Care Home: Trefusis

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What the care home does well Trefusis provides personal care and support for a maximum of 3 people. On the day of the inspection residents and staff were interacting well, discussing the events of the day and preparing for the evening meal.The staff seemed to work well as a team. Pre admission assessments are always carried out to ensure that the home can manage the needs of the person, although the current residents have lived at the home for a number of years. Ongoing training, provided by Spectrum, means that staff are up to date and have the skills to look after the residents. Documentation and records seen were well organised, up to date and stored as required. People are given choices about how they spend their time as well as having a structured activity programme to ensure the residents mix with other people, get enough exercise and develop life skills by helping to run the household. Regular audits of systems in place and regular meetings with the residents means that the home is run in the best interests of those that live there and is always working to improve the quality of the service provided. Spectrum have a robust recruitment system in place followed by a detailed induction and probation period to ensure that the staff recruited have the skills to look after and support the residents. What has improved since the last inspection? Medication policies and procedures have been reviewed and updated to reflect laid down legislation. Regular audits of the medication and the system in place ensures ongoing monitoring is in place. All care plans have a copy of the the homely remedy list signed by a GP included in them. A lone working policy has been introduced and risk assessments are in place to protect those staff who are on duty overnight on there own. A night log is completed to show that a security and safety check of the premises took place and to record any relevant information that happened overnight. Hand gel and paper towels are in use in the house to reduce the risk of cross infection. Regular supervision sessions are in place and staff report that they feel well supported by the manager. There is a statement in residents files about how they access information about them kept by Spectrum and information in the Statement of Purpose (each resident has one in a format suitable for them) about Data Protection and access to documentation relating to the residents. What the care home could do better: Staffing levels should be maintained at all times to ensure residents can carry on with their planned activities. There should be a system in place to ensure that a staff member working in the office on the first floor (when there is nobody else in the house) can hear the door bell or people coming and going. This would ensure increased personal safety of staff and residents. Key inspection report Care homes for adults (18-65 years) Name: Address: Trefusis 38 Trefusis Road Redruth Cornwall TR15 2JH     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: Mandy Norton     Date: 2 6 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 26 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 26 Information about the care home Name of care home: Address: Trefusis 38 Trefusis Road Redruth Cornwall TR15 2JH 01209219333 01326371099 mail@dcact.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Spectrum Name of registered manager (if applicable) Type of registration: Number of places registered: care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Trefusis is a care home providing accommodation and personal care for up to 3 adults with a learning disability. The home is run by Spectrum (formed in 1982 as a nonprofit making registered charity and Limited Company. Originally named The Devon and Cornwall Autistic Community Trust), an organisation that provides specialist care in small units to adults who have autistic spectrum conditions. The aim is to provide residents with a homely environment in a local community setting and to enable them to live as normal a life as is possible. Spectrum employs a manager and team of staff to provide care and support for the people living in the home. Senior managers from outside of the home are available to provide additional specialist input as and when it is required. The house is a detached, dorma bungalow set in its own grounds. The home is situated within easy reach of the town of Redruth with good access to transport and all the facilities of the town. The home has transport and drivers. Care Homes for Adults (18-65 years) Page 4 of 26 Over 65 0 3 Brief description of the care home Residents are provided with individual furnished bedrooms and a shared bathroom. The home has a kitchen and dining room, separate office and a lounge, which doubles as a staff sleeping in facility. The home has a spacious garden that is well maintained. There is a lockable office on the first floor of the building. Fees are charged dependant on a persons needs and are discussed as part of the pre admission assessment. Spectrum will be able to supply information about their range of fees if required. Additional charges are made to residents for hairdressing, certain activities outside of the home such as bowling and swimming and personal items. Care Homes for Adults (18-65 years) Page 5 of 26 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: This unannounced Key Inspection took place from 12 midday until 4.40pm on 26th June 2009. It was conducted with the manager. A tour of the home was carried out and residents and staff were observed and spoken to informally during this time. A variety of records were seen during the course of the day. Other evidence gathered since the previous inspection such as notifications received from the home (e.g. regarding any incidents which occurred), the annual quality assurance assessment (AQAA) (a self assessment document that the home completes annually and submits to the Commission) and completed surveys from both care staff and residents was also used to help form the judgements made in the report. Care Homes for Adults (18-65 years) Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Adults (18-65 years) Page 7 of 26 Staffing levels should be maintained at all times to ensure residents can carry on with their planned activities. There should be a system in place to ensure that a staff member working in the office on the first floor (when there is nobody else in the house) can hear the door bell or people coming and going. This would ensure increased personal safety of staff and residents. 