment documents for the person planning to move to the home, the complaints policy and records of complaints, the minutes of meetings with people living in the home, menus, staffing rotas, training and development records, a sample of medication records, quality assurance documents and a sample of Regulation 26 reports. The outcomes for people have been assessed in relation to twenty-four of the fortythree National Minimum Standards for Care Homes for Younger Adults; including those considered to be key standards to ensure the welfare of people living in the home. Care Homes for Adults (18-65 years) Page 6 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Adults (18-65 years) Page 7 of 29 following this report, you can contact them using the details 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 8 of 29 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 9 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A thorough assessment is carried out before a decision is made about someone moving to The Thimbles. Evidence: The home has a detailed process for carrying out a thorough assessment before someone moves to the home. Information is gathered from the person themselves, relatives and health and social care professionals who have worked with them. There is a comprehensive assessment form that includes all aspects of the persons health and personal care needs as well as information about their background, interests and spiritual needs. The home obtains a copy of the assessments carried out by social workers and any relevant information from healthcare professionals. There is a vacancy in the home and there is someone who is interested in moving to The Thimbles. There has been a slow introductory period to make sure that the person is making an informed decision and that their needs could be met by staff in the home. The other people living in the home also have some involvement as it is important that a new person would be compatible with the group. The trial period began in March and at the time of the site visit the person was staying for a week before they Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: make a final decision about moving. We saw the assessment documents and records of each planned visit. It was clear that detailed information had been obtained from the person and all those who know them. The staff working with the person during each visit had made notes and these observations and comments were included in the assessment process. Minutes had also been kept of meetings with the person and their social worker and the people currently providing care. This process gives people time to make an informed decision and to ensure that staff are very aware of the persons needs before they move. The people living in the home said they had got to know the person planning to move in and the member of staff said that they seem compatible and were getting to know each other well. The manager said in the AQAA that the person who may move to the home has been given the information they need about the home and also an individual contract that is in symbol format that makes it easier for people to understand. Care Homes for Adults (18-65 years) Page 11 of 29 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. Each person has a plan of care and their needs and goals are at the centre of all planning in the home. People are supported to take risks as a part of an independent lifestyle. Evidence: The manager said in the AQAA that the individual service plans reflect the needs and aspirations of each person and that people are supported to contribute to their individual plan. We read the care plans for the two people living in the home. These were detailed and included information and guidance about each persons communication needs, likes and dislikes, things that are important for them as a guidance to staff and things that are important to them in their daily lives. The care records were very person centred and focussed on each persons strengths and goals they wish to achieve. There is an emphasis on supporting people to develop their independence skills and this was the focus of the guidance provided for staff, for example a goal for one person is: for X to be able to do his/her jobs such as cleaning Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: the bathroom floors, recycling waste and locking up at night....to be supported to be as independent as possible and not let staff do things for X that he/she can do for themselves, helps cook dinner, helps with fire alarm test and outside light test. For another person: X writes his/her own shopping lists and X knows where to get the hoover and how to use it safely. Peoples spiritual needs and wishes were also documented in their care plan including the way staff can support people with their spiritual wishes. Guidance is provided to staff about the best form of communication to help people make choices, for example: keep sentences short and language basic and X has very keen eyesight, visual aids are a useful tool in communicating with X. The member of staff gave examples of times when visual aids have been used to help people to make choices. The two people in the home gave permission for us to look at their care plans and they both knew what was in them. Monthly one to one meetings take place with staff as a review of how things are going. The written notes of these meetings were seen in the case files and showed that the persons needs and wishes are at the centre of decision making about their daily lives. As part of the development towards increased independence people are supported to take risks at home and in the community. Copies of risks assessments on file showed that possible risks had been identified and strategies put in place to support people in a safe way without them losing any independence. One person has a call system so that he/she can stay at home unsupervised for periods of time. This person was going out to shop independently in the morning and the member of staff on duty gave him/her support and encouragement with the process. For another person there was guidance on the file:: I can get my own small knife from the kitchen drawer for me to use- I also like help to get the right chopping board for the job I am doing. It was clear that care plans and risk assessments are kept under review and changes made if necessary. Staff complete written handover notes at the end of each shift so that the person coming on duty knows the details of key events and changes in care that people may need. The member of staff on duty said that staff know the people in the home well and understand their needs. New staff work alongside more experienced staff for several weeks to make sure they understand what is required of them. She said that although the home has had to use agency staff they always request people who have been to the home before and know the people who live there. Staff who returned surveys indicated that they know and understand peoples needs. The home has a clear focus Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: on supporting each person as an individual so that they better understand the choices that are available to them. The manager and staff have attended training in equality and diversity issues and always look to develop better ways to support people, for example they plan to provide a video phone that will be easier for people to use. Care Homes for Adults (18-65 years) Page 14 of 29 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 