Care Home: Tony Long House

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What the care home does well Information was available in a statement of purpose and service user guide so that people could make an informed decision about where they lived. People`s individual needs and aspirations were fully assessed so that their needs could be met. Each person had a statement of terms and conditions and a contract so they knew what they had to pay for. People`s assessed needs were reflected in care and support plans and reviewed and changed as necessary so that their diverse needs would be met. People were assisted to make decisions about their lives. People were supported to take risks to promote their independence. People had opportunities to be part of the community and to take part in appropriate day time and leisure activities. People maintained relationships with their family and friends. People`s rights were respected and their responsibilities were recognised in their every day lives. People were offered a healthy diet and enjoyed their food. People received personal support in ways that they preferred and needed. Their physical and emotional health needs were being met. The arrangements for managing and recording medication helped to ensure that people were protected. There was a complaints procedure and people`s views were listened to and acted upon. There were policies and procedures about safeguarding adults and staff received appropriate training. This helped to protect people from abuse, neglect and self harm. The lounge was large with a dining area and there was a kitchen with adjustable work surfaces so that people could use them more easily. Each person had a single room which was individually decorated and furnished. Each bedroom had an ensuite shower and toilet and there were adaptations to support people. The laundry facilities were separate from food preparation areas and each person`s laundry was washed separately. People lived in a homely, comfortable, clean and hygienic environment suited to their needs. People were supported by an effective staff team, who were appropriately trained, qualified and competent to meet people`s needs. People were on the whole protected by the home`s recruitment practices. The manager was appropriately experienced and was working towards an appropriate qualification. They were in the process of applying to become the registered manager and they have not yet been approved as a fit person to manage the home. The manager had made several improvements since the last inspection and people were benefiting from a well run home. There was a quality assurance system and people`s views were collected using questionnaires and during meetings. People`s views underpinned all self-monitoring, review and development by the home. There were comprehensive health and safety systems and measures so that people`s health, safety and welfare were promoted and protected. What has improved since the last inspection? Each person had begin given a copy of the service user guide so that they knew what they could expect from the service. A copy of the statement of purpose had been made available to all enquirers and a copy was available in the front hall. Risk assessments had been reviewed and revised as people`s needs changed so that people were kept safe. Information about how to manage some behaviours had been included in one person`s care plan and this was being reviewed and revised as needed so that their behaviour and needs were understood. Information about complaints had been removed from the front hall so that people`s privacy was respected. However, information about how to make a complaint had been put on display in the front hall so that people knew how to complain. Staffing levels had been reviewed and more staff were on duty at busy times. The manager was devoting more time to management of the home and this has enabled her to make improvements to the running of the home. The manager was in the process of applying to become the registered manager so that she could be approved as a fit person to run the home. What the care home could do better: People who use the service must have their risk of pressure damage regularly assessed to reduce any risk of developing pressure sores. Improvements need to be made to the way that changes to the medication administration records are recorded to make sure that people get the right medication at the right time. The registered person should make sure that the controlled drugs cabinet meets the current storage regulations (The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007), so that any controlled drugs prescribed can be stored safely. A record should be kept of the date when staff start to work with people. This will make it possible to tell whether the new staff have received all the recruitment checks before they start to work with people so that people are kept safe. Key inspection report Care homes for adults (18-65 years) Name: Address: Tony Long House 18 Shaplands Casson Road Swindon Wiltshire SN3 4FF     The quality rating for this care home is:   two star good 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: Elaine Barber     Date: 2 4 1 1 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 30 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 30 Information about the care home Name of care home: Address: Tony Long House 18 Shaplands Casson Road Swindon Wiltshire SN3 4FF 01793821791 01793831694 hannah.lee@sanctuary-housing.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Sanctuary Care Ltd care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users that can be accommodated is 6. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the care home are within the following category: Physical disability (Code PD) Date of last inspection Brief description of the care home Tony Long House is a large purpose-built home in a residential area of Swindon. The home is in keeping with other buildings in the area. Tony Long House provides accommodation for six people who are physically disabled. The home is run by Sanctuary Care Ltd and there is currently a new manager who has not yet been approved as the registered manager. Each person has a large single bedroom and a large ensuite toilet and shower room. There are hoists and equipment in the rooms to assist people. Information about the home is available in a statement of purpose and service user guide. Care Quality Commission inspection reports are available in the home or from our website www.cqc.org.uk. Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 6 1 5 1 0 2 0 0 8 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We asked the home to complete an Annual Quality Assurance Assessment, known as the AQAA. This was their own assessment of how they were performing. It also gave us information about what has happened during the last year, and about their plans for the future. We sent out surveys so that these could be completed by the people who lived in the home and by the staff. We had surveys back from five people who lived in the home and five staff members. We also received a survey from a health care professional. We looked at all the information that we had received about the home since the last inspection. This helped us to decide what we should focus on during our inspection. We visited the home on the 24th of November 2009. We talked to the deputy manager, two members of staff and a community nurse. We looked at some of the homes records and talked to three people who lived in the home and asked them about their experience of living in the home. We spoke with the manager in a phone call following our visit. Care Homes for Adults (18-65 years) Page 5 of 30 The judgments contained in this report have been made from all the evidence gathered during the inspection, including the visits. The last inspection of the home was on 15th October 2008. Care Homes for Adults (18-65 years) Page 6 of 30 What the care home does well: What has improved since the last inspection? Each person had begin given a copy of the service user guide so that they knew what Care Homes for Adults (18-65 years) Page 7 of 30 they could expect from the service. A copy of the statement of purpose had been made available to all enquirers and a copy was available in the front hall. Risk assessments had been reviewed and revised as peoples needs changed so that people were kept safe. Information about how to manage some behaviours had been included in one persons care plan and this was being reviewed and revised as needed so that their behaviour and needs were understood. Information about complaints had been removed from the front hall so that peoples privacy was respected. However, information about how to make a complaint had been put on display in the front hall so that people knew how to complain. Staffing levels had been reviewed and more staff were on duty at busy times. The manager was devoting more time to management of the home and this has enabled her to make improvements to the running of the home. The manager was in the process of applying to become the registered manager so that she could be approved as a fit person to run the home. 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 8 of 30 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 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had the information that they needed to make an informed decision about whether the home was the right place for them. Peoples needs were assessed so that their needs would be met. People had contracts and statements of terms and conditions so that they knew what they had to pay for and their interests were safeguarded. Evidence: The manager told us in the AQAA that the home has a statement of purpose and a philosphy of care. They said that these documents gave clear guidelines about how staff would support people. We made a requirement at the last inspection that people who use the service must be given a copy of the service users guide. The deputy told us that each person is given a copy of the service user guide and has a copy in their room. When we looked at the records we saw that some people had a copy of the service user guide in their personal file. The manager told us in the AQAA that they planned to put the service user guide into different formats over the next twelve months to make it more Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: accessible to people. We made another requirement at the last inspection that a copy of the homes statement of purpose must be made available to all enquirers so that they know what the home provides. We saw that a copy of the statement of purpose was displayed on the notice board in the hallway. When we looked at the statement of purpose we found that it did not contain all the required information, for example, the qualifications and experience of the registered manager and registered provider. However, it provided most of the information required by the Care Homes Regulations and National Minimum Standards. We saw that the service user guide contained all the required information for a guide. It also contained the information that was missing from the statement of purpose. Between them the two documents contained all the required information so that people would know what the service offered. Five people completed surveys. They all said that they had been asked if they wanted to move into the home and they got enough information before they moved in so that they could decide if it was the right place for them. We looked at the personal files. We saw that two people had assessments of their needs by social workers. One of these people was having a short stay for respite care. A third person had notes from a review meeting which contained information about their needs. The deputy told us that staff updated peoples assessments when they came in for respite as peoples needs changed between visits. We saw that three people had contracts with Swindon Borough Council