Care Home: Turning Point (Hoole Road)

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What the care home does well The information that tells people how the service works (the statement of purpose and service users handbook) is clear and gives people the information they would need to help them decide whether Hoole Road was the right place for them. People had received checks of their individual needs before they came to stay at Hoole Road. This meant that they and the staff had the information they needed to decide if the person`s needs could be met at the service. The home has a small established staff team who were keen for high standards to be maintained. People`s plan of care and individual case notes were well written and reflected each person`s needs. This helps to make sure that each person receives the care and support they need in the way they prefer. Staff at Hoole Road assist people to access their preferred activities throughout the day. Also voluntary work is also encouraged by the staff team and this helps people to keep busy and fill their days. An excellent standard of hygiene was seen throughout the home and the standard of decor and furnishings was good. People`s bedrooms were decorated to a good standard and thought has also been given to make sure that there is enough light and heat throughout the home. People who were staying at Hoole Road commented, "They promote challenging existing thoughts and emotions that have caused the addiction. They promote self awareness and explore triggers and consequences and coping mechanisms. Promote ability to make decisions about life style and developing interests and skills whilst in rehab for use when discharged" and "They support people with drug and alcohol issues well". Staff commented, "We support service users with drug and alcohol issues well. There are usually enough staff on duty to meet the needs of people who use the service" and "We work well together as a staff team. The manager is good". What has improved since the last inspection? All previous recommendations we have made have been met. The people who use the service now have up to date information in the service users` handbook and details of the commission have been updated. The manager has considered how therapeutic activities, other activities and support from staff known to the residents are available throughout the week, including the weekends. All staff who administer medication have completed certificated medication training. Consideration has been given to providing a dedicated therapy room. To ensure that appropriately qualified staff cares for residents, 50% of the support staff team are now qualified to NVQ level 2 or above. For the ease of access to information the supervision and appraisal notes have been separated and the manager has obtained NVQ level IV in Management. What the care home could do better: One requirement and a number of recommendations were made and these included ensuring that mandatory training is brought up to date and that specialist training should be undertaken. Also that a decoration and refurbishment plan should be completed to ensure that high standards are maintained for the home. Key inspection report Care homes for adults (18-65 years) Name: Address: Turning Point (Hoole Road) 27 Hoole Road Hoole Chester Cheshire CH2 3NH     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: Maureen Brown     Date: 1 9 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Turning Point (Hoole Road) 27 Hoole Road Hoole Chester Cheshire CH2 3NH 01244314320 01244325875 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.turning-point.co.uk Turning Point Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 past or present alcohol dependence past or present drug dependence Additional conditions: The maximum number of service users who can be accommodated is: 14 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Past or present drug dependence - Code D Past or present alcohol dependence - Code A Date of last inspection Brief description of the care home The service, which is run by the national charity Turning Point, aims to provide a supportive substance free environment where residents can examine their lives to date, reach a greater understanding of their substance misuse and develop ways of achieving changes. Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 0 14 14 Brief description of the care home The residential project comprises of the house at Hoole Road, which provides 10 places and Phillip Street that provides 4 places these are close to Chester City Centre with community facilities and amenities. Referrals are accepted from all areas of the country and people stay between 3 and 6 months. As part of the projects philosophy, people who use the service participate in a range of individual and group activities, including one-to-one support; relapse prevention; stress/anxiety management and relaxation. Alternative therapies such as auricular acupuncture, aromatherapy and Indian head massage are also available for service users. The fees for the service are 455.00 pounds per week. Optional extras include personal items, transport costs, other activities and hairdressing. Care Homes for Adults (18-65 years) Page 5 of 30 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 carried out an unannounced visit to the service on 19 April 2010 and the visit lasted seven and three-quarter hours. It was done by one inspector. The report will say we when referring to what was done and found at the visit, as it is written on behalf of the Care Quality Commission. The visit was just one part of the inspection. Before the visit the manager was asked to complete a questionnaire to provide up to date information about the home. We sent out questionnaires to the people who were staying at the home and the staff team to find out their views about Hoole Road. Other information about the home was also reviewed. During our visit we looked at various records and the premises. We looked at the care records of all eight people staying at Hoole Road, to see how their needs were being met. We also looked at all three permanent staff files to ensure that thorough Care Homes for Adults (18-65 years) Page 6 of 30 recruitment processes had taken place and that people who stay at Hoole Road were safeguarded from harm and supported safety. We spoke with some of people who were staying at Hoole Road and the manager and other staff who were on duty at the home at the time of this visit. The all gave their views about the service. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: One requirement and a number of recommendations were made and these included ensuring that mandatory training is brought up to date and that specialist training should be undertaken. Also that a decoration and refurbishment plan should be Care Homes for Adults (18-65 years) Page 8 of 30 completed to ensure that high standards are maintained for the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 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 10 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive excellent information about the home for them to make an informed decision about using this facility and their needs are assessed before they arrive so they know that these can be met by the service. Evidence: A copy of the information that tells people who the service is for (the statement of purpose and service users guide, known as the service users handbook) was available for each person. The service users handbook had been reviewed in 2010 and contained a welcome statement, information about Turning Point Chester, the staff team, aims of the service, statement of purpose and function, who the service is for, external links, facilities and local amenities, moving in, care plans, group work, leisure activities, stages of rehabilitation, policies and procedures, health and safety, on call procedures, consultation and communication, fire safety, hepatitis and HIV, complaints, useful phone numbers and weekly planner. It was written in plain English and standard print format. It is also provided in format suitable for people who are dyslexic (printed on green paper which is easier for people with dyslexia to read). Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: The previous recommendation about people having up to date information had been met. The statement of purpose and function was included in the service users handbook and included details of how to contact the commission. There was a document available for staff to use with people before they move into the home, to check on what their needs are. The document covers information on personal details, next of kin, substance misuse, support details, benefits, health issues, support from family and friends and other information. It was signed by the client, staff and was dated. Care Homes for Adults (18-65 years) Page 12 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. The support needs of the people staying at the home are met effectively by the staff and support is provided in a way the ensures peoples privacy, dignity and choice. Evidence: We looked at the care plans of all eight people staying at Hoole Road, to check on the support they were receiving. These contained a complete needs assessment, care plan, risk assessments, information sheet, licence, relapse prevention, housing, benefits/ finance, health issues, one to one time, funding and leaving. All documents were clearly detailed and up to date. A photograph of each person was included in the file. The support plans cover physical health, mental health, medications, self care and diet, alcohol and drugs, finances, relationships, promoting independence, religious/cultural needs, activities and daily structure, legal and resettlement. All the information was well written and up to date. Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: The people living at Hoole Road who we spoke with were aware of their files and were involved in completing their own records. They knew the files were kept securely and that the information in them was held confidentially. People who use the service told us this was a good facility and that the staff were friendly and helpful. They confirmed they were able to make decisions on a day to day basis and they had to attend daily group meetings and regular one to one sessions with their key worker and extra sessions could be requested if required. Residents meetings were held with regard to household chores; these were discussed and agreed as to who would being doing each task. A rota was completed at this time. People were being encouraged to take certain risks in accordance with their rehabilitation programme, but only after a detailed risk assessment had been completed. People were encouraged to take part in activities that would help them towards an independent life, including cooking, cleaning, laundry and shopping. Care Homes for Adults (18-65 years) Page 14 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. There is a range of social activities for people who are staying at Hoole Road so they have some daily variation and interest in their activities. The meals are good to make sure people who stay are Hoole Road have good quality and variety of food. Evidence: A range of activities are provided at Hoole Road. The people who stay at Hoole Road are encouraged to participate in activities that are both therapeutic and occupational. When people arrive at the home they are not always able to attend college or take on volunteer work. Staff encourage the people to develop at a pace that is acceptable to them depending on where they are up to in their detoxification programme. Some people have undertaken volunteer work in local charity shops, on conservation projects, being involved in other charities and in local community projects. The previous recommendation with regard to looking at how therapeutic and other Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: activities could be provided throughout the whole week, including weekends, has been met. People who use the service write the menus for their meals and these include a range of meats, cheese, eggs, fish, fresh fruit and vegetables. A rota is produced and people decide what they want to cook on each day. They take it in turns to produce the evening meal for themselves and the rest of the group. The people who live at Hoole Road have access to the local and wider community in line with their individual package of care. As part of the package offered each person is given a pass to the local leisure centre. Volunteer counsellors visit the home two or three times a week and people confirmed that they found this to be a valuable service offered to them. Relationships are developed as per individual choice. Most people have moved away from family and friends for this part of their support. It was noted during discussions with people who live at Hoole Road that good support networks have been established between one another. 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. The health, personal care and social needs of the people at Hoole Road are met by the staff team in a way that enables them to maintain their privacy and dignity. Evidence: People who live at Hoole Road are prompted with personal care as needed and supported with each aspect of daily living and this is reviewed regularly. The people are fully involved in their assessments and have a daily group meeting and regular one to one time with their nominated key worker. People who use the service register with the local GP service and visits to the doctors are recorded on their support plans. Other visits to specialists or consultants are also recorded. Most of the other services are not usually needed as people stay at Hoole Road for a short time only. However, if dentists, opticians or other health services are required staff would support people in accessing these within the local community. Staff also supply people with information on general heath care and specific issues relating to their lifestyles and needs. All staff administer all prescribed medicines. People