have the opportunity to take part in activities of their choice and are well supported to use community facilities and to maintain relationships with relatives and friends. People are involved in choosing, preparing and cooking their meals. Evidence: The two people living in the home are supported to plan their daily activities and leisure time to suit them rather than to fit in with what the other person is doing. While both people said they get on well together their needs, abilities and interests are different. The care plan reflected peoples different backgrounds and interests. One person has been supported to learn to plan their own menus, do their own cooking independently with staff present, do their own banking, do their weekly shopping and travelling independently on trains. People have access to local day centres to take part in activities they enjoy. One Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: person helps in a shop twice a week and said in their review: works good, I like it a lot. Both people told us that they enjoy the activities they take part in. They both take a pride in their home and keeping it clean and both people do their own laundry. Both people help with the garden and showed us the vegetables that they have planted. Friendships and family relationships are encouraged and staff provide support to do this. Guidance on one persons file was: X likes speaking on the phone to his/her Mum and other family members and for another person: If possible during the summer staff should try and arrange a visit for X to travel to see Y in Lincolnshire. Visitors are welcomed in the home and one friend comes for a meal on a regular basis. Leisure activities are sometimes shared with people living in the home nearby; people told us that they had been to a party the previous day after they had cooked their roast lunch together. People are supported to use local facilities and one person has recently joined the local mobile library service. One person is supported to attend church meetings and is also involved in social activities arranged by the church. There is a social club that is run once a month in the evenings and both people said they go to this. Social events are also arranged in the home from time to time. There is a weekly house meeting so that people can be involved in decisions and plans for the coming week. Relatives who returned surveys said they are very satisfied with the care provided in the home and that they are kept informed about their relatives welfare. Peoples privacy is protected and they know that staff will not go into their room without permission. One person was very keen to keep his/her room locked and this clearly gave them some comfort and reassurance. Staff do not open mail without the persons consent. During the day people were being spoken with in a respectful manner and their needs clearly come first in the daily running of the home. There is an advocacy service available if this should be needed. Both people have been supported to choose a destination for a holiday. One person is going to Disney Land in Paris with a friend and staff the other person is going to Bournemouth for a few days with a chosen friend and staff. Both people were very excited about their holiday. People living in the home are involved in planning their menu for the week, they are also involved in food shopping, food preparation and cooking depending on their abilities. The menu was seen and showed that a varied diet is provided. People have plenty of fresh fruit and vegetables. Each person has their weight checked each month and when problems are identified this is monitored to try to find out the cause. The member of staff on duty showed us an example of a recent health concern and how this is being addressed. People have their meals in the dining area of the large Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: kitchen. This is a relaxed and homely environment. People are able to choose when they take their breakfast and other mealtimes are planned around individual need. Care Homes for Adults (18-65 years) Page 17 of 29 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. Peoples personal and healthcare needs are provided for. The medication policies and practices usually protect people living in the home. Evidence: Personal care needs are documented in peoples care plans to make sure they receive the care they need in the way they choose. The care plans included details of peoples abilities as well as their needs, for example: X can do all intimate personal care for himself/herself, Staff may help X with his/her bath by recording the bath temperature in the book and putting the body wash on the flannel for him/her and X requires no support to use the toilet and will wash his/her hands without the need of prompting. During the morning people were being appropriately supported with bathing as agreed in the care plan. A separate file is kept for peoples healthcare and medication needs. It was clear that people have access to a general practitioner (GP) when they need one and that other healthcare professionals are involved when necessary. The home has a good relationship with the local primary care team and the multi disciplinary community team who support people who have learning disabilities. Surveys returned by health Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: and social care professionals were very positive about the care provided in the home. It was clear that peoples emotional and mental health needs are assessed and monitored. On one persons care plan it was noted that staff should help the person to realise changes to routine are inevitable and to learn how to deal with this and we are looking to see when X gets most anxious. People do not yet have health action plans that would encourage them to be more active in promoting their own well being. One person has recently attended a local well persons clinic to have their health checked. The healthcare files were not in good order and it was difficult to see which information was up to date and to identify key information about peoples past medical history. The manager said he is planning to address this so that all information is well organised and easily available to people in the home and to staff. There are medication policies and procedures in place and staff who support people with their medication have attended training. People are encouraged to self medicate if this is safe. One person has learnt to order their own medication, collect the prescription, hold their medication and keep a record of when they take it. There was a brief risk assessment and procedures have been set up to ensure that the persons abilities are monitored, however the risk assessment should be in more detail to show that the persons competence has been clearly assessed and is reviewed as required in order to keep the person safe. The manager agreed to put this in place as a matter of urgency. The storage facilities for medication meet requirements and the recording systems were up to date. Care Homes for Adults (18-65 years) Page 19 of 29 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 feel their concerns are listened to and acted upon. There are procedures in place to help to protect people from harm and abuse. Evidence: The home has a complaints policy that is given to people when they move to the home. There is a complaints form that is provided in a symbol format to make it easier for people to understand. The