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 26 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 26 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 plan to live at Trefusis (and their representatives) have comprehensive information about Spectrum and the home in order to make an informed decision about whether the service is right for them. The personlaised needs assessment means that peoples diverse needs are identified and planned for before they move into Trefusis. Evidence: There is a clear pre admission assessment procedure in place that is completed prior to anybody moving into Trefusis. The current residents have lived at Trefusis for many years but the manager is aware of the admission procedures used by Spectrum. The Service Users Guide seen has been updated since the new manager started in May 2009 and clearly describes the services the home and Spectrum can offer.Each resident has one in a format that suits them. A copy would be given to prospective residents when a pre admission assessment is carried out and it is available in the home. All 3 completed Service User Surveys indicated that they had enough information about Trefusis before choosing to move in. Care Homes for Adults (18-65 years) Page 10 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The practice regarding the planning and delivery of care means that people can be sure that their health and personal care needs will always be fully met. Residents are involved in a number of decisions made at Trefusis meaning that they contribute to the overall outcomes for people. Evidence: The care plans examined (kept in the office although accessible to the residents) had a lot of information about the individual and their lifestyle choices. They have been developed using a person centred planning (PCP) approach that all staff have training about. They had been regularly evaluated and were generally up to date. There is a PCP meeting monthly that includes the resident, key workers and often the care manager. At this meeting goals are set and agreed for the next 6 months and reviewed at monthly reports and meetings. The manager has audited the care and support plans since she took over and has identified areas where they need to be updated, she has asked the key workers to do this and will continue to audit the files to ensure they are being maintained as required. They are well constructed and are Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: also in place are separate medical notes, daily diaries that the staff complete and individual logs that the residents complete daily. The residents also have a support plan (kept in the kitchen for ease of access fro the residents) in a style that suits them so that they can see what they are to be doing on a daily basis, they know about the home, how to make a complaint and general information about them as people. The AQAA and the manager described chat time that is used each day to assess the wellbeing of the residents and to ensure they are getting the care and support they need and want. The manager talked about the system in place to manage peoples money that includes recording expenditure and keeping receipts as evidence. When the staff and 2 residents came back from a day out the staff member straight away recorded any expenditure as required. The manager described how residents can be involved in the day to day running of the home this includes deciding on the household duties and the list of who along with the staff will do them and being involved in the weekly shopping lists. They are introduced to prospective new staff and will show them around the home and are asked for opinions of them once they have met them. Spectrum has policies and procedures about confidentiality and records seen were accurate and stored safely. Care Homes for Adults (18-65 years) Page 12 of 26 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. A range of activities at Trefusis and within the local community mean that people have opportunities to participate in stimulating and motivating activities. Peoples rights are respected and people are encouraged to take appropriate responsibility in their daily lives. Meals provided at Trefusis ensure that the guests have a healthy and varied diet. Evidence: The manager and staff spoken to during the inspection were able to say how residents spend their time, what they do outside the home and what they like to do as individuals. The residents are often out during the day. They all have local links and are included in the local community when they are out and about. The staffing levels vary according to the daily needs of the residents. The AQAA states that The service users at Trefusis have been given the opportunity to choose activities that enable them to maintain and develop social, emotional, communication and independent Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: living skills with the support of staff, ensuring that their individual needs and preferences are taken into consideration when planning activities that are appropriate for them. It goes on to say that residents do voluntary work, take part in local activities and Spectrum activities and have various means of getting around including use of the homes car, local buses (using bus passes) and by foot. The manager said the staff discuss with the residents about what they like to do and try to vary the opportunities people have. The current residents like to have structured lives and have daily routines and activities detailed/displayed in the kitchen, this is done on a rolling rota basis so that they dont do the same things each week. The home has a dining room where residents are encouraged to eat but they can eat in their rooms or the lounge if they wish. The residents help prepare and cook the meals. The manager said that all the residents have had food hygiene training and are encouraged to help with the meals and chores around the home to develop life skills. Staff are available throughout mealtimes to offer help and support as required. The residents have access to all parts of the home (apart from other residents rooms) and gardens. One of the residents likes dogs and meets a staff member at the gate to walk her dog with her as dogs are not allowed on the premises. Care Homes for Adults (18-65 years) Page 14 of 26 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. Personal care and support and management of medicines are of a good standard meaning peoples needs are met. Evidence: Staff provide sensitive personal support and care when required. The manager said that residents can go to bed when they want to, but realise they sometimes have to get up at a certain time in order to attend activities during the week. Support plans seen included individual records that detailed peoples preferred routines and likes and dislikes. The residents are encouraged to choose their own clothes and style to reflect their personalities. Designated key workers ensure consistency and continuity for the residents and relationships with family and friends are encouraged. Healthcare support is ongoing. The residents have access to e new service in the town designed to focus on health and wellbeing including diet and exercise advice. If relevant this has been incorporated into the residents care and support plan to encourage them to remain healthy. The residents are registered with a local GP and have access to dentists and opticians locally. Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: Medication is dispensed from a blister pack (monitored dosage) system that is delivered by the pharmacist each month. Spectrum have robust medication policies and procedures in place for receipt, storage, management and disposal of medicines. Staff files examined show that staff have had training in medicines management. The AQAA states that a medication audit is carried out every 2 weeks and recorded on the back of the medication administration record (MAR) sheet. Each care plan has a homely remedy list in it signed by a GP so that if a resident needs a medicine such as paracetamol that is not prescribed then it is fine to give as long as it is signed for on a MAR sheet. Care Homes for Adults (18-65 years) Page 16 of 26 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. Formal complaints and safeguarding policies and procedures are in place and are available to staff at all times. All staff undertake safeguarding training. This means that people who live at the home are adequately safeguarded. Evidence: There is a formal complaints procedure in place which is in the Service Users Guide and also in each individual support plan in a format that suits the resident. The Commission have received no concerns or complaints about this service. The completed AQAA stated that the home has had no complaints in the last 12 months. All 3 completed Service User surveys indicated that they know who to speak to if they are not happy and all four completed staff surveys indicated they knew what to do if someone had concerns about the home. During discussion with the manager it was clear that there is an awareness of safeguarding procedures and people would know who to contact if necessary. Spectrum has policies and procedures around complaints and protection that are available to staff at all times and include a whistle blowing policy and local vulnerable adults procedures from sponsoring authorities. The manager and AQAA said that all staff have training on safeguarding adults, this was confirmed by certificates seen in staff files examined. Each member of staff has a criminal records bureau (CRB) check and POVA First check before being able to start work with Spectrum. Care Homes for Adults (18-65 years) Page 17 of 26 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 domestic nature of the home and the ongoing maintenance and redecoration means people have a comfortable, homely and safe environment in which to live. Evidence: Trefusis is owned and managed by Spectrum (www.dcact.org) an organisation based in Cornwall with approximately 20 other small homes. It is a Dorma bungalow in a residential part of Redruth near to the town centre and local facilities. The house and gardens are accessible to all of the residents. There is one residents room and the staff office upstairs and 2 residents rooms, a bathroom, kitchen , lounge and dining room on the ground floor. The fixtures and fittings are domestic in nature. The manager said that all individual rooms are decorated with input from the resident. The garden was well kept and accessible to all residents. The manager said the garden is used quite often in the good weather. The stair and landing carpet is quite worn and will need replacing in the near future. The fire risk assessment seen was detailed and easy to understand. Overnight the staff member sleeps in the lounge using a put up bed, the manager said that all of the residents sleep well overnight but know how to contact a staff member if necessary. There is space in the home for staff to store personal belongings securely. On the day of the inspection the home was tidy, clean and hygienic. The ongoing Care Homes for Adults (18-65 years) Page 18 of 26 Evidence: household chores are done by staff and residents on a rota basis, this was seen displayed in the kitchen. There are hand washing facilities throughout the home. Training on infection control is provided to staff by Spectrum. Ongoing repairs and maintenance are carried out by Spectrum. Care Homes for Adults (18-65 years) Page 19 of 26 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. The staffing levels and skill mix are generally satisfactory meaning peoples needs are usually being met. The robust recruitment procedure means that people who live at Trefusis are being looked after by appropriate staff and their welfare is not at risk. Evidence: Spectrum have a robust recruitment procedure. Included in the staff files seen were a CRB check, 2 written references, previous employment history, job description and a contract of employment. An application form and job descriptions can be seen on Spectrums website (www.dact.org). All of the completed staff surveys said that Spectrum carried out CRB and reference checks prior to being employed. The manager said that the induction process that Spectrum use is robust and the first 6 months of employment are classed as a probationary period. She added that the basic induction (5 days initially in the home) gives people an indication of the type of work they will be doing but that the process is ongoing as most of the learning is done once a person is actually doing the job. This is confirmed by the completed staff surveys that indicated that their induction covered everything they needed to