who use this service accept this as Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: part of their contract with the home and it is clearly stated in the service users handbook. The people sign a consent form for the home to hold and administer their medication. At the time of our visit no controlled drugs were being used; however appropriate storage was available should it be needed. The home had a policy on the safe and secure handling, storage, error reporting and administration of medication. Also there was a policy and procedure on dispensing medication. Medication administration record sheets were being completed and were seen during this visit. All medication is dispensed to people from the medication room, where all medicines are stored securely mostly in monitored dosage blister packs which help to make sure that people receive their medicines correctly. Staff have access to the homes policies on medication for guidance and have medication awareness training so they know about the medicines they are dispensing and can give these out safely as prescribed by peoples doctors. The previous recommendation with regard to staff having medication awareness training has now been met. 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. There are effective procedures for complaints and safeguarding so that the concerns of people who stay at Hoole Road are listened to and they are protected from abuse and harm. Evidence: We looked at staff files during our visit and these showed that staff had completed training about safeguarding adults. The manager confirmed this and showed that she was aware of the policy, procedure and guidance on safeguarding. There were also policies available in the home including local information in Cheshire West And Chester Councils No Secrets, local guidelines for addressing inappropriate comments and behaviour, policy on safeguarding vulnerable adults and referrals to the Independent Safeguarding Authority (ISA) list, preventing and responding to bullying and harassment of service users and disclosure policy (whistle blowing). The safeguarding file was seen and no referrals had been made by the service during the year before this visit. The complaints procedure is known as the customer feedback policy and a leaflet was also available regarding the complaints process. This describes the three stages a complaint can go through with timescales included. No complaints have been received by the commission about Hoole Road during the year before this visit. Three complaints had been received by the service itself during that time and these were all resolved within 28 days. People staying at Hoole Road confirmed that they would Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: contact the staff or manager if they had any concerns or problems. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Hoole Road is well maintained and furnished to an excellent standard so the people who stay there do so in safe, comfortable surroundings. Evidence: During our visit we toured the building and saw all the shared (communal) rooms and a number of bedrooms. The decor was of a high standard throughout the home. People usually only stay for a short time and therefore they only bring with them what they need for a short stay. The communal areas were well decorated and furnished. The previous recommendation about providing a dedicated therapy room had been met. At the time of our visit, the premises were starting to show signs of wear and tear and there was no plan for redecoration or refurbishment in place. It was recommended that a plan should be produced to ensure that the good standards are maintained. The home was found to be very clean and free from unpleasant odours. Overall the home was well maintained and of a good standard. All of the people staying at the home take part in cleaning the home and they decide who is doing what at the weekly domestic meeting. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff at Hoole Road have gone through a thorough recruitment process so that the needs of people staying there are met and they are safe from possible harm or poor practice. A lack of up to date training for staff could mean that people are put at risk. Evidence: The staff rotas showed the number of staff on duty over the week. The registered manager is supported by the team leader, support worker, administrator, and regular casual staff are also used. The home is staffed between 9 am and 8 pm and after that time an on-call service is available. This had meant that the people who live at the home did not have access to staff in the building overnight. People living at Hoole Road told us they were satisfied with the on-call arrangements and confirmed that they did not need staff there overnight. The manager confirmed that the system of staff being there 24 hours a day had been gradually phased out when it was realised that this was not necessary. There are currently two vacancies for staff at Hoole Road. We checked the staff files of all three permanent staff to check the processes that had been used for their recruitment. All the necessary checks had been obtained including completed application forms, references, and Criminal Record Bureau checks. The staff had also been issued with contracts of employment and job descriptions. Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: Good progress has been made with the National Vocational Qualification (NVQ) level 2 in care. Out of two staff one has NVQ level 2 and the previous recommendation about having 50 staff qualified in NVQ has been met. Day to day supervision of staff was good and annual appraisals were carried out during July and August 2009, and up to date records were seen. Formal supervision sessions had been undertaken during February and March 2010 and again records were up to date. This level of contact with their managers enabled staff to have the chance to discuss their work so they could continue to provide good quality care to the people who stay at the home. The previous recommendation with regard to splitting appraisal and supervisions notes in staff files had been met. The staff had completed an induction course which is linked to the Skills for Care training and can be used to lead into the NVQ level 2 in care. Although most staff had undertaken mandatory training this was about two or three years ago. The manager confirmed that she had been in contact with Turning Points learning and development department to get mandatory training brought up to date for the staff team, and evidenced this by emails sent requesting training. However, this had not been forthcoming and mandatory training has lapsed. A requirement was made that mandatory training must be brought up to date. The mandatory training undertaken in the past included health and safety, fire safety, safeguarding of vulnerable adults, basic food hygiene, moving and handling, emergency first aid and working with diversity. Specialist training had been undertaken, but again this some was some time ago. A recommendation was made that