manager said in the AQAA that the home takes a pro-active approach to concerns and complaints and efforts have been made to help people understand their right to raise issues that cause them worry or concern. Weekly house meetings or monthly one to one meetings provide an opportunity for people to raise concerns. There have been three complaints recorded and investigated by the home in the past twelve months. The records were seen and showed that action had been taken to address the issues. The operations manager said that senior managers are always made aware of serious complaints made about the organisations homes. The home follows the West Sussex multi agency policy and procedure for safeguarding vulnerable adults however there was no copy of the new revised policy available in the home. The area manager said that she would make sure the home obtains a copy for staff reference. Staff have attended training in safeguarding vulnerable adults and recognising signs of abuse. The member of staff on duty was clear about her responsibility to pass information on immediately to the manager on call however it Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: was not clear that it would be the responsibility of the person in charge of the home to report concerns to Adult Services if the on call person was not available. There are strategies in place for supporting people with physical and verbal aggression. There was clear guidance for staff about supporting people with their behaviours in their care plans, for example: If my behaviour does become extreme then walk away from me and leave me to be angry on my own as I may hit you or throw an object around. There was guidance about possible triggers to behaviours and how staff should avoid escalation in order to protect the person and those around them. Care Homes for Adults (18-65 years) Page 21 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe environment that is maintained to a high standard. Evidence: The house is a listed building and is maintained to a high standard to provide a safe and homely environment. People said they like their rooms and they have had a say in the choice of decoration for their rooms and communal areas of the home. We saw the communal areas and one persons bedroom that has ensuite facilities. Bedrooms are large and reflect individual personality and taste. There is a separate bedroom for staff who are on night time sleeping duties. People are supported with cleaning and laundry duties. A new cooker has been purchased and one of the bedrooms has been redecorated. People also take a pride in the garden that is well stocked and well used in good weather. A garden coordinator has been employed and he has improved the layout of the gardens. There are arrangements for the day to day maintenance of the home. The manager carries out regular checks to ensure that the premises are safe. Care Homes for Adults (18-65 years) Page 22 of 29 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 supported by staff who are competent and well trained. The recruitment policy protects people in the home Evidence: There is one member of staff on duty at all times who support the two people living in the home. Staff working in the neighbouring home are available in an emergency and there is a manager on call at all times. The member of staff at night is on sleeping duty as people do not need staff support at night. The manager said in the AQAA that the home has had difficulty recruiting staff until recently and there was a heavy reliance on agency staff. The manager said that this has now reduced significantly following a recruitment drive, there are four contracted members of staff for the home and a team of relief staff who all know the people living in the home well. The manager said in the AQAA that the home has a thorough recruitment process and that all the required checks are carried out before people begin work. The member of staff on duty said that people living in the home are involved in the interview process and they said that they are involved. The manager was not on duty and staff information is securely stored to protect confidentiality in his absence. It was therefore not possible to verify that the recruitment procedure is robust. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: The induction programme for staff meets the Skills for Care standards and the member of staff on duty said that newly appointed staff always work with more experienced staff until they have the knowledge and skills to work alone with people in the home. There is a training programme that includes the mandatory training topics and other subjects that people need to understand including working with people who have challenging behaviour and people on the autistic spectrum. Staff who returned surveys indicated that they have the training they need so they have the knowledge and skills they need to do their job. The member of staff on duty showed us the personal development file that all staff have now been given so that they can keep a record of their training and identify additional training needs as part of their annual appraisal. Care Homes for Adults (18-65 years) Page 24 of 29 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 living in a home that is well run and their views are taken into account in the development of the service. The health, safety and welfare of people in the home and of staff are promoted and protected. Evidence: Mr Matthew Jones is the registered manager and he has achieved the National Vocational Qualification (NVQ) at level four in management. He said that he is encouraged and supported to attend additional training sessions for his own personal development. There are good management systems in place and Mr Jones is well supported by senior staff in the organisation. There are quality monitoring systems in place. The manager said in the AQAA that organisational audits are carried out regularly and Regulation 26 visits are carried out every month. Written reports are provided and examples of these were seen. People living in the home are at the centre of the development of the service. They are encouraged to make comments or suggestions about ways to improve the home. Examples of completed questionnaires were seen. These have not yet been collated to Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: show people that their comments have been taken into account. A copy of the service plan for the year is displayed on the wall in the kitchen with other notices about planned events. There are procedures in place to ensure that the home is kept safe for people living there and for staff. The manager told us in the AQAA that all equipment is services as required. All staff have attended mandatory training sessions including fire safety. There is a fire risk assessment and evacuation procedures are displayed. Incidents and accidents are recorded and monitored and steps taken to prevent risks to people living in the home and to staff. Periodic safety checks of the building are carried out. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R 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 27 of 29 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 Requirement 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 Requirement 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 28 of 29 Helpline: Telephone: 03000 616161 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). 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