Care Home: Wellwick House

What the care home does well The service aims to inform people considering moving into the home and to understand how they will need to be supported. The service offers individualised support to residents and encourages independence and the development of personal life skills in comfortable, homely surroundings. The staff complete care plans that set out instructions for staff in meeting people`s needs. There is a great emphasis on the resident as a whole in both the care plans and the staffs recording of the resident`s daily lives. The premises are generally clean and homely. They provide a comfortable environment for the people living there. People are able to personalise their rooms. The service maintains and reviews all policies and procedures in a clear, tidy format that are easily accessed and readily available. Other required documents are also well stored and maintained. What has improved since the last inspection? This is a new service and only operational since October 2009. It has been inspected in line with current inspection guidance and legislation as a new service. Improvements will be noted at following key inspections. What the care home could do better: No requirements were made at this inspection and only three recommendations were made:- Risk assessments should be person specific and indicate the assistance required to reduce the risk in the case of restraint and how this will aid the service users predominant need. This information should correlate with the care plan and daily evaluations to ensure all service users individual care needs are met. Transcribed medications should evidence two signatures to ensure service users receive their correct medication A consistent programme of supervision should be in place for all staff so that service users can be assured they are supported by competent and appropriately skilled staff. Key inspection report Care homes for adults (18-65 years) Name: Address: Wellwick House 100 Colchester Road St. Osyth Clacton-On-Sea Essex CO16 8HB     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: Helen Laker     Date: 2 0 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 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) © 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 28 Information about the care home Name of care home: Address: Wellwick House 100 Colchester Road St. Osyth Clacton-On-Sea Essex CO16 8HB 0 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): TLC Care Homes Limited Name of registered manager (if applicable) Miss Regina Green Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following categories of service: Care Home CRH. To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: LD Date of last inspection Brief description of the care home Wellwick House is a newly registered care home providing support for up to six people with a diagnosis of learning disability. The house is in a residential area of St Osyth and in close proximity to local shops, a public house and amenities. It is a converted property consisting of a main house adjoined to two self contained flatlets. A local bus service provides access to the nearest towns of Clacton and Colchester, for local amenities such as day centres, local hospital, sports centre, swimming pool, library, colleges and the town centre for shopping. Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 6 Brief description of the care home Information about the service is provided to prospective service users in the homes Statement of Purpose. The current fees are £2045.42 to £2645.70 per week, all-inclusive. Inspection reports are available from the home and from the CQC website www.cqc.org.uk 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: 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: The quality rating for this home is two star. This means that people who use this service experience good quality outcomes. This key unannounced inspection looking at the core standards for care of younger adults took place on the 14th April 2010 between 10:00 and 16:00. A further visit was made to the home on the 20th April 2010 as the service manager was not available on the initial day of inspection and was the only one with access to some records required. These were reviewed on the second day of inspection. The manager and staff were available on the day of inspection and assisted with the inspection process by supplying records and information. This report has been compiled using information available prior to the visit such as surveys sent out, evidence found on the day of inspection and the annual quality assurance assessment (AQAA), which is required by law and is a self assessment completed by the service. The AQAA provides an opportunity for the service to tell us what they do well and areas they are looking to improve and/or develop. It is anticipated that some progress be noted at subsequent inspections as Care Homes for Adults (18-65 years) Page 6 of 28 this contributes to the inspection process and indicates the homes understanding of current requirements, legislation changes and own audited compliance. This document will be referred to as the AQAA throughout the report. During the day the care plans and files for four of the residents were seen as well as four staff files, the policy folders, the medication administration records (MAR sheets), some maintenance records and the fire log. The manager also supplied a copy of the duty rota, the menus, and other pertinent documentation which was required. A tour of Wellwick House was undertaken and two residents and five members of staff were spoken with. The home was clean and tidy offering homely accommodation to the residents. The residents seen were relaxed and clearly felt at home in the environment using all areas of the building. All the records and files were well maintained and interactions between staff and residents were friendly and appropriate. Care Homes for Adults (18-65 years) Page 7 of 28 What the care home does well: What has improved since the last inspection? 