this also be brought up to date. Specialist training undertaken in the past included conflict management, mental health awareness, substance misuse awareness, personality disorders, medication awareness, and motivational interviewing. Turning Points code of conduct included information on legal requirements, Turning Points policies, their values, supporting the service users, colleagues accountabilities, responsibilities and rights, equality and diversity, safe place to work, relationships with service users, relationships between colleagues, gifts and hospitality, declaration of interest, confidentiality and data protection, provision of services, financial transactions and engaging contractors, the use of alcohol and other drugs, enhancing and upholding Turning Points work, political activity, disclosure of criminal offences, additional employment, failure to follow the code, declaration of interests, declaration of gifts and hospitality and additional employments authorisation form. This gave the staff a wide range of information and showed the staff how Turning Point expects its Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: employees to conduct themselves whilst on duty. The staff handbook contains information on Turning Point, health and safety, starting work, salary and benefits, expenses and travel, personal development, time away from work, dealing with problems at work, leaving Turning Point and miscellaneous. This provided a detailed handbook of information for the staff to use. Care Homes for Adults (18-65 years) Page 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Hoole Road has policies and procedures in place to ensure the health and safety of the people staying there are promoted and protected and that the service is run in the best interest of the people who stay there. Evidence: At the time of this visit, the manager had worked for Turning Point for six years and had been in her role as manager since July 2006. She was registered with the commission and had recently completed her Registered Managers Award, NVQ level 4. She knew the people living at Hoole Road and the staff team well. She completed the information about the home we ask for each year, the annual quality assurance assessment, that gave us information about the home and what has been happening there during the twelve months before our visit. This was well written and gave us a good overview of the service. All of the people spoken with confirmed the manager was approachable and would listen to concerns and deal with them as appropriate. There is a quality assurance process for the service which includes staff meetings, residents meetings, an Internal Quality Assessment Tool (IQAT), monthly visits from Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: the provider, service users surveys, compliments file and domestic meetings. The Internal Quality Assessment Tool follows the current standards from National Minimum Standards for Younger Adults. Evidence is gathered to show how each area is being met. This appeared to be a very good tool with evidence included to show the service is meeting the National Minimum Standards. They have completed reviews on about half the standards and were working on the rest at the time of our visit. A representative from Turning Point was visiting the home each month to check on how it was running. These visits were completed on a regular basis and the most recent one before our visit was on 29.03.10. The report of the visit covered discussions with clients and staff, looking at the premises and a range of records. No issues or concerns were identified at the last visit. Staff meetings were being held every two weeks with minutes kept. The most recent one before our visit was on 07.04.10. All the team attended. Areas discussed included referrals, admissions and discharges, current clients, marketing and Quality Assurance. Domestic meetings were being held each week with the client group to decide who would go shopping, who was cooking on each day, what they are cooking and who was doing the domestic chores and when. A rota was drawn up at this meeting showing what each person had agreed to do. The people staying at Hoole Road decided between themselves who was doing what. Residents meetings were being held every two weeks with minutes kept; these were seen during this visit. The home had a compliments file with a range of compliments received. Comments included, Staff all good and plenty of 121 if you want it, Staff are here if you need them. Staff often go above and beyond to help me and I am grateful to all the staff for being there for me. Service user satisfaction surveys were being completed annually. The results were analysed and the manager produced an action plan from this information. This was seen during our visit. Comments on the surveys included, I find the better 121 care the more productive, When support is available it is delivered well and I am very impressed with how issues are dealt with by the management. A range of policies and procedures were seen during this visit. These could be Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: accessed by staff through Turning Points intranet and copies of the core policies were also available in the office. The policy on smoking stated the home and communal areas were smoke free; however there was a smoking area in the back garden for clients and staff to use. The gifts and hospitality policy stated that staff should avoid accepting gifts or receiving or accepting hospitality except in limited circumstances. Gifts of little value may be accepted on an occasional basis. Gifts of a value of over 20.00 or cash must not be accepted. Staff are not permitted to be beneficiaries of service users wills. We saw that safe working practices were in place within the home. There were up to date safety checks on the homes gas installation, electrical hard wiring and portable appliance tests. The accident book was kept up to date and records seen were stored appropriately. The fire safety equipment test log book was up to date and completed appropriately. A range of policies was available that included health and safety, food hygiene, COSHH, fire precautions, accidents, incidents and reportable diseases, safe moving and handling, risk assessment, smoking policy and receipt of gifts and legacies. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 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 35 18 Mandatory training must be brought up to date for the all members of the staff team. This is to make sure that people who use the service are supported by well trained staff. 30/07/2010 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 24 A redecoration and refurbishment plan should be produced to show how the good standards within the home are to be maintained. Specialist training should be brought up to date for the staff team so that people who use the service are supported by well trained staff. 2 35 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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