Care Home: The Willows

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What the care home does well The Willows provides accommodation for five adults who have a learning disability in the Cleveleys area of Lancashire. This service provides a clean, welcoming and homely environment for the people who live there. The home is situated close to Cleveleys town centre, meaning that the residents only have a short distance to travel to get to local shops, transport connections, restaurants, and other important facilities. The sea front is only a short distance away, and can be used for walks along the new promenade. Most of the people who use this service have day occupations, and good support is available during the day to ensure that the residents go out into the community to enjoy activities. Heath issues are monitored well and recorded properly in the care plans. The staff that we met were enthusiastic and competent in their role. The residents were well cared for and were treated respectfully by the carers. The people who used the service that we spoke to said that they enjoyed the food that was prepared, and enjoyed helping with the tasks that were associated with mealtimes, such as shopping for food, preparing meals, and washing up. Care staff are well trained and knowledgeable in their role. Training for the staff is good and a range of specialist training has taken place since our last full key inspection. What has improved since the last inspection? The service now has an acting manager who is in the process of becoming registered with the Care Quality Commission. The service is now being managed more successfully with improved outcomes for the people who live there. Care planning for the people who use this service has improved greatly since our last inspection activity. Each person now has an individual file that details health and social care needs. Each plan had good information on the needs of each resident, which enabled the care staff to work in a more planned and constructive way. People were now being care for in a more personal way, with individual health care needs being addressed suitably. During our last full key inspection we found that there were problems in the way that prescribed medication was being stored and administered. We undertook a random, unannounced inspection shortly after this, and the Care Quality Commission pharmacy inspector found that there were significant improvements. On this occasion we found that medication was being stored and handled well, and that records were clear and up-to-date. More care was being taken with `controlled` medication, which is medication that is closely monitored because of its strength or content. Support workers had received accredited training in this area. A significant amount of training had taken place since our last visit and there was a training matrix and certificates available to show what training had occurred. A good training programme is important because staff are given new skills and knowledge to improve outcomes for the people that they support. Training in medication awareness, epilepsy and autism awareness had taken place, along with mandatory safety training. Environmentally, improvements had been made throughout the home. Some decoration had taken place and people`s bedrooms were more personal and contained personal possessions, pictures, photographs and ornaments. What the care home could do better: We found that some of the information that was available within the home wasn`t in a format suitable for people who had literacy issues. The acting manager should look at better was to help ensure that people understand what services they should be receiving and how to express their concerns. We first visited this service in July 2009 and found that the service did not have a registered manager. The owner of the service was considering managing this service but has since appointed an acting manager with a view ensuring that she is registered to manage the service. Our records show that an application has not yet been made, although the acting manager has assured us that this is in hand. As part of the inspection process we asked the owner to complete an annual quality assurance assessment (AQAA). This enables the registered person to tell us about their service, what changes and improvements have been made, and what their plans are for the future. The owner completed this and returned it to us. Unfortunately the AQAA for this service was poorly completed on this occasion and the information that was given was brief and lacking in detail. We could not, therefore, acquire an accurate picture of the service and the way that this had developed. The Commission is also not receiving notification of significant events, as set down in Regulation 37 of the care Standards Act. These help to give us an accurate picture of day- to-day events within services. There had been no training in ensuring that people are moved safely and comfortably around the home. One person who lived within this service had significant mobility issues and relied on the support staff for regular help. This training should be arranged as soon as possible. Key inspection report Care homes for adults (18-65 years) Name: Address: The Willows 30 Slinger Road Thornton-Cleveleys Lancashire FY5 1BN     The quality rating for this care home is:   one star adequate 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: Christopher Bond     Date: 2 2 0 2 2 0 1 0 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 31 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 31 Information about the care home Name of care home: Address: The Willows 30 Slinger Road Thornton-Cleveleys Lancashire FY5 1BN 01253863059 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Seemy Addingadoo care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The registered person may provide the following category of service only: Care home only- Code PC To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability- Code LD The maximum number of people who can be accommodated is: 6 Date of last inspection Brief description of the care home This is a small, registered home for six adults who have a learning disability. The service is situated close to Cleveleys town centre. There are shops and other amenities close by, meaning that the people who use the service have the opportunity to experience an active life where resources are available without travelling long distances. The home is an ordinary semi-detached house. Parking in the immediate area is difficult because of restrictions; there is, however, a pay-and -display car park quite close by, and within walking distance. Cleveleys bus station is a short walk away and there is a tram service that runs from Cleveleys to Blackpool and