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. This judgement has been made using available evidence including a visit to this service. Peoples needs will be assessed and they will receive accurate details about the home prior to moving in. Evidence: The home has a statement of purpose and service users guide and both contain a lot of information about the service offered and the environment of the home and staff qualifications. This is readily available for review within the home or upon request. The admission policy was seen and offers prospective residents the opportunity to visit the home prior to moving in. There is the possibility of day visits or a trial period. This was evidenced for two recent admissions who visited the home and had graduated visits prior to permanent residency. Also as a part of their graduated admission any environmental changes can be made such as the windows having an appropriate safety covering in place. Residents are encouraged to bring personal items of furniture, ornaments and pictures with them when they move in to use in their own rooms. Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: The home currently only has five residents and three of their care files were reviewed and contained comprehensive pre-admission assessment documentation that looked at areas of daily life the resident may need support with. Areas covered included mobility, personal hygiene, diet, continence and any health problems. They also assessed the residents comprehension, looked at social needs, their likes and dislikes, whether there was any dependencies or challenging behaviours or if the resident was a smoker and any known allergies were recorded. The AQAA confirms the service Provides the service user with the opportunity to visit the home and meet the staff and other service users. Where required we will utilise alternative methods of communication so that the service user understands fully and is involved in this process.Transition plans are put into place with service users moving into the home, so that they are given the opportunity to test drive the prospective service. We also ensure that the service users have an individualised contract that outlines the service to be provided. The manager confirmed We get the necessary information needed for a new client from families, advocates , and others involved in their life ,enabling them to settle in well prior, to them moving in. Two service users spoken with confirmed they were welcomed at all visits and the process was a comfortable one and they were happy to become a permanent resident. 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. This judgement has been made using available evidence including a visit to this service. People who use this care service can be assured that their health care needs are met and that they are supported to be involved in decisions about their lives. Evidence: The care plans of three service users living at the home were sampled and inspected and used to case track care in the home. An assessment of needs identified, health, personal and social care needs. Person centred care plans had been created which covered topics such as Medical Care, Personal Needs, Mobility, Moving, Handling & Transferring, Behavioural & Emotional, Activities, Financial Management, Restrictions of Choice & Specific Risks and records choices, hopes, dreams and personal goals. The homes AQAA states We have informative person centred care plans. Service users are encouraged to partake in writing their care plan,(where possible) and where appropriate care plans are supported with a pictorial format. Service users sign these and actively take part in regular reviews of the plans. Care plan detail was seen in Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: the three care plans and goals/objectives and agreed actions were noted. The first three monthly review was also evident as the home only gained its first service users in October 2009. The homes staff working system ensures care plan reviews and updates are consistent. Where capabilities allowed in discussions with people living at the home it was evident that the level of support and risk taking is proportionate to the capacity of the individual and this is achieved by a combination of formal risk assessment and intuitive judgment based upon knowledge and understanding of the person. One example was evidenced with regard to trips out and ensuring safety checks are made. The extent of the primary risk assessment by the staff member was suitable to ascertain whether the person was likely to be at known risk. Observation of interactions between staff and people living in the home indicated that people are assisted and supported to make choices about their day-to-day lives, this was witnessed through interactions observed with the service users on the day of inspection. An example of this also would be where the a service user who was notably anxious and distressed on the day of inspection received specialist one to one care and supervision to help maintain their safety. The home is supported by the Home Assessment Treatment Team (HATS) and the Behavioural Advisory Team for Essex (BATS). The AQAA confirms We are actively encouraging all service users to have as much in put in writing their care plans. Any behaviours displayed from the service users are risk assessed, the management strategies are reviewed, and we will seek further input and advice from other professionals to ensure that we are providing the correct support for that person. We are liaising with health professionals to access training and input. Discussion with the manager confirmed that the home can access advocacy services on behalf of the people living in the home if required, but presently no service users require advocates. Documentation relating to limited decision making and