Inspection on 25/03/10 for 97 Luncies Road

This is the latest available inspection report for this service, carried out on 25th March 2010.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

97 Luncies Road 27/02/06

97 Luncies Road 03/10/05

97 Luncies Road 09/05/05

97 Luncies Road 01/11/04

97 Luncies Road 23/01/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 29/06/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: 97 Luncies Road 97 Luncies Road Basildon Essex SS14 1SD 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: Alan Thompson Date: 2 6 0 3 2 0 1 0 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: 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 35 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 35 Information about the care home Name of care home: Address: 97 Luncies Road 97 Luncies Road Basildon Essex SS14 1SD 01268555488 01268555488 lunciesrd@walsingham.com www.walsingham.com Walsingham Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 5 Number of places (if applicable): Under 65 Over 65 5 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 5 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: Learning disability - Code LD Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 35 A bit about the care home 97 Luncies Road is a care home providing personal care and accommodation for up to five adults who have a learning disability. The home is a two storey detached residence, which was originally built in the 1970s as a childrens home, and was later, in 1989 refurbished and registered as a Christian based home run by Walsingham. Walsingham is a registered charity. The homes facilities include a living room and separate dining room and each service user has their own single room. There is a garden with a separate patio area and seating. The home is situated at the end of a no through road next to a housing estate. Local shops are within waking distance, and a bus route passes close by which provides public transport access to Basildon and Pitsea town centres. There is a vehicle based at the home which is used by staff to take service users to and from their community based interests and activities. Fees for the current service users at the time of this inspection were Care Homes for Adults (18-65 years) Page 5 of 35 advised as £227.40 per day. Inspection reports can be obtained from the home or from the CQC internet website on, www.cqc.org.uk Care Homes for Adults (18-65 years) Page 6 of 35 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 Care Homes for Adults (18-65 years) Page 7 of 35 How we did our inspection: This is what the inspector did when they were at the care home We did this inspection over two days on 18th and 25th March 2010. This report reflects our findings on these days along with information provided by the manager and feedback by service users and staff. The manager was not at the home on the day of our first visit and all of the service users were going out when we arrived. Because of this we went back the following week to finish our inspection. Our most recent inspection before this was on 24th April 2007. The manager completed and returned their Annual Quality Assurance Assessment (AQAA) to before the inspection. This is a self assessment required by law which gives homes the opportunity of recording what they think they do well, what they could do better, what has improved as well as their future plans for improving the service. Some of the information and detail provided within the AQAA has been included in this report. We spoke with the manager, service users and staff, and we looked at some records, policies and procedures. We were also shown around parts of the home and grounds. Reference to feedback received from people has been made within this report. All matters relating to the outcome of the Care Homes for Adults (18-65 years) Page 8 of 35 inspection were discussed with the manager of the home, with full opportunity for discussion given and/or clarification where necessary. What the care home does well 97 Luncies Road had a friendly and supportive atmosphere. The lounge and dining room were comfortable and bright. Care plans are informative and help staff to understand the levels of assistance and support service users want and need. The staff team support service users to take part in activities, both in the home and around the local community. Care Homes for Adults (18-65 years) Page 9 of 35 What has got better from the last inspection What the care home could do better Service user agreements should be signed by the service user if possible, and by the home. The outcomes of care plan review meetings should be recorded and show any agreed actions or changes regarding the support people receive. Better records should be kept of activities taken part in or offered to service users, and the service complaints procedure should be displayed in the home. Care Homes for Adults (18-65 years) Page 10 of 35 Evidence needs to be available to show that all staff involved in administering medication have been trained for the role, and, where possible, service users consent to being given medication should be sought. The laundry needs attention to damaged walls and the ceilings in the shower room and the first floor rear right bathroom both need painting. The shower room doorframe is partly rotten and needs attention. There is mould on the walls of the first floor rear right bathroom which needs to be removed and the walls in the ground floor rear wc need repainting. Some carpets around the home are dirty or stained and need cleaning or renewal. The main areas needing attention are in both the ground floor and first floor corridors, and also in the front left bedroom on the first floor. The rear garden should be tidier and the grass should be cut. There should be better support available for staff who work at night and all staff should be offered 1 to 1 supervision/support at least six times a year. Care Homes for Adults (18-65 years) Page 11 of 35 Records need to be available to evidence that all staff have been trained on safeguarding awareness. Criminal records checks should be carried out by the provider for all staff, including casual staff. If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 12 of 35 If you want to speak to the inspector please contact Alan Thompson CQC Eastern Region Citygate, Gallowgate Newcastle upon Tyne NE1 4PA Tel: 03000 616161 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 set out 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 13 of 35 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 14 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering moving into 97 Luncies Road can be confident that the admission processes ensures that their needs can be met. Evidence: All current service users are placed and funded by local authorities. Records showed that these organisations had provided basic information to the home when making a referral on behalf of prospective new service users. Senior staff from the home had then visited propective new service users to undertake a more detailed assessment of needs using the homes own format. We looked at the homes format used to assess people. This included recording information on the individuals background with assessed needs under headings of, personal support and care, sight, hearing and communication, mobility, diet, health, moving and handling, mental capacity, behaviours, finance and general risks. The assessments we looked at contained the information necessary for service users initial needs to be met at Luncies Road. Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: The manager advised that new service users are invited to visit the home several times before deciding to move in and we spoke to people about this. However several service users were unable, because of their disabilities, to tell us about when they moved in, and one person we spoke with had been at the home for several years and could not remember if they visited before they moved to the home. However they did say they liked living at Luncies Road. Written agreements were seen on service users files confirming the support and service they could expect at Luncies Road. Unfortunately none seen had been signed by the service user their representative or by staff. We have recommended that where possible people are able to sign to confirm that they are aware of the terms of their residency. Care Homes for Adults (18-65 years) Page 16 of 35 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 information in care plans mostly ensures that peoples needs could be met in a way they would wish. Evidence: At the time of this inspection there were five service users living at Luncies Road. Two of their support/care plan files were inspected. These had risk assessments with guidelines for staff on methods to minimise risk and had been reviewed. Files seen also included consideration of behaviours and staff had been trained on managing challenging behaviours. Peoples assessed and identified daily care and support needs were shown in Person Centred Plans (PCPs). Areas covered included, personal history, what the person likes to do each day, their likes and dislikes, things and people who are important to them, behaviours, communication, personal support needs, health, medication, hearing and sight and any medical professionals involvement in their healthcare needs. PCPs seen showed the interventions required from staff to provide the support people need and prefer. Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: The manager said that PCP goals are reviewed by the service users key worker each month, and that full PCP reviews are held every six months with the service users involvement. We looked at these and saw that progress towards achieving the service users goals and any relevant life changes had been recorded. However the recording and review process had not always been on a monthly and six monthly frequency. We also noted that there was no consistency in the recording of service users involvement in the review process, or of comments or opinions they may have had at meetings. We have recommended that staff make improvements to their recording of discussions with people. Healthcare issues were seen to be recorded on service users files including visits to medical professionals, hospital visits, GP consultations, dentists and chiropodists. Service user meetings had been held, which provide people an opportunity to have their views and opinions about the service are listened too and taken account of. Service users who were able to express an opinion confirmed, when asked by us, that they thought they are included in day to day decision making within the home, with staff offering choices around routines and events. This two way interaction was seen going on during our visit. Care Homes for Adults (18-65 years) Page 18 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in 97 Luncies Road can expect to be offered a lifestyle to meet their expectations. However better records should be kept of the activities they take part in. Evidence: One service user is interested in finding a job and staff are supporting them with this goal. Some people attend local colleges for cookery and sports classes. Staff take people to these activities and remain with throughout the class. None of the current people living at Luncies are able, because of there assessed dependency needs, to access the community on their own. Staff support people when they go out and there is a motor vehicle based at the home to enable easy access to the local and wider community. Staff and the manager advised that the range of activities and outings offered to people included bingo, horse riding, pool therapy (we noted that people attended this activity when we first visited the home), shopping trips, days out in London, bowling, cinema, Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: dancing, coach trips (with staff), and trips to the coast. Several service users were unable, because of their disabilities, to tell us about the activities offered them, but one person did say that they regularly attend many of the activities available and that they enjoyed what they did. However when we looked at care records we could not see written evidence of the full range of activities that were advised by staff as having taken place. We have recommended that the recording of activities offered to and taken part in by people improves. Most of the service users see their families and friends regularly with staff offering to drive the service user home to ensure regular contact is supported. Contact includes regular visits home, including overnight stays. Records had been kept of family contact. The manager confirmed that said staff enter bedrooms only with the individuals permission, unless the welfare or well being of the service user is in question. Some have keys to their rooms but others do not, either by choice of because of the assessed risks. Throughout this inspection staff were observed to interact appropriately with service users and appeared to always use the individuals preferred form of address. Discussions between service users and staff about routines and choices