Fleetwood. Transport links are good, meaning that the people who use the service are able to use a wide range of resources and facilities. There are six bedrooms at this property, one being used by care staff who provide night time cover. One of the larger rooms is Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 6 Brief description of the care home being used as a shared bedroom. There are en-suite facilities in two of the rooms. One bedroom is on the ground floor because the person who uses this room has a physical disability. The owner of the service has provided information that informs prospective residents and their families representatives of the purpose, aims and objectives of the service. The current fees for the service are from GBP473.50 to GBP678.00 per week. There are extra charges for chiropody. Care Homes for Adults (18-65 years) Page 5 of 31 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: one star adequate 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: This was an unannounced random inspection that took pace on 22nd February 2010 and took a total of 7 hours. We looked at the care records and daily notes that were written about the people that use this service. We also looked at the practices the service uses regarding handling medication. We checked on what action had been taken to ensure that the people who this service were properly safeguarded from harm, and also what arrangements were in place to enable them to voice their concerns. We looked at the living arrangements and whether or not the home was properly maintained and furnished. We also looked at whether the home was being properly managed and staffed, so that the assessed needs of the people who use the service are being properly addressed. Care Homes for Adults (18-65 years) Page 6 of 31 We undertook a random inspection of the service on the 22nd September 2009. The owner of the home sent us an improvement plan to tell us what action he would be taking to ensure that the service complied with the National Minimum Standards. As part of the inspection process we asked the owner of the service to complete an annual quality assurance assessment (AQAA) to tell us what changes have taken place within the service and what future plans will take place for the benefit of the people who use the service. This also gave us some numerical information: the results of this have been noted and included within our inspection activity. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? The service now has an acting manager who is in the process of becoming registered with the Care Quality Commission. The service is now being managed more successfully with improved outcomes for the people who live there. Care planning for the people who use this service has improved greatly since our last inspection activity. Each person now has an individual file that details health and social care needs. Each plan had good information on the needs of each resident, which enabled the care staff to work in a more planned and constructive way. People were now being care for in a more personal way, with individual health care needs being addressed suitably. During our last full key inspection we found that there were problems in the way that prescribed medication was being stored and administered. We undertook a random, unannounced inspection shortly after this, and the Care Quality Commission pharmacy inspector found that there were significant improvements. On this occasion we found that medication was being stored and handled well, and that records were clear and up-to-date. More care was being taken with controlled medication, which is medication that is closely monitored because of its strength or content. Support workers had received accredited training in this area. A significant amount of training had taken place since our last visit and there was a training matrix and certificates available to show what training had occurred. A good Care Homes for Adults (18-65 years) Page 8 of 31 training programme is important because staff are given new skills and knowledge to improve outcomes for the people that they support. Training in medication awareness, epilepsy and autism awareness had taken place, along with mandatory safety training. Environmentally, improvements had been made throughout the home. Some decoration had taken place and peoples bedrooms were more personal and contained personal possessions, pictures, photographs and ornaments. What they could do better: 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 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 9 of 31 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 10 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about this service was readily available, although not in alternative formats for those without literacy skills. Evidence: This service had information available to give to prospective residents and their representatives about what facilities and support that are available, should they choose to live at The Willows, or are considering using the service. The acting manager should ensure that this information is available to as many people as possible, and in a format that most people can understand, with illustration and photographs for those who have difficulty reading. It is only by having a good understanding of what the service offers that an informed choice can be made by those wishing to live at this home. The acting manager was aware of the issues around accessing information and had planned to make changes to the Service User Guide and Statement of Purpose to help ensure that as many people as possible could use this information to make an informed choice. We saw that the people who used this service had been assessed and there was Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: information on file regarding peoples needs and aspirations. The acting manager was aware that new residents needed to be properly assessed to help ensure that the service could meet their specific needs: she also told us that prospective residents are free to visit the home to view the facilities that are on offer. The available bedroom had been left in neutral colours so that it could be decorated in a chosen colour scheme prior to a new resident moving in. Care Homes for Adults (18-65 years) Page 12 of 31 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. The people who use this service have more choices and more individual lifestyles. Peoples care was being planned and delivered in a more appropriate way, although the review process needs to be more formal. Evidence: A lot of work had been done by the current acting manager to ensure that everyone had an individual plan of care that described their current social and health care needs. Work was still progressing with these