the involvement of service users in the formulation of their care plans was seen and the manager confirmed that where possible relatives were used and their involvement welcomed. Sampling of care plans evidenced that risk assessments were in place, designed to enable people to maximise their independence. Risk assessments were in place relating to the following areas, Mobility, medication administration and personal care, each of the assessments identified the nature of the risk, who the risk may have an impact on, and the steps taken to minimise the risk. Some attention was noted to be required to the issue of restraint being used for challenging episodes of behaviour and the consent of the service user and relative being gained, as the AQAA identifies seven occasions where restraint was used. This was not clarified specifically in all care plans seen and the dating and signing of documentation to ensure a consistent approach with the writing, dating and signing of care plans amongst all staff was discussed with the manager. Care Homes for Adults (18-65 years) Page 13 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. This judgement has been made using available evidence including a visit to this service. Residents can expect to receive an adequate range of food at times to suit their lifestyle and can expect to be supported by the staff team to maintain family links, friendships and access to the community. Evidence: The location of the home is within a residential area of St Osyth and is ideal for service users to access a variety of facilities within neighbouring towns including seasonal entertainment, day drop in centres and general shopping. None of the service users are currently in any paid or voluntary employment. Sampling of activity records showed that people were involved in the following daytime activities, shopping, going out, visiting relatives, going swimming, playing pool, hydrotherapy attending local day centre/activity clubs for courses which include Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: drama, dance, music and pottery. The home regularly takes the service users for trips and lunch out. We are also informed that the home is actively trying to secure a work placement for one service user whom the home hope to support back into a supported living environment. The AQAA tells us All service users have individualised personal support care plans which detail how service user prefer their personal care to be provided and the level of support required.Service users are supported to access all therapeutic and healthcare services that are required as per their care plan. All service users have a health action plan and are carefully monitored, this information is incorporated into care plans and staff support service users to access GP services as required. Other health professionals are also involved when required. The home has an open door policy on the receiving of visitors, and viewing of the visitors book for the home indicated a range of visitors visiting the home. Discussion with the carers on duty on the day of inspection indicated that they all had an understanding of service users social development and that they had family or friends who had involvement in that too. Examination of records showed that the home operates a three weekly menu at present which is planned with the service users. Service users views gauged by nodding and smiles on the day were that they were happy with their meals and the food provided. The homes AQAA does not make reference to how the home has improved in the last twelve months as it has only been operational for six months, but does tell us All service users are supported to access educational, social, and other interests. Each service user is encouraged to plan their weekly activity planner. Service users take an active part in planning their holidays. Staff work hard to develop and maintain links with service user families and friends. Service users are encouraged to help develop daily routines for their home, to make choices about their daily lives and to participate in the day to day running of their home. Service users are encouraged and supported to assist in the preparation of well balanced menus, which encourage personal choices, preferences and healthy eating. Care Homes for Adults (18-65 years) Page 15 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. This judgement has been made using available evidence including a visit to this service. Residents can expect good support and assistance with health and personal care enabling appropriate consultation and respect of individual choice. People living in the home are adequately protected by the homes practice around administration of medicines. Evidence: Observation of the interactions between staff and people living in the home, indicated that staff were respectful of peoples dignity and privacy, staff were polite and respectful whenever they were speaking to people, and the responses received were happy and cheerful, staff were observed speaking to the people living in the home and not exclusively with each other. Discussion with staff indicated that, times for getting up and going to bed were flexible and that service users choices were paramount. The care plans sampled clearly identified the individuals needs, as well as the choices made as to how these needs were to be met. Care plans were well detailed, and took account of the changing needs of the individuals. The services of healthcare Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: professionals such as GPs community nurses, occupational therapists and consultant psychiatrists were accessed as necessary, evidence of professional input into the home was seen in the care plans. The home does not retain some controlled medicines currently and the requirement for the home to be able to store them in line with the Royal Pharmaceutical Guidelines was seen to be met. The home also uses homely remedies