know very well x 2, mostly x 1 and partly x1. There was evidence of regular supervision sessions (one to one) and appraisals having taken place. As the manager is new to Trefusis she said she has carried out supervision (one to one) with everybody to ensure she knows Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: what the training needs are and if people feel well supported. Staff meetings take place each month and the minutes of the previous one were seen during the inspection. All of the completed staff surveys indicated that they get support from the manager. The manager said that residents are asked to show a potential member of staff round the house during the interview process and their feedback is used when making a decision about whether to employ a person or not. The manager said that a variety of training is offered to staff this includes first aid, manual handling, fire safety, food hygiene and other training appropriate to the residents needs. The AQAA states that of the 8 permanent care workers 4 of them have level 2 NVQ (in health and social care) or above and the manager said more people are studying for their NVQ qualification. It goes on to state that all staff have had infection control training and 2 have had training in diet and healthy eating. All of the completed staff surveys indicate that they are being given training that is relevant to their role, helps them to understand and meet the needs of the residents and gives enough knowledge about healthcare and medication. Staff reported that sometimes staffing levels are not as required as staff have been called to work in other Spectrum homes. The manager confirmed this has been the case in the past and as a result sometimes the residents have not been able to carry out planned activities. She said some new staff have been employed and are currently on their induction and following feedback from the staff they are looking to review the shift patterns worked to see if they can have more staff at times more relevant for the residents. The manager hopes the staffing levels will be more consistent in the future. Care Homes for Adults (18-65 years) Page 21 of 26 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 systems and procedures in place are designed to meet the needs of the service as they strive to improve the service the home offers to the people that stay there. The attitude to health and safety shown by the providers, care and ancillary staff means that people live in a safe and well maintained environment. Evidence: Since the last inspection (June 2007) the home has notified the Commission of any incidences that they are required to report. The current manager has worked for Spectrum for 5 years and has been a registered manager for them in the past. Spectrum let the Commission know of the change of manager as required. She started at Trefusis about a month prior to the inspection. Since she has started she has carried out a number of audits to find out how up to date documentation and care plans were, she has got to know the staff and residents and has held a staff meeting (minutes seen during the inspection). She works well with the previous manager who has been promoted to a divisional manager within Spectrum and will continue to have regular contact with her. She said she is in the process of making an application to become registered as the manager with CQC. The AQAA states that she has nearly Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: completed an NVQ level 4 in management and has a diploma in Social Work. She attends regular training and updates to ensure she is up to date with the latest guidance and best practice recommendations. Spectrum has a formal quality assurance system in place which is based on seeking the views of those that live in the home and other people who visit the home in a professional capacity. A completed Annual Quality Assurance Assessment was returned to the Commission as required (June 2009). It was very detailed and included all the information the Commission asks for. A representative of Spectrum carries out a monthly visit to the home to speak with residents and staff, look at the environment and to review examples of documentation in use. A report is prepared and any actions required are documented and discussed during staff and management meetings. All records seen were up to date, well constructed and stored securely. In order to ensure safe working practices training is provided in manual handling, fire safety, first aid, risk assessments and food hygiene for example. Records of risk assessments that are carried out for the house are available to staff at all times. Individual risk assessments are kept in their care and support plans. These are updated as required and also available to staff at all times. The accident books seen was completed appropriately and the manage sees all entries as part of ongoing audits of documentation. The induction programme covers aspects of health and safety relevant to the current client group (when they are in and out of the house), the staff group and Trefusis including security of the premises, safe storage of hazardous substances, safeguarding and risk assessments. There needs to be a system in place so that a member of staff working alone in the office (when the residents and staff are out of the house) on the first floor can hear the doorbell and if anybody is coming and going in the house. This is to ensure staff personal safety and that of the residents when they are in the house. Overnight the premises are secured and the staff member on duty carries out a safety and security check before retiring. Care Homes for Adults (18-65 years) Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 26 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 33 The manager should ensure staffing levels are maintained at all times to ensure the residents are able to carry out planned activities and routines. Arrangements should be put in place to ensure that staff working in the office on the first floor can hear the door bell or if anybody is entering or leaving the house. This is to ensure the personal safety of the staff who may be working in the home on their own when everybody else is out and so that they know when residents are in and out of the house. 2 42 Care Homes for Adults (18-65 years) Page 25 of 26 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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