were taking place throughout the inspection and the atmosphere in the home was relaxed and friendly. Service users appeared at ease about expressing their views and preferences to staff. Nutrition records were looked at and evidenced a varied and balanced diet. Menus are decided on a weekly basis on Sundays. Service users decide with staff what they meals they want for the week, and some accompany staff on provisions shopping trips. Some also take part in meal preparation and clearing up as part of a planned activity, which we saw going on during our second visit. The manager confirmed that service users food preferences and likes/dislikes form the basis of menu planning. Service users who were able to talk with us confirmed, when asked, that they liked the food at Luncies Road. Care Homes for Adults (18-65 years) Page 20 of 35 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. Service users can expect to receive personal and healthcare support in an appropriate and dignified way that meets their needs. Evidence: Care records and discussion with service users and staff confirm that service users are usually supported in making their own choices around clothing styles, hairstyles and general appearance. Service user files also included preferences around daily routines, and details of the levels of personal care support needed were also seen documented. Several service users were unable, because of their disabilities, to tell us about the support provided them by staff. However those who did speak with us confirmed that they liked the staff and were satisfied with the care provided them in the home. Support plans contained a Health Action Plan showing the persons healthcare needs. The current service user group are offered staff support and guidance in recognition of their individual healthcare needs, and to access community healthcare facilities. Service users regularly visit community based healthcare services including consultant psychiatrists, hospitals, GPs and dentists with staff support. Service users healthcare needs were recorded within individual PCPs. PCPs also had records of appointments and Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: outcome notes. All but one of the people living at Luncies Road were receiving full staff support with their medication needs. However files seen by us did not include evidence to confirm that, where possible, their agreement to this level of support had been sought. Some service users did not appear to have a full understanding or awareness of the medical reasons for medication regimes prescribed to them. The manager confirmed that if service users refused medication then advice and encouragement is offered to them to understand the reason for the prescribed dosage. If they continue to refuse their prescribed medication the GP is contacted for advice. All service users have a medication profile and PRN protocols and the homes medication polices include guidance for staff on what is expected when dealing with medication. This included administration, recording, action to take when errors are made, as and when medication, receiving and returning stocks and storage. A random sample of medication administration records and stocks of current medication were looked at. No errors were noted. Staff and the manager said they staff had been trained on dealing with medication. We checked staff training records and some did show that they had medication training, others did not have this recorded. An internal audit has taken place on medication practice, and we saw evidence to show that staff are regularly reassessed for competency in dealing with medication. However we need to see evidence to confirm that all staff who deal with medication have been properly trained for this role. Care Homes for Adults (18-65 years) Page 22 of 35 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. Practices in the home generally ensure that service users are protected and that their views on the service are listened to. Evidence: The manager had a complaints procedure in place. This clarified the complaints process for service users and provided guidance for managers on how they should respond to complaints, including response timescales and investigation methodology. The home also had a complaints procedure in picture and text format which was included in the Service Users Guide. The format seen provided guidance and advice for people who would not have the ability to follow any written procedure. Unfortunately we did not see a copy of this displayed anywhere in the home. We have recommended that guidance on how to complain is made easily accessible to people who use the service. Comments made by service users verbally confirmed that if they were unhappy they would speak with staff or speak with the manager. Service users also have active involvement with their respective families and had regular contact with external health/social care professionals. One has also in the past used an independent advocacy service for advice. These people/organisations offer alternative routes for raising issues or concerns. There was a set template form for recording complaints and a compliments complaints record book. Information in the AQAA shows no recorded complaints in the 12 months Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: leading up to 13th February 2010, the date the AQAA was sent to us. The manager also confirmed at the inspection that no complaints had been received but assured us that if any complaints are received records would be kept of the issues raised and of the investigation and outcome. The homes policies on adult protection were inspected. There was written guidance for staff on recognising and reporting abuse, and the actions to be taken by staff if abuse is suspected. The guidance included types of abuse and a whistle blowing policy reminding staff of their responsibilities to report suspected poor practice. We are aware that a safeguarding issue was raised by the home in 2009. This was properly dealt with by management in liaison with local safeguarding authorities and was closed. Staff said they had been trained on safeguarding awareness and some records seen had evidence of this. Unfortunately not all records we looked at had evidence of this training and so we have made a requirement on this issue under staff training. However staff spoken with did display awareness and understanding of what was meant by safeguarding adults from harm. They also confirmed that if they suspected any form of abuse had occurred then they would contact the manager or other senior person. Care Homes for