and has to covertly administer medication to at least one service user. Appropriate procedures and individual protocols were seen to be in place for this. All staff administering medicines have received training. Four members of staff were on duty on the day of inspection and confirmed they had received training and also the training records reviewed provided evidence to support this. To supplement this training the home carries out its own medication update programme. Medication records sampled on the day of the inspection were all in good order. It was however noted that that some transcribed handwritten medications did not have two signatures to evidence robust checking procedures. This was discussed with the manager as not being best practice and to ensure that printed MARS charts are obtained from the pharmacy ideally. Care Homes for Adults (18-65 years) Page 17 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. This judgement has been made using available evidence including a visit to this service. People who use this service will have their complaints taken seriously and be protected from abuse. Evidence: The home has an appropriate complaints policy and procedure, which promotes complaints being taken seriously and responses to them are handled efficiently. Although responses from service users were limited they were able to indicate whether they knew what a complaint was and were able to respond positively about the complaints process and who to direct a complaint to if required. The home has provision to maintain records of complaints received and the AQAA confirms that one has been received since the last inspection. This concurs with the records reviewed on the day of inspection and was seen to be dealt with appropriately. No safeguarding incidents have been reported. The provision of the complaints procedure in alternative formats was prominent, pictorially and within service users plans and complaint forms were available. Management of complaints was discussed with the manager and carers on duty and the homes AQAA informs us that We have complaints and compliments folders which are available to all. Any complaints are dealt with promptly and reported to the relevant authorities. Currently there have been no complaints from others, and service users wishing to make complaints are supported to do so and we follow company policy and procedures. Service users complaints are also in pictorial and symbol format. The home has in place a robust complaints procedure that includes Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: the contact details for the Care Quality Commission. The AQAA details there have been no adult protection referrals made since the home registered in October 2009. Staff in post have received training in adult protection, and provision is made for any new staff appointed to receive the training once they are in post. The last SOVA training course took place on 13th April 2010. Staff on duty on the day of inspection displayed via discussion a good awareness of the whistleblowing policy and procedure. All staff have been appropriately checked for employment, and Criminal Records Bureau (CRB) clearance checks were evidenced. 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. This judgement has been made using available evidence including a visit to this service. Residents can expect the communal areas of the home and bedrooms to be of a good quality standard and to live in a clean and safe environment. They can be assured that the maintenance of the home protects their health and welfare. Evidence: The environmental tour of the premises showed the home to be homely, generally well maintained and decorated. Individual bedrooms were appropriately furnished and equipped to meet the needs of the people in residence. Furnishings and fittings in the home were of a good quality and were domestic in nature. All communal areas were easily accessible to the residents accommodated. Some fixtures and fittings have been specially adapted to ensure they are suitable for use according to residents independent requirements. The building is in keeping with the local community and provided easy access to local facilities. The AQAA, although not confirming any plans for the next twelve months tells us under what we do well that the home Provides a homely environment and empowers service users to make choices and decisions in their daily lives. The home is clean, safe, homely and airy, with suitable lighting and heating. Furnishings and fittings are regularly maintained and serviced and weekly fire and water checks are Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: made along with monthly audits on health and safety. and a daily cleaning schedule is completed. The infection control policy was seen and gave full guidance on the prevention of cross infection. It included details of good hand-washing techniques, the use of protective clothing and the safe management of soiled linen. The toilets and bathrooms seen had adequate soap and drying facilities available for hand washing. A member of staff spoken with explained the procedure for the management of soiled linen and the use of the high temperature programmes on the washing machines. Feedback from surveys did not highlight any environmental issues and one stated Very clean and fresh. On the day of the inspection the home was clean and tidy, and was free of any unpleasant odours. 