and Tony Long House. They had signed the contracts to show their agreement with them. The three people also had statements of terms and conditions from Tony Long House. Two of these people had signed their statements of terms and conditions. Care Homes for Adults (18-65 years) Page 11 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have their care and support needs set out in an individual care plan so that their needs will be met. People make decisions about their daily lives. Most risks are assessed and action is taken to reduce risks and promote independence. Evidence: The manager provided information about care planning in the AQAA. They said that each person had a comprehensive person centred plan that reflected their needs aspirations and goals. We looked at the care plans of three people. Each person had a detailed care plan including their daily routine. Each person had signed their plan and the plans were reviewed about every six months and the dates were recorded. The care plans included the aims and objectives, any limitations and risk assessments. There was information about any personal care needs, medication, mobility, manual handling needs, use of equipment, finances, social care needs, emotional needs and advocacy. Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: We spoke to a community nurse who told us that this was very much peoples home and they were able to decide what they wanted to do each day. Five people completed surveys. Four people said that they always made decisions about what they did each day and one said that they sometimes made decisions. They all said that they could do what they wanted during the day, the evening and at weekends. When we looked at the records we saw that peoples choice of meals and activities was recorded. The activities records showed that people chose to spend time in the lounge chatting and watching television or in their rooms. We observed people spending time in the lounge during the day of our visit. We saw that peoples preferred daily routine and their choice of times for getting up and going to bed was recorded in their care plan. One person told us that they were a member of a self advocacy group. Another person had a car and staff supported them to go out independently. We made a requirement at the last inspection that risk assessments must be reviewed and revised as needs change, so that peoples changing needs are noted and they are protected from harm. We saw that each person had a series of detailed risk assessments and the dates of reviews were recorded. There were also manual handling assessments and health and safety risk assessments. These contained information about the risks and the control measures to reduce risks. We made another requirement that behaviour management strategies must be in place and regularly reviewed. This was so that any behaviours are understood and action is taken to minimise them. We saw that one person had a record of behaviours and there was information about how to manage these behaviours included in their care plan. This was being reviewed regularly and the date was recorded. We made a further requirement that people must have their risk of developing pressure damage regularly assessed to reduce any risk of developing pressure sores. The deputy manager told us that staff monitored pressure areas but there were no formal risk assessments about pressure damage. Care Homes for Adults (18-65 years) Page 13 of 30 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. People have opportunities to access the local community and to have leisure activities of their choice. People are supported to keep in contact with their family and friends. People are offered a healthy diet and enjoy their food. Evidence: The manager told us in the AQAA that each service user is supported to have a lifestyle that meets their aspirations and goals. One person told us that went to a day centre. When we looked at the care plans we saw that this person and one other went to this day centre. One person had a National Vocational Qualification at level II and wanted to go to work. The deputy told us that staff were helping this person explore options for work. The statement of purpose and service user guide stated that visitors were welcome in the home at any time. The manager told us in the AQAA that people were supported Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: to keep in contact with their families and friends. When we read the files we saw that peoples contact with their family and friends was recorded in their care plans. The deputy told us that they held quiz and bingo nights about once a month. They said that families visited them and joined in. We saw from the records that families visited regularly. During our visit three relatives visited different people. The manager told us in the AQAA that strong links with the community have been developed. During our visit a beautician came to see people. The deputy told is that a hair dresser visits as well. One person told us that they liked to go out socially and they liked to go to football matches. The deputy told us that staff took people out for meals and they would be taking people out for Christmas dinner. They said that staff take people out on their birthdays. One person was going on holiday at Christmas time. The deputy also told us that staff members took people into town to do their personal shopping. We saw that one person had a car and the deputy told as that staff or their relatives took them out in their car. When we looked at the records we saw that people had various leisure activities. There had been a bonfire party on November 5 and a bingo night on 27 October. A Christmas party was planned for 22 December and all the families had been invited. The deputy told us that staff took people shopping into town and they also took them for days out. An outing was planned for the following Thursday. During our visit we saw that people spent time in the lounge socialising and