Care Home: Touchwood

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What the care home does well Anyone who was considering moving into the home would have their needs assessed and would be supported with the move at their own pace. People who live in the home are supported to take risks as part of an independent lifestyle. People who live in the home are enabled to participate in activities which interest them and to be part of the local community. People are supported to maintain contact with family and friends who are important to them. Staff who work in the home respect each person`s rights and responsibilities to lead the life they want to. People are supported to maintain a healthy diet and make choices about the food they eat. Person centred approaches to care mean that individuals receive the care they need and want in the way they prefer. Staff enable people to receive the physical and emotional support they need to live their life safely. The home has a medication policy and practice which enables people to have control of managing their medication if they wish. People who live in the home know who to talk to if they are unhappy and they know their concerns will be listened to and acted upon. Staff are trained to understand how to protect people from harm. The home is comfortable,safe and clean. Staff who work in the home are qualified, skilled and understand the needs of the people they support. Recruitment practice ensures that vulnerable people are protected. Staff receive the training they need to do the job well. The views of people who live in the home is used in its development. The health,safety and welfare of people living in the service is promoted and protected. What has improved since the last inspection? At the end of the key inspection in 2007 there was one requirement and four recommendations. The manager registered with the commission. Care plans are written in an accessible format for the individuals who use the service. This means they are involved in developing their own plans. All staff who work in the home receive safeguarding training which means they understand how they should protect people from harm. The home is working towards everyone achieving at least level two in the national vocational qualifications. All staff working in the service receive supervision which means that the manager has a good understanding of how staff are performing. What the care home could do better: At the end of this inspection there are no requirements and only one recommendation. People who use the service should be supported to manage their own finances if they wish. Key inspection report Care homes for adults (18-65 years) Name: Address: Touchwood 13 Somerset Road Christchurch Dorset BH23 2ED     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Tracey Cockburn     Date: 2 3 0 9 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 28 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 28 Information about the care home Name of care home: Address: Touchwood 13 Somerset Road Christchurch Dorset BH23 2ED 01202487575 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: touchwoodcare@aol.com Principle Care Ltd care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: One named service user (as known to the Commission for Social Care Inspection) under the age of 18 may be accommodated. Date of last inspection Brief description of the care home Touchwood is a care home situated in a residential area close to the centre of Christchurch. The home was first registered in April 2004 and provides support, accommodation and personal care to a maximum of five people with learning disabilities. The registered provider is Principle Care Ltd who also owns two other care homes in the area. The house is domestic in size and is in-keeping with neighbouring properties. There is a large garden at the rear and some parking on the front driveway. The home provides five bedrooms, all with en-suite bathrooms. One bedroom is situated on the ground floor and the remaining four bedrooms are on the first floor. There is a lounge with dining area and a kitchen. There is also a fully equipped laundry/utility room, a staff sleep-in room and a small office. The home has its own vehicle to support people with accessing their community. The home is also close to a bus stop, which offers routes into Christchurch town centre, Boscombe and Bournemouth. The home is staffed on a 24-hour basis with one waking night member Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 5 Brief description of the care home of staff and one sleep-in duty each night. The current weekly residential fees at Touchwood ranged from #1250 - #1733 per week inclusive of day care. Also included in the fee are basic toiletries and medical requisites, provision of transport by the home and holidays. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We visited the service without warning. We used an expert by experience to help us find out what life is like for people who live in the home. We sent out survey forms to get peoples opinion of the service. We looked at care records, recruitment files and audits. We spoke to people who live there. We spoke to staff. Care Homes for Adults (18-65 years) Page 6 of 28 What the care home does well: What has improved since the last inspection? At the end of the key inspection in 2007 there was one requirement and four Care Homes for Adults (18-65 years) Page 7 of 28 recommendations. The manager registered with the commission. Care plans are written in an accessible format for the individuals who use the service. This means they are involved in developing their own plans. All staff who work in the home receive safeguarding training which means they understand how they should protect people from harm. The home is working towards everyone achieving at least level two in the national vocational qualifications. All staff working in the service receive supervision which means that the manager has a good understanding of how staff are performing. 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 28 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 28 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 who may be considering using the service have the information they need to choose a home which will meet their needs. Evidence: No new admissions to the home since the last key inspection in 2007. We spoke to the manager about transitions into the home, especially as one person is in the process of moving on. The manager told us they are very aware of the importance of getting transitions right and involving other people in the home in the decision making. The annual quality assurance assessment submitted by the home says: The Service User Guide and Statement of Purpose give prospective Service Users the opportunity to access information about Touchwood and what we provide, both of these are made available on initial contact. A fully coordinated approach to admission is the aim for each Service User. The Home Manager is responsible for carrying out a pre admission assessment to identify the needs of the Service User and to ensure