Adults (18-65 years) Page 24 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a comfortable and homely environment but not all areas of the home and grounds were well maintained. Evidence: During our visits a partial tour of the home was made accompanied by staff and the manager. The communal areas and bedrooms looked at were acceptably decorated and furnished, and the kitchen looked adequately equipped and maintained. The lounge looked comfortable and was bright, and the dining room was roomy. Bathing and toilet facilities in the home comprise of two bathrooms with wc, a separate wc and a shower room. All of these rooms need attention. The shower room had flaking paint on the ceiling and part of the door frame was rotten. The walls in the wc had two uneven patches of white paint on top of the base blue colour, and one of the bathrooms had flaking ceiling paint and mould on the walls. We also noted whilst looking around the home that some carpets on both floors were dirty/stained and need to be cleaned or replaced. These areas were mainly in the corridors and one first floor bedroom. All private rooms are singles with one of these on the groundfloor and the remaining four on the first floor. All private rooms seen had wardrobes and adequate storage facilities. Service users spoken with said they liked their rooms and that staff helped them keep their rooms clean. They also said they were Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: involved in choosing their furniture and the colour of their rooms. The manager confirmed that service users are provided opportunities to personalise their rooms to their own tastes and requirements, and rooms inspected included various items of personal possessions according to individual choices. The laundry room was in an adjoinging building at the rear of the home. The equipment provided looked suitable for the size of the service but the room was not well maintained. There was an area of damaged/marked wall and the floor covering did not look clean. The home has a rear garden which could be accessed directly from the lounge and from the corridor next to the kitchen. There were also side gardens on either side of the home. The rear garden needed some attention and the side gardens looked overgrown with long grass. There was also some rubbish visible in the side garden to the front right of the home. The manager advised that the rear garden was part of the home but the side gardens were not and therefore could not be maintained by them. The manager did say that a letter had been sent to the organisation responsible for the side gardens requesting that they are tided up. There is a driveway on one side of the property which provides parking for the homes vehicle and for staff/visitors. Care Homes for Adults (18-65 years) Page 26 of 35 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. People using this service are supported by staff who have been recruited properly but may not all be sufficiently trained for their roles. Evidence: A staff rota was shown to us on our first visit. Five service users were living at the home and there were four support staff on duty. Three of these were agency staff. The senior permanent member of staff on duty confirmed that normal daytime staffing was a minimum of two staff on duty plus the manager. We were also advised that additional staff are brought in to work when service user activities are scheduled outside the home. This was evidenced at our first visit when there were four staff to support service users in attending a swimming pool therapy session in Southend. We were advised that night time staffing comprises of just one waking member of staff with a manager on call. However we noted that the on call person may not be locally sited to Luncies Road. We have therefore recommended that support for night staff is improved to ensure that local responsive support is on hand should it be needed. High numbers of agency staff are employed at Luncies Road, however permanent staff we spoke with, and the manager, confirmed that regular agency people are used to ensure that they know service users, and service users know them. The manager also produced evidence to show that agency staff go through basic induction about the service and that records are held to confirm their role, that references had been obtained, that Care Homes for Adults (18-65 years) Page 27 of 35 Evidence: they had a CRB check, training they had undertaken and their photo ID. We looked to see that regular staff team meetings take place to provide staff the opportunity to be included in service planning, and to aid good communication and consistent practice. We noted that team meetings had commenced since the new manager took up post in July 2009. Prior to this there had not been a full management team at the home for twelve months after the previous registered manager was promoted to a role away from the service. During this period regular meetings had not been held. Staff spoken with said that they felt better supported now that there is a full management team in place at Luncies Road, and the new manager said they will ensure that regular meetings continue in future Staff recruitment files were looked at. The manager advised us that the main records are held at the providers head office, with the home holding staff profiles as evidence that proper recruitment checks had taken place. Files see had proforma sheets signed by a senior manager confirming that references had been obtained and ID and employment history had been checked. The home have evidence that CRBs had been obtained and a photograph on file. The provider had arranged for CRB checks on permanent staff however we are aware that this has not always been the case in relation to casual staff, (not including agency staff), where it was noted that a CRB had been accepted from an organisation not linked to Walsingham. We have recommended a change to this practice. New staff undergo basic initial induction training when they first start work at Luncies Road. After this they progress to the Sector Skills induction training for the service type. Staff said they had received induction training and this had covered what they needed to know. Staff also said that they received ongoing training although some indicated that this lapsed when there was not a manager in post. They added that training opportunities had improved recently and that the new manager was responsive to their requests for training. We looked at training records. These showed that training had generally been provided on NVQ, fire safety, infection control, food hygiene, first