sometimes watching television. Five people told us in their surveys that they always make decisions about what they did each day. They said that they could do what they wanted during the day, the evening and at weekends. The manager stated in the AQAA the routines of the home promoted independence and choice according to peoples person centred plans. The deputy told us that people like to be involved in the daily routines of the home such as tidying and organising their rooms. They said that some people like to make drinks and we saw one person making drinks during our visit. They also said that people like to help with baking and also like to be there when staff prepared food. They told us that one person liked to do the recycling and another person liked to put out the rubbish. During our visit, we saw one person doing the recycling and the other person putting out the rubbish. There is information in the AQAA to say that people were involved in planning the menu on a daily basis and meals were provided according to cultural and dietary needs. The AQAA also said that staff advised people about a healthy diet. It said that snacks and fruit were available throughout the day. During our visit the deputy told us that people help to choose the menu. We saw that peoples choice of food was Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: recorded in their care plans. We also saw that there was a varied menu and there was a choice of meals at lunchtime and breakfast. The deputy told as that healthy eating was promoted to help people stabilise their weight. During our visit we saw people enjoying their lunch and teatime meals. Care Homes for Adults (18-65 years) Page 16 of 30 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 health care needs were generally being met. People were on the whole protected by the arrangements for medication but some attention was needed to the records so that people were kept safe. Evidence: When we looked at the care plans we saw that these included information about how people like to be supported. The manager told us in the AQAA that staff supported people to have annual checks for example with the dentist, optician and audiologist. We saw that records were made in the daily notes of appointments kept with healthcare professionals. We saw that people had appointments with the GP, consultants, district nurse, occupational therapist, dentist, optician and chiropodist. During our visit we spoke to a community nurse who was visiting. She told us that the staff worked well with the community nurses and called them appropriately. She said that staff made sure that peoples health care needs were met. She visited weekly and was able to monitor whether peoples health care needs were being met. A healthcare professional who completed a survey said that the home usually sought advice and acted upon it to meet peoples health care needs and improve their well being. They also said that staff always had the right skills and experience to meet peoples social Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: and healthcare needs. We made a requirement at the last inspection that people who use the service must have their risk of developing pressure damage regularly assessed. When we looked at the files we saw that there were no risk assessments about pressure damage. The deputy told is that two people had risk of developing pressure sores and were seen weekly by the community nurse. They said that records were kept of this in the community nursing notes. They told us that each person was monitored on a daily basis and staff checked people daily but there was no assessment of risk. We saw that there was information in the personal files about the medication which each person took. We saw the medication was stored in a locked cabinet. It was not clear whether this met the requirements for the storage of controlled drugs. A monitored dosage system was used. No controlled drugs were prescribed at the time of our visit. Three people who lived in the home permanently had printed medication administration record sheets. These contained a record of medication received into the home and administered to people. These were on the whole well recorded. Medication was administered by one member of staff and witnessed by a second member of staff. A separate record sheet was kept by the member of staff administering the medication and by the member of staff who witnessed the medication. Some medication was recorded as directed but there was no information about what this meant. One person was staying in the home for a short stay. They had a handwritten medication administration record sheet this was dated but it was not signed by the member of staff who had completed it and it was not witnessed. Each person had a medication care plan if they took any medication for a short time. There was a separate record of medication returned to the pharmacist. The health care professional who completed a survey said that the home always supported people to administer their own medication or managed it correctly where this was not possible. Care Homes for Adults (18-65 years) Page 18 of 30 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 knew to make a complaint and their complaints would be taken seriously and acted upon. People were safeguarded from abuse. Evidence: When we looked at the statement of purpose and service user guide we saw that these contained information about the complaints procedure. These documents were displayed in the front hall and were accessible to people. There was also more detailed information about the complaints procedure in a folder in the front hall. We made a requirement at the last inspection that the complaints log must not be publically displayed. This was to respect peoples privacy and confidentiality so that people were not inhibited from making a complaint. This had been addressed and no information about individual complaints was kept on display. Another requirement that the organisations complaints policy and procedure must be made available in the home had also been addressed. The organisation had conducted a survey of peoples views about the service by sending them questionnaires. When we read these questionnaires we saw that each person knew how to make a complaint and they had a copy of the complaints procedure in their room. These people had also completed survey forms for our inspection. They told us that they knew who to speak to if they were unhappy and they knew how to make a complaint. The deputy told us that there had been no complaints since the last inspection. Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: We saw that there was information about safeguarding vulnerable adults in the front hall. We also saw that there was a leaflet about No Secrets, the local procedures about safeguarding vulnerable adults, in the office. The deputy told us that staff had in-house training about how to safeguard people. When we looked at the training records we saw that staff received training about protecting vulnerable adults as part of their induction. This training was also updated annually. Five staff who completed surveys told us that they knew what to do if someone was concerned about the home. The deputy told us that there had been no safeguarding issues. Most people looked after their own money. Staff only kept money on behalf of two people. The money was kept in a safe and records were kept of all transactions, with receipts. Two staff signed the records when the money was given to the person or an item was bought on their behalf. Care Homes for Adults (18-65 years) Page 20 of 30 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 homely, comfortable,clean environment suited to their needs. Evidence: The deputy told us that the home had been refurbished since the last inspection. When we looked around the home we saw that there was new decor in all areas. There were new carpets and flooring in the communal areas, the bedrooms and shower rooms. There was a large lounge where people were sitting. This had been decorated ready for Christmas and looked very homely. There was a large accessible kitchen with adjustable work surfaces so that people could use them easily. Everyone had their own bedroom with a large ensuite shower and toilet. The bedrooms were individually decorated and furnished according to each persons choice. The bedrooms contain adaptations such as overhead hoists and adjustable beds to suit the needs of the people using them. We saw that there was a separate laundry room. The deputy told us that each persons laundry was washed separately and the colours were sorted so that they did not run. There was information for staff about control of infection. Alcohol gel was available for visitors to stop the spread of infection. We saw that the house was clean throughout. Care Homes for Adults (18-65 years) Page 21 of 30 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 were receiving support from staff who were appropriately trained and qualified. The recruitment processes on the whole protected people from being cared for by unsuitable staff. Evidence: We made a requirement at the last inspection that staffing levels must be appropriate to the needs of the people who use the service and other responsibilities that staff are expected to undertake. This was so that people who use the service could receive the care, support and social experience that they had been assessed as needing. The manager told us in the AQAA that the organisation had reviewed the staffing levels at the end of 2008. They also told us that they had recruited more skilled staff. The deputy told us that there are either two or three staff on duty during the day so that there was an additional member of staff at busy times. When we looked at the rota we saw that there were two or three staff on duty during the day and two staff sleeping in at night. A community nurse who completed a survey told us that the staff knew each person well, including all the people who have respite care. They also told us that staff were good at meeting peoples needs. When we looked at the staffing records we saw that there were 11 care staff including the night staff. Nine of these staff had a National Vocational Qualification (NVQ) level Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: II in care. The two new staff did not have an NVQ. We saw that there was an induction checklist for each new member of staffs induction into the company. As part of induction staff received training about health and safety, food hygiene, manual handling, fire safety and protection of vulnerable adults. There was additional training about dementia, death and dying, challenging behaviour, promoting continence, control of substances hazardous to health (COSHH)and medication. Protection of vulnerable adults training was updated annually. We looked at the recruitment records of two new staff. Both of these staff had completed an application form which contained a declaration that they had no offences and they had not been referred to the protection of vulnerable adults (POVA) list. One of the staff had two written references before their start date of 31st August 2009. However, their POVA first check was not received until 7 September and their criminal records bureau check (CRB) was not received until 29th September. The Deputy told us that this member of staff would not have started work until their POVA first check was received. It was not clear from the records when this member of staff started to work with people. The records showed that the second member of staff had two written references, a POVA first check and a CRB check before they started work. The original CRB checks were kept at head office and each member of staff had a letter from head office to say that a clear CRB check had been received with the disclosure number. Each member of staff had a copy of their passport kept as proof of identity. Care Homes for Adults (18-65 years) Page 23 