Care Home: Westmead

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What the care home does well Westmead House provides individuals with a clean safe well maintained home that has been adapted to meet the needs of people with complex physical needs. Care and support is well planed and provided by a staff group that are trained and understand the needs of the people who live at the home. One person commented in their survey `Westmead is managed very well with caring and sensitive staff who are friendly and easy to approach. I feel very happy here as Westmead is a nice environment to being where all your needs are met and are encouraged to be as independent as my disability will allow. Peoples choice is encouraged at all times.` In answer to the question what does the home do well another person said in their survey `The home does well in my personal care, eating different meals, helping me visit my girlfriend, helped me find a job and get there.` A good choice and variety of meals are provided with individual likes and dislikes taken into consideration when menus are planned. The home have developed good systems for ensuring that individuals views are listened to and that people have their say about how the home is run. Examples of this are individuals who live at the home being involved in interviews for new staff, having a Representative on the management board meetings and ensuring people have access to advocacy groups and meetings. What has improved since the last inspection? The dinning room has been extended and now includes a kitchen area where drinks and snacks can be made. Other areas of the home have been updated and refurbished. The recruitment process is now more robust and ensures that references are in place before a position is offered. What the care home could do better: Plans of care should be enhanced to include more detail about individuals` preferred routines. Plans should be in formats that individuals can easily understand. Where hand written entries are made in the medication records, they should be double signed to help prevent against errors. Although the interim management arrangements appear to be working well, the home needs to appoint and register a new permanent manager for the service. Key inspection report Care homes for adults (18-65 years) Name: Address: Westmead Leonard Cheshire Saunton Road Braunton Devon EX33 1HD     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: Joanne Walsh     Date: 2 6 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 31 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 31 Information about the care home Name of care home: Address: Westmead Leonard Cheshire Saunton Road Braunton Devon EX33 1HD 01271815195 01271814501 james.lawrence-parr@Lcdisability.org www.lcdisability.org Leonard Cheshire Disability care home 19 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who can be accommodated is 19. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Physical disability - (Code PD) Date of last inspection Brief description of the care home Westmead provides accommodation and 24-hour care for nineteen adults with physical and learning disabilities, under the ownership of the Leonard Cheshire Foundation. Although their age category ranges from nineteen to sixty-five, the majority of service users are 40 years or under. The home is an older property and has been adapted for wheelchair users throughout. All bedrooms are for single occupancy only. Westmead is located in Braunton, a large village offering shops, banks, pubs and other amenities. The home is within easy reach of local beaches and Barnstaple is 5 miles away. The home has specially adapted vehicles available those who live at the home, enabling them to enjoy trips away from the home. Overnight accommodation is available for visiting relatives and friends. The cost of care can be obtained directly from the Care Homes for Adults (18-65 years) Page 4 of 31 19 Over 65 0 Brief description of the care home service. Additional costs, not covered in the fees include transport, which is currently under review, hairdressing and personal items such as toiletries and newspapers. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk Current information about the service, including CQC reports, is available from the main office. Care Homes for Adults (18-65 years) Page 5 of 31 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 health care support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took during a week day in November and looked at all the key standards and focused on listening to the views of the people who live at the home. We did this by using surveys and by the use of an expert by experience. CQC are trying to improve the way we engage with people who use services so we gain a real understanding of their views and experiences of social care services. We are now using a method of working where experts by experience are an important part of the inspection team and help inspectors get a picture of what it is like to live in or use a social care service. The term experts by experience used in this report describes people whose knowledge about social care services comes directly from using them. The expert helped to speak to people about their experiences of living at the home as well as making some general observations. Their comments are included throughout this report. The home had been notified that a review of the home was due and had been asked to Care Homes for Adults (18-65 years) Page 6 of 31 complete and return an AQAA (Annual Quality Assurance Assessment). This shows us how the home has managed the quality of the service provided over the previous year. It also confirms the dates of maintenance of equipment and what policies and procedures are in place. Information from this document was used to write this report. During the inspection 3 people were case tracked. This involves looking at peoples individual plans of care, and speaking with the person and staff who care for them. This enables the Commission to better understand the experience of everyone living at the home. As part of the inspection process we try ask as many people as possible for their opinion on how the home is run. We sent questionnaires out to people living at the home; representatives, health and social care professionals (including GPs and care managers) and staff. At the time of writing the report, responses had been received from 9 people living at the home, and from 4 staff. We also received 2 surveys from social and health care professionals. Their comments and views have been included in this report and helped us to make a judgment about the service provided. The reason we completed this key inspection at this time was because the home had been subject to several safeguarding issues. We were confident that the home had responded quickly and appropriately to these issues, we wanted to be assured that individuals were still happy and felt safe within the home. Care Homes for Adults (18-65 years) Page 7 of 31 