aid, health and safety, challenging behaviours, risk assessment and mental capacity awareness. Unfortunately records seen did not confirm to us that training had been provided to all staff on adult protection awareness and medication administration. We have made statutory requirements on these shortfalls. Staff said they feel better supported now that the home has a full management team and there was evidence that some regular staff supervision/support meetings had taken place in 2009 and early 2010. Records of discussions covered house and service user issues, however the frequency of these meetings did not meet the recommended timescales and should be increased to provide staff with the support opportunities they may need. Care Homes for Adults (18-65 years) Page 28 of 35 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. People live in a home that is run and managed with their best interests in mind. Evidence: Since our last inspection a new manager had commenced working at Luncies Road in July 2009. The manager said they have ten years previous experience of working in social care, including four years management experience. The manage is studying for the Leadership and Management Award and had begun the process of applying for registration with the Commission. Prior to the manager starting at the home the home had been overseen by the deputy manager for twelve months after the previous registered manager was promoted within Walsingham. Staff spoken with confirmed that they felt better supported with a full management team in place. The registered providers annual quality assurance (QA) process involves service users views sought by sending them survey questionairre forms for completion. We saw evidence of this in surveys including an easy read version. Questions ask for peoples views on the food, environment, care, lifestyle and staffs attitudes regarding respecting their privacy and dignity. The results of the responses are provided to the home manager for action where necessary. The registered provider also carries out regular monthly Care Homes for Adults (18-65 years) Page 29 of 35 Evidence: checks on the service regulation 26 reports. Those seen included records of discussion with service users where their views on the service were sought. The manager confirmed that personal spending monies are held for safe keeping for service users, and that staff also support some people to access their bank accounts. Records had been kept of the balances held and of receipts for expenditure. A random sample of these were checked and found a minor discrepancy that that manager undertook to rectify. The manager said that balances and receipts are checked every week and the providers own finance staff visit the home twice a year to check the record keeping and accounts. Random samples of records required to be kept by regulation were inspected. These included regulation 26 reports, staff rota, visitor book, nutrition records, assessments, care plans, staff recruitment, complaints, medication records, fire procedures and fire drills. Discussions with staff, management and inspection of records confirmed that training is provided to staff in first aid, fire safety, health and safety and food safety. We also saw a health and safety audit on the premises which had been carried out in Novemver 2009. Certificates and service records were seen to confirm that the homes hoists, fire equipment and alarms, gas boilers, electrical installation supply and portable electrical appliances had all been tested/serviced. The manager confirmed that hot water supply is delivered at or near 43 degress celcuis, and that daily checks on this take place. Records of this were seen and also of legionella tests to try to minimise risks regarding the homes water supply. Care Homes for Adults (18-65 years) Page 30 of 35 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 31 of 35 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 Description 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 Description Timescale for action 1 20 18 Evidence must be available to confirm that staff who administer medication to service users have been trained for the role. 30/06/2010 This is show that staff have been trained for the role they perform. 2 24 23 The shower room doorframe is partly rotten and needs attention. There is mould on the walls in the first floor rear right bathroom which needs to be removed, and the walls in the ground floor rear wc need repainting. 30/07/2010 This is to ensure that service users live in a clean and well maintained environment 3 24 23 Marked andor stained carpets in corridors around the home and in the front 30/07/2010 Care Homes for Adults (18-65 years) Page 32 of 35 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 Description Timescale for action left bedroom on the first floor need cleaning or renewing. This is to ensure that service users live in a clean and well maintained environment. 4 30 23 Repairs are needed to the marked and cracked wall in the laundry room. 30/07/2010 This is to ensure that service users and staff have a clean and well maintained environment to live and work in. 5 35 13 Evidence needs to be available to confirm that all staff have been trained on safeguarding awareness. 30/06/2010 This is to show that staff are trained for their roles and that service users are protected. 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 5 Service user agreements should be signed by the service user if possible, and by the home. Care Homes for Adults (18-65 years) Page 33 of 35 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 2 6 The outcomes of care plan review meetings should be recorded and show any agreed actions or changes regarding the support people receive. Better records should be kept of activities taken part in or offered to service users. Service users consent to being given medication should be sought where possible. The rear garden should receive attention with the grass cut. This is to ensure that the external grounds are kept maintained and tidy. There should be better oncall support available for staff who work at night. Records should be available to show that all staff are offered 1 to 1 supervisionsupport at least six times a year . 3 4 5 14 20 24 6 7 36 36 Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 03000 616161 or 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. © 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. Care Homes for Adults (18-65 years) Page 35 of 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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