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was being run by a manager who was appropriately qualified and experienced. They were in the process of applying to become the registered manager so that they could be approved as a fit person to run the home. There was a quality assurance process and peoples views were obtained so that the home was run in their best interests. Peoples health, safety and welfare were promoted by the health and safety measures. Evidence: We made a requirement at the last inspection that the proposed manager must progress their application to register as manager in order to comply with registration requirements. We found that the previous manager had since left and a new manager, Julie Williams, had been appointed. The deputy told us that this new manager had an NVQ level III in care and was undertaking an NVQ level IV in leadership and management of health and social care. We spoke to the manager on the phone after our visit and they confirmed that they were completing the management qualification and that they kept their training up to date. They told us that they were in the process of making an application to become the registered manager. During our inspection we Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: found evidence, described elsewhere in the report, that the new manager had improved the management of the home. We made another requirement that the manager must have sufficient time allocated to managing the home. This was so that the aims and objectives of the organisation, improvements to the service, administrative duties and other responsibilities could be achieved. The deputy told us that the manager spent about half their time on management tasks and half their time on care tasks. When we spoke to the manager on the phone they told us that they spend less and less time on care. They also told us that they had been allocated another 66 staffing hours which would enable them to recruit two more members of staff. This would mean that they had even more time to spend managing the home. The manager completed an AQAA and sent it to us before the inspection. The AQAA was completed fully and contained all the information that we asked for. The deputy told us that there were monthly service quality audits and an annual service quality audit was completed in October 2009. We saw a copy of this and it included reference to the findings of service user surveys. The deputy told us that they had recently conducted a survey of peoples views. We saw surveys that have been completed in September and October 2009 but a report of the findings from the surveys had not yet been completed. The manager told us in the AQAA that there were regular service user meetings where people could comment and make suggestions about the running of the home. We made a requirement at the last inspection that the monthly reports on the conduct of the home must be sent to the home and to the Commission, as required by Regulation 26. This was so that all aspects of running the home are being appropriately monitored. The manager told us in the AQAA that regulation 26 visits were taking place monthly. Reports of these visits were being kept in the home. There was a health and safety policy. We saw that each person had a health and safety risk assessment in their file. There was also a record to show that health and safety information had been explained to each person. We saw records of safety checks for hoists, slings, beds, bed rails and wheelchairs. We saw that there were accident records and monthly monitoring of accidents. There was an annual health and safety audit and there were monthly health and safety checks of the building. There was a gas safety certificate and records of testing of the water supply for Legionella. There were records to show that portable appliances had been tested. Radiators were covered and there were thermostatic Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: valves on taps. Water temperatures were taken and recorded monthly. The deputy told us that the staff took temperatures of the water before people showered. There was a fire risk assessment and there were records to show that the required fire safety checks were taking place. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 19 13 People who use the service 12/12/2008 must have their risk of developing pressure damage regularly assessed. To reduce any risk of developing pressure sores. Care Homes for Adults (18-65 years) Page 27 of 30 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 19 13 People who use the service 08/01/2010 must have their risk of developing pressure damage regularly assessed. To reduce any risk of developing pressure sores. 2 20 13 When medication is dispensed with the instructions As directed staff must refer back to the prescribing doctor to obtain full directions. 08/01/2010 So that people get the right medication at the right time. 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 19 When a member of staff makes a written addition to the medication administration records they should sign the record and a second member of staff should witness the addition and sign the record to confirm that it is correct. Page 28 of 30 Care Homes for Adults (18-65 years) 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 So that people have the right medication at the right time. 2 19 A registered person should make sure that the controlled drugs cabinet meets the current storage regulations (The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007), so that any controlled drugs prescribed can be stored safely . A record should be kept of the date when staff start to work with people. This will make it possible to tell whether the new staff have received all the recruitment checks before they start to work with people so that people are kept safe. 3 34 Care Homes for Adults (18-65 years) Page 29 of 30 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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