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. This judgement has been made using available evidence including a visit to this service. Staff employed in the home are appropriately trained and skilled to meet the needs of the people living in the home, and people are supported by the homes recruitment process. Evidence: Examination of four staff records, as well as discussion with the manager and care staff provided evidence that care staff had a good understanding of their roles and responsibilities and that they were qualified and competent. Records sampled on the day of the inspection showed that staff were receiving LDAF (Learning Disability Assessment Framework) and common induction standards core training, which included, fire awareness training, health and safety, manual handling, first aid, food hygiene, PRICE (Protection Rights In a Caring Environment), ICE (Inclusive Communication Essex) abuse awareness, mental capacity, deprivation of liberty and medication administration. Examination of staff rotas showed that staff were employed in sufficient numbers to meet the needs of those living in the home. Staff ratios were one to one with extra staff on duty if situations necessitated such. Additionally there is always one team leader on duty per shift and the manager is also available. The homes recruitment records overall provided evidence that the homes recruitment Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: policies and procedures were robust and effective, records sampled all contained copies of the following documents, application forms, copies of two written references, Criminal Records Bureau Checks (CRBs), evidence of induction and training and development. The AQAA confirms the home has High staffing levels, good staff retention, good staff morale, staff training and a good working environment. We have our own training manager who arranges in house and external training for all staff. Additionally it states The home provides one to one support in house and two to one support for service users that requires it when accessing the community. All staff receive induction with the training manager on their first day covering all aspects of the company policies and procedures, and mandatory training. New staff will also have up to five days shadowing an experienced staff member or a senior which may be a team leader assistant, team leader or the home manager. Comments from one service user were staff are lovely I like it here and they take me out and look after me As the home has only just commenced service since Oct 2009 the formal supervision of staff had only recently commenced and it was not possible to determine if the frequency of supervision met with levels set out in the National Minimum Standards. Staff spoken to confirmed they did have some supervision however documentary evidence for this was not available on the day of inspection. The AQAA does however state that the homes plans for the next twelve months are To continue to provide good standard of training to all staff. Be proactive in our recruitment and to ensure staff supervisions and appraisals are up to date and all staff to have in place personal development plan. In discussion with staff and from observation of their practice, all went about their tasks in a caring, friendly and supportive manner. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. Residents can be assured that all aspects of the home are managed appropriately. They can also expect that quality systems are based upon appropriate consultation and that they safeguard their health and welfare. Evidence: The home is managed in an open and transparent manner, by a registered service manager who has over twenty years of experience in the field of learning disabilities and management. She has been employed by the company who owns the home, for three years and is also the registered manager for two other homes in the group. There are plans for the current registered manager to become the service manager for a group of homes and a new manager who has already been appointed to be the registered manager. She has been in post since February 2010 and is managing the home on a day to day basis, but as yet has not made an application to be the registered manager. She has twenty six years of experience in the learning disability field and was previously an area manager for learning disability provider services in Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: Essex. She holds an NVQ level 4 registered manager award and is appropriately qualified in specialist courses. The home has a quality assurance process is place and this includes the use of questionnaires to a range of interested stakeholders including those living in the home, staff, relatives and visiting professionals. An analysis report of these is to be submitted to the CQC. In addition to this regular audits are undertaken by the manager and other responsible individuals to monitor the effectiveness of the service. Sampling of a range of the homes safety certificates indicated that the home has in place safe working practices, which protect both the people living in the home as well as staff. The home has its own maintenance personnel and evidence was seen to show that they are attending appropriate course such as PAT testing to ensure the home remains safe. The home is reminded to document all names of persons attending fire drills so a clear audit may be kept. The last fire drill recorded for the home was on the 12/04/2009. Care Homes for Adults (18-65 years) Page 25 of 28 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 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 9 Risk assessments should be person specific and indicate the assistance required to reduce the risk in the case of restraint and how this will aid the service users predominant need. This information should correlate with the care plan and daily evaluations to ensure all service users individual care needs are met. Transcribed medications should evidence two signatures to ensure service users receive their correct medication A consistent programme of supervision should be in place for all staff so that service users can be assured they are supported by competent and appropriately skilled staff. 2 3 20 36 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. 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). 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. 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