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. Care Homes for Adults (18-65 years) Page 8 of 31 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 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and health care 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 31 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. Individuals needs are assessed prior to them being offered a place so that the home can be confident that they can meet all needs. Evidence: We looked at and discussed with the manger the pre admission information for two newer people to this service. We saw that the home had obtained the individuals joint assessment from their funding authority and this included detailed information about their personal and health care needs. We also saw that the organisations own pre admission assessment had been completed, which includes sections on social interests as well as physical needs. In one instance this had been completed by another Lenard Cheshire home as the person was not residing in the Devon area. The information gathered is sufficient to enable the home to make a decision about whether they can meet the individuals needs. It also helps staff to plan for their care and support. Some staff we spoke with confirmed that they were given good information about Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: individuals needs and where possible individuals were encouraged to visit several times to meet staff and other people living at the home. One person who was new to the service told us they had not been able to have introductory visits to the home as they did not live near. they said that they were getting used to living at the home and that staff had been very good at helping them to settle in. They could not recall if they had been involved or consulted in the pre admission assessment. The home did take someone whose mental health needs were more prevalent than their physical needs, and despite having pre admission assessment information, it became clear after only a short while that this home was not appropriate for them. Where individuals have complex dual diagnosis the pre admission assessment needs to include a multidisciplinary approach. Care Homes for Adults (18-65 years) Page 12 of 31 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. Individuals care is well planed and people are enabled to make choices and decisions in their every day lives. Evidence: We looked at plans of care for two people. These are kept in individuals own rooms so that they and staff have easy access to them. Plans are usually developed with the individual their key worker. Plans have started to work toward being more goal focused and person centered, but further work is needed to ensure that daily routines and individuals goals and wishes are recorded with how these can are to be achieved. Plans do set out how individuals personal care is to be delivered and where physiotherapist input is needed, plans also include photos of positions that individuals should be assisted to sleep in, be hoisted in and rest in. This is essential to ensure that staff are fully aware of correct positioning and for consistent care. We were told that plans do now include a section on individuals mental capacity and Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: areas that they may need support in, but this was not viewed during the inspection. Plans could be developed to ensure that they are in formats that individuals can easily access, For some this may include photos and symbols. Work has begun on this, but now needs to be developed further. Staff we spoke to were able to give examples of how they assist individuals to make decisions in their everyday lives. One staff member described how for some individuals this meant ensuring that you gave them plenty of time to answer any questions given and to make a choice about what they wear, what drink they would like and what they would like to do for that day. Several people at the home use assistive technology to enable them to communicate. One staff member said that they are learning all the time about how to tweak this so that individuals get the most out of their communicators. This has enabled staff to better support people in making choices and decisions each day. People we spoke to said that they could choose where they spend their day, what times they got up and went to bed. Some people did say that sometimes they were not able to do activities such as accessing the community as much as they liked because there was not always sufficient staff. One person commented in their survey Westmead is managed very well with caring and sensitive staff who are friendly and easy to approach. I feel very happy here as Westmead is a nice environment to being where all your needs are met and are encouraged to be as independent as my disability will allow. Peoples choice is encouraged at all times. In answer to the question what does the home do well another person said in their survey The home does well in my personal care, eating different meals, helping me visit my girlfriend, helped me find a job and get there. People who live at Westmead are supported where possible to manage their own finances. One person has found that this has lead to increasing debts that they now need support to manage. There has been a safeguarding issue around individuals money and bank cards being used without consent. Since this has been discovered, the home took immediate action and involved the safeguarding team and Police. Measures have been put in place whereby people can still manage their own finances, but that photo identification is used instead of a pin number system. They home also does spot checks on the audit trail of finances that is completed by someone independent of the support staff. The plans of care include risk assessments that include details of what should be done Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: to minimise any risks. The home have a clear policy on missing persons and have put this into practice to good effect. Staff are aware of the policy and know who they should inform if someone is thought missing. Care Homes for Adults (18-65 years) Page 15 of 31 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. Individuals are supported to engage in appropriate leisure and work based activities although this is sometimes limited by availability of staff. Individuals rights are respected and people are able to make choices and decisions in their everyday lives. Evidence: We asked the expert by experience to speak to individuals about their expediences of living at Westmead and about opportunities for social fulfillment. This is the report from the expert. The Expert by experience was asked to talk with a selected number of residents about quality of life issues and to identify any changes they felt would improve life for them. The discussion with each resident was conducted in a fairly informal and loosely structured way. An equal numbers of male and female residents were spoken with and half of these used some level of communication support for our discussion. Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: The female residents spoken with were generally more satisfied with their quality of life than were the males. The female residents also appeared, from their comments, to have established a more structured lifestyle within the constraints of the home; however it was commented on by both male and female residents that perceived low staffing levels resulted in little, if any opportunity for any degree of spontaneity especially at weekends when people traditionally relax and socialise. Seventy five percent of those spoken with also felt the home was becoming increasingly institutionalised with less encouragement toward independence. Examples given were around individual choice of carer gender for personal care; increased pressure to socialise in groups rather than being able to go to the pub with a carer of their choice. It was commented on that there has been no activities coordinator in post since 2007 It was generally felt that while care was good, quality of life issues had to be arranged around staffing levels rather than sufficient staff being available to enable residents to plan on the day rather than be forced to plan some days ahead. One of the positives mentioned around quality of life was the opportunity to do a temporary place swap if a resident had someone they wanted to visit and who lived nearer to one of Leonard Cheshires other care homes. Another was that although there is a large number of new carers being inducted; contact and interaction with these carers is positive and they are settling in well. The suggestion was also made by more fifty percent of those spoken with that consideration be given to splitting the home into a number of smaller living units on a similar principle to student shared accommodation, the argument being that this make it less of an institution. The manager and staff did acknowledge that it was not always possible to provide spontaneity for outings and activities and that is was a reality of residential care and not being funding for one to one support for people. Areas where staff have worked to ensure that social, educational and work needs are being better met are looking at volunteer work placements, ensuring that staff are available to facilitate people to be involved in people first advocacy service. The staff team spoken to and those who returned surveys all identified this is one area that they could improve on, but that to some degree this was reliant on staff availability. The home does employ a part time volunteer coordinator who has got more volunteers so that people can be assisted to access the local community more often. The home employs a computer tutor who works five days per week and offers individual and group sessions to work on computers and helping people being more familiar with their communicators. Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: The senior team leader told us that they have an activities programme about to be implemented that includes carriage driving, trips out, helping out at a local farm, gardening, sessions using public transport. These will run along with cooking skills and computer sessions each day. The routines of the house do try to promote independence, with peoples preferred choice of key worker, and gender for who assist them clearly stated and where possible this is honoured. We looked at the staffing rotas and saw that the team leaders have tried to ensure there is always an even mix of male and female carers. Staff spoken to said that they try to ensure individuals privacy at all times, only entering their room once they have knocked had had a response, unless in an emergency situation. People who live at Westmead have access to most areas of the home except the main kitchen, although kitchen facilities are available to people in the ground floor dining area. The computer suite door needs to be widened to allow easy access to everyone at the home. Although it is just wide enough, some specialist chairs are wide and this makes maneuvering around into and out of the computer room difficult for some people. We saw that people are offered a good range and choice of meals each day, and that drinks and snacks are available throughout the day. People told us that meals were usually very good and that the cook knew their likes and dislikes. One person said they were given treats like steak and chips. Another person said that meals can always be held for you if you are out and that the cook always ensured that there was something that you liked. People who need support to eat their meals were given this in a caring and respectful way. Meals that need to be pureed, are done so that each element of the meal is individually pureed. Care Homes for Adults (18-65 years) Page 18 of 31 Personal and health care 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. Individuals personal and health care needs are well met. Evidence: People who live at the home told us that they were able to choose what time the got up and that they choose and decide on what they wear, how their hair should be styled. Peoples choice is reflected in their individuality and this is promoted by staff who know and understand the preferred routines of individuals. One staff member said that they work hard to promote a good self image and that some individuals enjoy and appreciate extra time spent by staff in ensuring they look good. All of the staff we spoke with and those who returned surveys said that they thought that individuals personal and health care needs were well met. Staff spoke knowledgeably about individuals complex health care needs and about how best to support individuals in their personal care. The AQAA states A £10k physiotherapy package is purchased annually from the Community Physiotherapy Team to assess, train and deliver physiotherapy on a weekly basis. This is supported by a paid in-house Physiotherapy Assistant who has a Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: further 16 hours per week to deliver specialist physiotherapy programs. Sleep programs have also been devised with service users and the external physiotherapist to provide postural support throughout the night. Most people have special adapted wheelchairs and some people use computer communicators that are adapted to suit their individuals needs. Plans of care show that there is good involvement from physiotherapists and occupational therapists. People we spoke to said their health care needs were well met. Medication storage and records were seen during this inspection. The current system is robust but we recommend that any hand written entries are double signed to ensure against mistakes. We were told that no one currently self medicates, but that they were moving toward this by having medications kept in a locked cabinet within each individual bedroom. This is being implemented shortly. Care Homes for Adults (18-65 years) Page 