documents and training had been arranged so that a more person centred approach to care planning could be achieved. Each plan had good information on the needs of each resident, which enabled the care staff to work in a more planned and constructive way. People were now being care for in a more personal way, with individual health care needs being addressed suitably. We did notice, however, that the review process needed to be developed and refined. The care of each person should be formally reviewed on a regular basis so that Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: changes to the care plans can be made to reflect immediate and current need. A good review process also helps the support workers to ensure that information is consistent and current: goals can then be formulated, and achieved with staff help. In this way, progress can be measured and care can be monitored appropriately. On out last visit to this service we found that choice for people who were using this service was limited. During this visit we found evidence within the care plans to tell us that people were more involved in the service and how it was run; there was evidence to show that people were being seen as individuals with identified needs and wishes. There was a clear move away from group activities, and people being looked after rather than being involved, and using their skills to do things for themselves. There were risk assessments available within the care plans to show that any daily hazards were being assessed properly. A certain amount of controlled risk is necessary for people to lead an ordinary life. Risk assessments help the care staff to be aware of areas of risk and make adjustments to minimise these. It was clear that the care staff were more aware of confidentiality. Individual records were being held more securely. There were no box files within the dining area, as we found last time we visited the service, although the acting manager should look at ways in which some records can be stored in more appropriate surroundings in the office on the top floor of the building, and keep the living areas on the first two floors for the residents use only. Care Homes for Adults (18-65 years) Page 14 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service uses enjoy a more personal and fulfilling lifestyle. Changes have been made to improve outcomes, and opportunities for personal development. Evidence: There had been positive changes in peoples lifestyles since our last visit to the home. The manager told us that the people who used this service were being encouraged to become involved in household tasks, such as cooking and cleaning their rooms. This helped people to be more involved and to develop their individual skills. There were regular daily activities available. One person was involved in a gardening project within the local community. The local social club was being utilised and some people had become interested in line dancing. Some people also attended the local Mencap Club on one evening per week: this was a facility only for those with a learning disability. Daytime activities included the Rock Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: Centre, which was a work rehabilitation project in Blackpool. One person attended a traditional day facility for people who have a learning disability. The service was close to Cleveleys town centre and local facilities were regularly used. The people who used the service were known as part of the local community, and valued resources were being used to improve their community presence. Daily activities were detailed within each persons care plan and staff support was available whenever necessary. The daily staffing rotas showed that there were enough support workers on duty during the day, and in the evenings, to provide support for activities. One person told us via our survey, I like to bake and I love to go out to the club, and to the cafe. Three people were able to tell us that they could usually do what they wanted during the day and in the evenings. Friends and family were encouraged to visit The Willows, and valued relationships were supported. Although there were menus for the support workers to follow at mealtimes, the acting manager told us that the residents often chose what they would like eat, and were involved in preparation. This was positive because skills were being developed and enhance and choice was being offered. Advice regarding nutrition was available. One person told us that the meals were fantastic. Care Homes for Adults (18-65 years) Page 16 of 31 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. Health care needs and personal support are being delivered properly in a planned and measured way. Outcomes for the people who use the service have significantly improved in this area. Evidence: We saw that there were health care records within each plan, and records were made of visits by, and to, health care professionals. The local dental surgery had replied to our survey and told us that this service seeks timely and appropriate dental care, and follows any advice given. Individual health care needs were now being addressed properly, with an emphasis on ensuring that individual issues were being addressed appropriately. A good example of this was the significant changes that were being made in the mobility, diet and communication abilities of one of the residents. Although reliant on a wheelchair, steps were now being taken to improve the persons walking skills with the help of a physiotherapist. Nutritional advice had been sought and a thickening agent was no longer being used with liquids and certain foods. A speech therapist was now involved with developing the persons communication skills. The manager had communicated Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: with the day service that this person used and valuable work was being carried out both at home and within the day centre, with regular communication reports on progress. Details of this type of care were clearly written in the care plan. This type of support was clearly improving outcomes for the person involved. We observed how the support staff cared for, and spoke to the people who use the service. There was a pleasant atmosphere and individuals were being spoken to with respect, and treated with dignity. Two people were sharing a bedroom; a screen had been installed to ensure that both had privacy, and maintained their dignity when personal care was being delivered. Three people told us that the staff were pleasant, friendly and treated them well. They also told us that the care staff always listened and usually acted on what they were told. Training in areas such as medication awareness, epilepsy awareness and mandatory safety training had taken place