they can be met, this would include the provision of any specialist equipment should it be needed prior to admission.Staff would also be made aware of any specialist care and if Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: necessary training in this area would be arranged.The contract, including fees charged, what they cover and the cost of facilities not covered by fees and the terms and conditions of the home will be clearly explained to prospective service users and wherever possible a choice of room would be offered. No Service User will be admitted against their wishes. The transition into the home can be as long as it takes for the Service User to feel comfortable in their surroundings, this will consist of several visits to the home and will include meals, overnight stays, weekends and involvement in activities.The transition will highlight any queries or concerns and these will be addressed at the time they are brought up. Details of the Service Users life history will be gathered and the information recorded appropriately to build an individualised care plan with them to suit all personal needs and preferences. Any necessary restrictions are agreed with the client and they would be requested to sign written agreements. Current service users are encouraged to air their views regarding prospective new comers and also will be involved in their welcoming to the home. Care Homes for Adults (18-65 years) Page 11 of 28 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 are enabled to make decisions about their life and play an active role in planning the care and support they receive. Evidence: We looked at the records for two people who use the service. The annual quality assurance assessment says: All Service Users are encouraged to participate in the day to day running of their home, house meetings are held each Sunday and during this time service users are given the opportunity to express their views and meal choices for the forthcoming week. Staff ensure that Service Users are familiar with the complaints procedure and that they know who to talk to should they need to. Where service users have limited communication, information would be sought from relatives and healthcare professionals and if necessary an advocate in order to promote choice to the highest level. Service Users are encouraged to make informed decisions about their welfare and in working with them we can develop a care plan involving aims and objectives, giving them the opportunity to express goals and aspirations with monthly monitoring to see if these are met. We recognise that all Service Users have the right Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: to make decisions and staff provide the necessary assistance to help them do this, if decisions are made by others in a best interest situation this would be recorded and the reasons why. Details of advocacy groups are made available to service users should they wish to access this facility. Service Users are supported to manage their own finances wherever possible and the level of support is detailed in their Individual Care Plan and is risk assessed. Risk Assessments and any other restrictions are clearly explained to all service users and discussed before they are asked to sign in agreement. Service User confidentiality is respected at all times and information about them and will only be accessed on a need to know basis The expert by experience told us in his report: When I arrived I was greeted in a warm and friendly manner by one of the residents. He also wrote about care plans in his report, this is what he said: They have their care plans reviewed monthly with their keyworker. The residents write their care plans with their keyworker. One of the residents showed me their file with their care plan. It was very detailed and person centred. From the way he was showing me his file and plan I knew he understood it. The residents risk assessments are also reviewed monthly. A recommendation was made at the last key inspection that plans should be in a format that each person could understand and that they should keep their own plans. People we spoke to choose to keep their plans in the office which is accessible to them and where they can look at them when ever they want. We found the care plans were clear, person centred and focussed on the individual in a positive way. One person had an identified goal as working on my behaviour In the two plans we looked at both were very different and very individual and detailed the support people needed to keep safe and information staff need to support people in taking responsibility for their behaviour and managing their anxieties and frustrations. We looked at the minutes of meeting held in the home were people are able to express their wishes about decisions being made inthe home from meals each week, to activities and decor. The manager told us how people are supported to make decisions in their life and how they support people in using advocates as well as using the guidance and expertise of other health care professionals. There is only one person living in the home who manages their own finances with the support of staff. The other people in the home have their finances managed by relatives. Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: There are risk assessments in place to support people both in the home and out inthe wider community. Theses assessments are reviewed with the individual. We looked at several risk assessments relating to accessing the kitchen, finances, abuse and challenging behaviour when in the community. Care Homes for Adults (18-65 years) Page 14 of 28 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 who use the service are able to make choices about their life style and are supported to develop their life skills. Evidence: The annual quality assurance assessment says: Each Service User has an individual timetable on file and in their rooms highlighting the activities they choose to fulfill on a weekly basis, they are encouraged to request activities they may choose to do in addition to these during the house meetings. This is recorded and staff aim to ensure this is included in the weeks activities. Improvements Staffing is more structured and the key workers play a much more active role in Service Users care planning, we have found that service users are much more willing to try new activities when interest is highlighted based on conversation during this time. Plan for next 12 months Staff still to receive training in person centred planning. Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: The expert by experience told us in his report what he found out about activities, he said: One of the residents has lived there for four years. He said I like living here and like the staff. He does lots of things including going to college, he does cooking there. I asked if he cooked at home. He said no, dont know why I asked the staff if the residents cooked at home. I was told the home has a cook who supports the residents to prepare and cook food. All the residents make their own breakfast with support. Residents use the kitchen any time, they make their own hot or cold drinks. One resident went on a course and got an NVQ in Horticulture. He is now contacting gardening firms to apply for jobs. There is no set time for residents to go to bed, they decide. The expert by experience also wrote in his report about how people are supported to make decisions he said: Staff said they were concerned about one of the residents as they did not feel he was making his own choices. They asked him if he would like an advocate and Dorset Advocacy were contacted. He got an advocate very quickly and he told me he likes working with her. There is a camera in the home which is used whenever people go out so they can take a pictoral record of the activities people particicpate in, and the pictures can be put in each persons personal portfolio. The photographs are also used in communication, one person has a booklet of photographs with pictures of places he goes to such as the day centre or the supermarket. The manager explained that one person used to be uphappy whenever they went out in the car, through using pictures staff found out that they were not taking him were he wanted to go and now they use the photographs of different places he likes to find out where he wants to go. The person is no longer being frustrated because of poor communication. The manager said the staff are working with the individual and together as a team to develop the photocards. One person who lives in the service has mobility allowance and through that has a car but only limited access to the car which is kept somewhere else. The person should have access to the car on a daily basis to enable them to live the life they want to. Care Homes for Adults (18-65 years) Page 16 of 28 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. The health and personal care that people receive is based on their individual needs. the principles of respect, dignity and privacy are put into practice. Evidence: The annual quality assurance assessment says: Privacy and dignity are respected throughout the process of supporting Service Users with their personal care. We consider it essential that Service Users independence is promoted to a degree that they feel in control of their lives. Individual care plans are designed with the service user to tailor each individuals needs and choices, support is person specific. All service users are registered locally with a GP and we have appropriate in put from other healthcare professionals as required. We looked at the support plans for two people, there was evidence that they are attending medical appointments. There is also information on each file about health care professionals involved with each person such as GP, dentist, optician, speecha dn language therapist. The manger told us they have a good working relationship with the community nurse who has responsibilities for four people who live in the home. There is a section of the support plan which details when someones next appointment Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: with the optician or podiatrist is or their next appointment with the dentist. There is also information on how people need to be supported when they see health care professionals as this can cause anxiety for some people. We looked at medication which is stored in a locked metal cabinet in the office. Each person has medication in a monitored dosage system supplied by a local pharmacy. At the time of the inspection no controlled drugs were beign used by anyone living in the home, however the home has a controlled drugs cabinet should the need arise. The medication is audited every week and the pharmacy completes an ausit twice a year. The manager said staff had risk assessed the use of a red tabard when dispensing medication. We looked at the medication administration record, two people sign the record the membr of staff dispensing and the member of staff reading. We found that any medication which is given as and when needed (PRN) was clearly recorded in the care plan. Care Homes for Adults (18-65 years) Page 18 of 28 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 who use the service are able to express their concerns, have access to a complaints procedure and are protected from harm. Evidence: The annual quality assurance assessment says: Service users are encouraged to voice how they would complain and who they should complain to should they feel the need to do so during the weekly house meeting. We have a clear, precise and effective complaints procedure and a timescale for the procedure. The home holds a policy on Safeguarding of vulnerable adults and we ensure that all service users are safeguarded from all forms of abuse. The home promotes its whistleblowing policy and all allegations and incidents of abuse are taken seriously and the guidelines followed. New staff members are only recruited after a CRB disclosure has been received and two references. we are currently formatting a service user friendly complaints form All new staff to receive SOVA training within the induction timescale A recommendation was made at the last key inspection that the service continue to source safeguarding training for staff, this has been addressed and all the staff who work in the home have completed safeguarding training. Care Homes for Adults (18-65 years) Page 19 of 28 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. The physical design and layout of the home enables people who use the service to live in a safe,well maintained and comfortable environment which encourages independence. Evidence: The annual quality assurance assessment says: The home exceeds the national minimum standards for room sizes and facilities available in the home, all service users have an en suite facility. The home is warm, comfortable and well maintained. The home is kept clean, hygienic and free from offensive odours. The home holds a policy on infection control and all staff are trained in the promotion of this. Risk assessments are also in place in order to minimise risk. The majority of furniture and fittings are clean and in good order. All electrical equipment is PAT tested yearly and all fire safety procedures are followed and recorded appropriately.We have weekly monitoring of the environment through water temperature checks, fire , kitchen which is recorded and checked by Senior management on a monthly basis. Extensive recording of all areas concerning environment, in particular health and safety. On going replacement of equipment and repairs. Records kept of work in progress The carpet in the home in the communal areas is new and the people living in the home chose it. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: We looked round the home which is bright and comfortable. the communal areas are accessible to the people who live there. A handrail has been fixed to the wall in the hall to provide support for one person to maximise their mobility. The home is an ordinary house in the street and looks no different to any others. The manager told us that there are on going improvements to the home and repairs are dealt with quickly. All staff have completed training in infection control and the home was clean on the day of the site visit, people who responded to the survey said the home is always clean. there was liquid soap, paper towels and pedal bins in the bathroom. Care Homes for Adults (18-65 years) Page 21 of 28 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. Staff in the home are trained,skilled and in sufficient numbers to support the people who use the service. Evidence: The annual quality assurance assessment says: Touchwood now have their own staff as opposed to sharing with the two other houses within the company, this has proved most effective in regard to the consistency and continuity of care provided. This has enabled the role of the Key worker to be much more effective. 84 staff have achieved or are working towards NVQ levels 2 or 3 One member of staff who returned a survey form said under the heading what does the service do well: Give the staff the support and help we need and another member of staff wrote under the same heading Give me very good support. It is a good friendly atmosphere and very welcoming. One person wrote that they thought the management and staff are bogged down with paperwork One member of staff expressed concern that staff are expected to use their vehicles to transport people who live in the home around. All staff who responded to the survey were positive about they way they were recruited and they also thought that induction covered everything they needed to Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: know about the job. All six staff who responded to the surveys said that the training they received was relevant to their role, helped them understand and meet the individuals needs, keep them up to date with new ways of working and gave them enough knowledge about health, care and medication. We looked at the recruitment records for one person, the application form was fully completed with both a health questionnaire and rehab of offenders declaration. There was a detailed record of the interview, proof of identity included passport, birth certificate and utility bill. There were two references on file and confirmation from head office that a satisfactory criminal records bureau disclosure had been returned. The manager told us that the provider is in the process of changing the information it sends to managers about criminal records bureau checks as it is aware the current procedure is not meeting the regulations. The new procedure, which starts on 28/09/09, will mean that the disclosure is held in the member of staffs file until it is seen by the commission. People who live in the service are involved in the recruitment of staff. Five staff who work in the home already have NVQ at level two, and four other support staff on booked to start the course. A recommendation made at the last key inspection said all staff should receive supervision. the manager told us this is in place. Throughout our visit staff on duty engaged with people living in the home are were supporting them to participate in a variety of activities. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on openness and respect and the manager has an effective quality assurance process which ensures that people living in the home have a say in how the service operates. Evidence: A requirement was made at the last inspection in 2007 that the manager register with the commission. This requirement has been fully met and the manager is registered. The annual quality assurance assessment says: The home has extensive policies and procedures in place to comply with the national minimum standards. Also records are maintained and kept in line with the Data protection act, service users have full access and involvement in any records concerning them and wherever possible any parts written in house are signed by the service user themselves. Six monthly reviews are held for each service user, time is taken to spend time with the service user to write their own review wherever possible. All the needs and concerns of service users are responded to on a daily basis, the statement of purpose and service user guide have been built around the needs and views of service users and aids in turn this helps to measure success in achieving aims and objectives. As registered manager I ensure to Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: the best of my knowledge that we meet the National minimum standards. Service users now take a much more active role in the developing care plans, reviews and risk assessments. Care plans are person centred and are written in first person context. Care plans and risk assessments are updated monthly by Key workers in discussion with Service users and these are then signed off by myself. Areas of the home including catering, medication, pressure areas, accidents/incidents, complaints,personnel and recruitment and vacancies are audited monthly, as is a home audit covering all aspects of requirements to be met by NMS Summary More person centred approach to care planning. Staffing more structured with positive results. Management of the home more structured and continuously monitored through monthly audits. Staff training has improved greatly and a training plan is now in place The expert wrote the following in his report: All the residents money is kept in the office. The residents are not able to keep their own money in their rooms but they are very involved in being in charge of it by signing for it. I think this is good as it is promoting their independence. The manager told us that she completes monthly audits which are then verified the following month by a Senior manager who visits the service. We looked at the homes fire risk assessment which had been reviewed. We looked at the fire records and found those to be up to date. The manager told us that if the person who does the weekly and monthly fire checks is away it is the responsibility of either herself or the deputy to complete the checks. The manager meets with other managers of homes owned by the provider in Devon and Dorset each month and finds this peer support invaluable. All staff are up to date with mandatory training such as moving and handling, fire, food hygiene, infection control and first aid. There are gaps in training in health and safety. There is a corporate quality assurance process in place, which uses the monthly audits by the manager as a basis for development. People are asked their views about the home they live in and are part of the development of the service through a person centred approach to their care and support. Care Homes for Adults (18-65 years) Page 25 of 28 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 37 CSA 11 The proposed manager of the 01/11/2007 home must submit an application for registration to the Commission for Social Care Inspection. Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 The registered manager should support people who live in the home to manage their own finances if they wish. Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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