20 of 31 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. Individuals views are listened and acted upon. Evidence: The home has a clear complaint procedure and people we spoke to and those who returned surveys said they knew how to make a complaint. The home have various ways that it tries to ensure people have their views heard including regular meetings with the whole group, individual key work meetings, a representative on management meetings, and they have also tried having people who live at the home on staff interview panels to help employ staff. The home keep good clear records of what complaints have been raised and how these have been resolved. Some people are actively involved in advocacy groups and this is supported by the home, including providing staff time and transport to enable this. There have been two safeguarding alerts made, both by the home and CQC are confident that the alerts were made as soon as possible and individuals were fully protected form any further potential abuse. The local authority safeguarding chair has said they they have been very impressed by the manager and home in being fully engaged in the safeguarding process. All staff have since the last key inspection received additional training in safeguarding Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: ans whistle blowing processes. Care Homes for Adults (18-65 years) Page 22 of 31 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. Westmead provides people with a well maintained, specially adapted, spacious and safe home Evidence: During this inspection all of the communal areas and some of the individual bedrooms were looked at. The communal space has been improved with an extension to the lounge/dining area. This includes an area for making drinks and developing independent living skills, such as making snacks and basic cookery. We were told that any refurbishment is always in consultation with the people who live at the home, with them making the decisions about decor and fabric of the building. Some areas are still in need of redecoration, but overall the building is well maintained. The expert by experience did not that during his visit the home appeared cold to him. This was not commented on by any individuals we spoke with or reflected in the surveys. All parts of the home are clean and free form odour. The kitchen has been awarded five stars out of five for its cleanliness by environmental health. The home have had a new call system installed that meet the needs of people who live Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: their including voice activation, computer software activated systems, specialist touch pads (with or without bespoke flexible arms) and pendants for service users exploring the grounds of the service. The AQAA tells us that the call system has been audited to ensure that it is usable by all service users and additional equipment purchased at the request of service users to further enhance the system. Care Homes for Adults (18-65 years) Page 24 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are well trained and supported to do their job. Evidence: We looked at the staffing rota and saw that there are sufficient staffing levels for the number and needs of the people who live there. The team leader who completes the rota includes a tally of number of each gender for each shift so that there is an even spread of male and female carers where possible. Staff that we spoke to and those who returned surveys said that they had good training opportunities. This was supported by the training matrix we were shown by the training coordinator. Areas that have been identified for further training or updates have been planed so that staff have all the core training they require to do their job. Staff we spoke to showed a really good understanding of the needs of they people they support, and we observed support being offered in a professional and respectful manner. Individuals we spoke to who live at Westmead were very complimentary about the staff. Some people did mention that there had been lots of staff leaving, but that new staff were being introduced, and people saw this as very positive. Staff recruitment files for the four newest staff members were seen and we are Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: satisfied that all checks and references are in place prior to them being offered employment. Care Homes for Adults (18-65 years) Page 26 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run, although a permanent registered manager in post would help to ensure that individuals feel that the home is being run in their best interests. Evidence: The home does not currently have a registered manager in post, but the organisation has kept CQC informed of their interim management arrangement until they can find a new manager. They have a experienced manager from another home as an interim arrangement. Staff and individuals who live at Westmead all expressed their regret at losing their last manager who they all respected. The manager left to take up another position outside of the Devon area. People said that the interim management arrangements were working but people were anxious to know when they will get a new permanent manager and who they may be. The registered providers need to ensure that they appoint a new permanent manager as quickly as possible. The home have good processes in place for ensuring that they listen to the views of Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: the people who live at the home, via meetings surveys and one to one time. The registered provider visits on a monthly basis unannounced and completes spot checks on areas, key documents, medications as well as talking to people and staff to see if there are any issues. The AQAA provided us with detailed information about how well the home is maintained, what services to equipment have been completed as well as what policies and procedures are in place in relation to health and safety. Staff spoken to said that they had training in all areas of health and safety and we saw that a comprehensive induction programme is completed for all new staff. We saw that accident and incidents are reported and recorded well, and the home have a good record of keeping CQC informed of any major issues that affect the well being of people who live at the home. Care Homes for Adults (18-65 years) Page 28 of 31 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 29 of 31 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 2 6 14 Plans of care should be more person centered with goals and be in a format that the individual is able to understand. The home should ensure that the range, choice and times of activities is developed further so that individuals have more opportunities to do things they enjoy Any hand written entries in medication records should be double signed to help prevent against errors. 3 20 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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