since our last visit, giving the support workers more skills and an awareness of good practice. Most of the care staff had a nationally recognised qualification in care (National Vocational Qualification in Care level 2 or 3). During our last full key inspection we found that there were problems in the way that prescribed medication was being stored and administered. We undertook a random, unannounced inspection shortly after this, and the Care Quality Commission pharmacy inspector found that there were significant improvements. On this occasion we found that medication was being stored and handled well, and that records were clear and up-to-date. More care was being taken with controlled medication, which is medication that is closely monitored because of its strength or content. Support workers had received accredited training in this area. There had been no training in ensuring that people are moved safely and comfortably around the home. One person who lived within this service had significant mobility issues and relied on the support staff for regular help. This training should be arranged as soon as possible. Care Homes for Adults (18-65 years) Page 18 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are safer because of improved knowledge and training regarding safeguarding issues. Better ways need to be developed for people to voice their opinions and concerns about this service; the complaints procedure needs to be understood by the people who use the service. Evidence: There had been significant improvements in the availability of information regarding safeguarding issues; there were policies and procedures regarding ensuring protection within the home from both of the placing authorities, Blackpool and Lancashire. Most of the support workers had been trained in this area since our last visit to the service and had a better knowledge of safeguarding issues. The people who used the service were safer because of this. The acting manager was aware of her responsibilities and what action she needed to take should a safeguarding issue occur. There had been training for the support workers regarding understanding challenging behaviour. This is important because through a greater undertanding of trigger points the staff were more able to support individuals through difficult times. A complaints procedure was evident within the home and details about making a complaint were written in the Service User Guide and Statement of Purpose. The manager should look towards developing a system where the people who use this service can understand the procedure. There is a need for the residents to be enabled Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: to express their views on the service and any issues that they may have regarding their care. There had been trainnig for the manager and the owner of the service in deprivation of liberty safeguards. Staff were soon to complete this training. This would mean that they would have a greater undertanding of the rights of individual residents. Care Homes for Adults (18-65 years) Page 20 of 31 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 lived in a clean, warm and safe environment. Evidence: The manager and the owner showed us around the home. A lot of improvement had taken place since out last full site visit. Areas of the home had been decorated and developed and bedrooms were personalised and brighter in their outlook. It was clear that the people who used this service were being encouraged and enabled to have more control over how their personal space looked, there were pictures on most of the bedroom walls, which wasnt evident during our last visit. Maintenance tasks throughout the house had been completed and there was a more homely feeling to this service. There were areas of the home that still needed to be looked at and updated. Bathroom suites were old and in need of replacement. The acting manager told us that there were plans to redevelop these and make the bathrooms a nicer place to be. The owner of the home should ensure that the improvement in the environment is continued, and that furniture and carpets are replaced when they show signs of wear and tear. Communal areas were well decorated and spacious. One person who lived at this home had significant mobility issues and a room had Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: been converted on the ground floor for her to use. An en-suite bathroom was available and we saw that there were aids and adaptations in place, along with specialist equipment for moving her safely. The acting manager should ensure that the support workers are fully trained in operating this equipment safely. A filing cabinet had been left in the conservatory area for the storage of items. This used to be the main storage cabinet for medication. It would be good practice to look at replacing this with a more domestic, or homely cupboard. The service was clean and fresh smelling in most areas. Continence issues were being addressed regarding one person, and their room was much fresher. The rear garden was used during warmer weather, and there were chairs available for people to sit out. The acting manager told us that this area would be developed during the summer. It was a cold day and the house was warm and comfortable. Care Homes for Adults (18-65 years) Page 22 of 31 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 well trained and supported in their role. Residents are safer because of good recruitment practice and procedures. Evidence: There were enough support workers on duty whilst we were at the home to ensure that the assessed needs of the residents were properly addressed. Staffing rotas confirmed that support was good, and individual support was available at times when it was most needed. The acting manager told us that staff support had been reorganised to ensure that the support workers were employed at more appropriate times to ensure that the service ran for the benefit of those who lived there. A significant amount of training had taken place since our last visit and there was a training matrix and certificates available to show what training had occurred. A good training programme is important because staff are given new skills and knowledge to improve outcomes for the people that they support. Training in medication awareness, epilepsy and autism awareness had taken place, along with mandatory safety training. Three people who returned our surveys told us that they thought that their training and support given by the service was good. One support worker commented, We receive pretty regular training, and I feel that they give me the right skills to do the job. Most of the care staff had a nationally recognised qualification in care (National Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: Vocational Qualification in Care level 2 or 3). We could not look at the personal files of the support workers on this occasion as the key to the storage area was not available. We looked at this information during our last visit and found that recruitment and selection was good, and records were sufficient and up-to-date. All of the care staff had been properly checked before they started work. No new care staff had been recruited since we last viewed this information. It is important that this information is available for inspection at all times. Care Homes for Adults (18-65 years) Page 24 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service needs to have a manager in place that is registered with the Care Quality Commission. Management of this service has improved, which has enhanced outcomes for people who use it. Evidence: We first visited this service in July 2009 and found that the service did not have a registered manager. The owner of the service was considering managing this service but has since appointed an acting manager with a view ensuring that she is registered to manage the service. Our records show that an application has not yet been made, although the acting manager has assured us that this is in hand. As part of the inspection process we asked the owner to complete an annual quality assurance assessment (AQAA). This enables the registered person to tell us about their service, what changes and improvements have been made, and what their plans are for the future. The owner completed this and returned it to us. Unfortunately the AQAA for this service was poorly completed on this occasion and the information that was given was brief and lacking in detail. We could not, therefore, acquire an accurate Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: picture of the service and the way that this had developed. This was discussed with the owner during our visit. The accuracy and volume of information that we ask for within this document has a bearing on the fitness of the owner to run the service, and he should bear this in mind when we next ask for this document to be completed. The owner of the service visits on a regular basis and is in full contact with the acting manager and support workers to provide advice and assistance. Ways need to be explored as to how the people who use the service can have a greater say in how the home is run, and that there best interests are being addressed. This may be with the help of the advocacy service. As the care planning process becomes more person centred the service will evolve to take into account personal views and concerns. The policies and procedures that help the acting manager and support workers to provide a good standard of support have been updated and improved. The acting manager and the owner were not aware of their responsibility regarding notifying the commission of important and significant events, such as outbreaks of illness, accidents, staffing issues, or any changes in the management structure. There should be an awareness of regulation 37 of the Care Standards Act and how this affects the home and the responsibility of the registered person. The acting manager of the service showed us the changes and improvements that have been made since our last full inspection activity. Changes have been significant and outcomes for those who use this service have improved. There were regular meetings for the staff team, which helped important information to be passed on to all of the team. A communication book supplemented this where regular daily information could be written down and passed on to other support workers on a daily basis. Care planning was more detailed and the plans were used daily as a tool to address personal need. Each plan had good information on the needs of each resident, which enabled the care staff to work in a more planned and constructive way. People were now being care for in a more personal way, with individual health care needs being addressed suitably. All of the people who used this had an element of risk in their daily lives. This is sometimes necessary for people to experience life and achieve goals. We found that risk was recorded and assessed properly so that the support workers were aware of what action to take within a given situation to minimise danger. There were certificates to show that competent, trained people had checked the fire alarm, gas systems, electrical installations and lifting equipment. There were also yearly checks to the fire safety equipment and water supply. This helped to ensure that the service users lived in a safe environment. The service was properly insured to help ensure that the people who use the service were protected. There had been training in safety issues, such as infection control, food hygiene and health and Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: safety. This helped to ensure that people lived in a safer home. To conclude, the service was being managed more successfully than on our first visit to the service in July 2009 and a significant amount of good work has been achieved, for the ultimate benefit of the residents of this service. There are still goals to achieve and a careful eye needs to be kept on the service by the owner to ensure long term and sustained improvement. Care Homes for Adults (18-65 years) Page 27 of 31 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 28 of 31 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 1 37 37 The registered person must notify the Commission of significant events that occur within the service. This is so that we can get a complete and accurate picture of what is occuring within the service. 31/03/2010 2 42 13 Moving and handling training 30/04/2010 must take place for all care staff and be repeated on an appropriate basis to remain aware of current good practice. This is to help ensure that people are moved confidently and safely around the home. Care Homes for Adults (18-65 years) Page 29 of 31 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 1 Information provided about the service should be in a suitable format. People who are using the service or are interested in living at the home must have information that they can understand in order to make an informed choice. 2 37 The acting manager should be registered with the commission as soon as possible to help ensure the smooth running of the service. Information required by the Commission as part of the inspection process must be completed fully and accurately. This is to help ensure that the Commission has a clear picture of current and future developments within the service. 3 37 Care Homes for Adults (18-65 years) Page 30 of 31 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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