Inspection on 26/08/09 for Hart Lodge

This is the latest available inspection report for this service, carried out on 26th August 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Hart Lodge 01/08/06

Hart Lodge 23/01/06

Hart Lodge 30/06/05

Hart Lodge 19/11/04

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Hart Lodge 10 Whalebone Grove Chadwell Heath Romford Essex RM6 6BU     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sandra Parnell-Hopkinson     Date: 2 6 0 8 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 29 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 29 Information about the care home Name of care home: Address: Hart Lodge 10 Whalebone Grove Chadwell Heath Romford Essex RM6 6BU 02085907077 02085009339 hartlodge@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: R Hart Care Ltd care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 9 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: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Hart Lodge is a registered care home providing a rehabilitation service for nine people of either sex who have mental health needs. The care home is situated in a residential area of Chadwell Heath, within the London Borough of Barking & Dagenham, and can be reached by road via the A12 and A13 or by bus routes, and is within easy reach of central Romford shopping amenities. The building has been converted from a family house to a nine-bedroom care home. The home provides a high standard of accommodation with all bedrooms being single with en suite, and some with shower en suite. There is a lounge/dining room with a rear garden which has been decked and Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 9 Brief description of the care home has seating for residents. Residents are encouraged to be independent and to be part of the local community. Hart Lodge is owned by Hart Care Ltd which owns and operates two other care homes in the county of Essex. At the time of this inspection the minimum fee is £950 per week up to an unspecified maximum fee level which is dependent upon the assessed needs of the individual. The statement of purpose and the inspection report were available in the lounge area of the home, and a copy of each can be obtained from the home upon request. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection which took place from 08:00 hours on the 26th August 2009. On this inspection the lead inspector was joined by an expert by experience. This is a lay person who is provided by a voluntary organisation under contract with the Care Quality Commission. Experts by Experience are used to obtain an independent view of the service and to speak to service users and staff about their experiences within the service. Other information has been gathered from case tracking, viewing records and documentation, discussions with healthcare professionals, notifications and the 2008 Annual Quality Assurance Assessment which was updated during the inspection process. Unfortunately, due to a systems failure within the Commission a new Annual Quality Assurance Assessment was not requested prior to this inspection. Care Homes for Adults (18-65 years) Page 6 of 29 What the care home does well: What has improved since the last inspection? Pictures has now been provided for the lounge walls, and these new pictures have been painted by a service user who is extremely proud of them. During the inspection he Care Homes for Adults (18-65 years) Page 7 of 29 told us that he really enjoyed painting and was planning to do more. The smoking area for service users has now been moved to the garden area where a permanent wooden shelter, with seating, has been provided. Smoking within the home is discouraged, and generally service users respect this and to smoke in the wooden shelter. 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 29 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 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are considering using the service have the information needed to choose a home that will meet their needs. Evidence: The home provides a statement of purpose that is specific to the individual home and the service user group they care for. It clearly sets out the objectives and philosophy of the service supported by a service users guide. Service users know what to expect when they move into the home, and gives a clear account of the services provided, quality of the accommodation, how to make a complaint and a copy of the recent inspection report is also available to them. Admissions are not made to the home until a full needs assessment has been undertaken. The assessment is conducted professionally and sensitively and involves the individual and families or representatives where appropriate. Admissions only take place if the service is confident staff have the skills, ability and qualifications to meet the assessed needs of the prospective resident. The management team considers the application and listens to shared views and comments before agreeing to the Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: admission of a particular service user. The assessment focuses on achieving positive outcomes for people and this includes ensuring that the facilities, staffing and specialist services provided by the home meets the ethnic and diversity needs of the individual. The home operates a key worker system, and all prospective service users are given the opportunity to spend time in the home, including overnight stays, and a member of staff is allocated to them information and to help them understand how the home is organised and run, together with the facilities and services available. New service users are provided with a statement of terms and conditions and this sets out in detail what is included in the fee, the role and responsibility of the provider and the rights and obligations of the individual. The manager actively promotes the opportunity for discussion and clarification and terms and conditions are reviewed regularly. Care Homes for Adults (18-65 years) Page 11 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are involved in decisions about their lives, and they play an active role in planning the care and support they receive. Evidence: The service is very clear that service users are in control of their lives and that they direct the service. Staff are fully committed in supporting individuals to lead purposeful and fulfilling lives as independently as is possible. We spoke to service users, staff and health care professionals who all told us that service users are encouraged and supported to make their own informed decisions and that they also have the right to take risks in their daily lives within the bounds of their discharge sections under the Mental Health Act. Care plans are very person centred and comprehensive and are being used as working tools. All relevant areas of equality and diversity are also covered within the care plans. They can easily be understood by all staff and to others who may not be as familiar with the individual service users. The service operates a key worker system Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: who ensures that care plans are being kept up to date through regular evaluation and review. All service users plans of care are in line with the Care Programme Approach (CPA) and are reviewed in accordance with CPA procedures by the service users Consultant Psychiatrist. The manager has developed very good working relationships with other agencies, and this ensures that there is effective and well co-ordinated mental health care for service users. All service users are actively encouraged and supported to be involved in the development of their care plan, and the motivation of individuals can be challenging for staff due to the enduring and severe mental health problems experienced by people living in the home. Plans are all different and highly individualised and they include evidence that the service values improving outcomes for the service users. We spoke to one service user who told us I have a plan which I was involved in, and the staff are always kind and always ask me what I want. Care plans include a comprehensive risk assessment which is regularly reviewed. It was very apparent during the inspection from observation and from talking to service users, staff and from documentation that the service has a can do attitude and risks are managed positively to help people using the service to lead the life they want. Each service user has a service agreement which states any restrictions or infringements of rights for the safety of all who live in the unit and the reasons why the need for restrictions are given and agreed by the individual. The attitude and practice of the service and that of the staff team, promotes opportunities for service users to remain independent, exercise choice and express their wishes and needs. Some of the service users who wish to reduce their smoking needs, are actively being supported by staff to do this and one service user has a care plan in place around this. We were able to speak to several healthcare professionals who confirmed that the service has a very positive approach to the needs of people with mental health problems. The referral form has been redesigned and more information is now gathered around hobbies, interests and previous employment and this has helped in service users being encouraged to regain the skills on subjects they are more familiar with, and this has helped in the building of confidence and self-esteem. Advocacy services are available to all of the service users. All service users are supported in developing skills on budgeting, and they have financial records and where able are encouraged to actively take control of their finances. Some service users who require more support and assistance in managing their finances are given this. A programme is put into place where discussions are held with service users to ensure that their money lasts for the week or the month. All service users are encouraged to open a bank account, and generally benefits are paid Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: into a card account with the Post Office. The service works creatively and actively with other agencies to ensure that the service users whole life needs are met, and goals addressed. When needed support is sought from other professionals to meet the individual needs of each service user. However, there are some difficulties when service users are outside of their funding authority. This does sometimes mean that they are unable to access day centres run by the local authority in which the home is situated. The service actively advocates on the individuals behalf but this can be time consuming while different authorities sort out the funding issues. Meetings are held with the involvement of service users and they are fully involved in the decisions as to the day to day life of the home and its future development. The manager is currently pursuing ways of involving service users in the recruitment of new staff to the home. From viewing documentation and in discussions with staff it was evident that they were aware of the need to respect the confidentiality of service users and to handle information about service users in accordance with the homes written policies and procedures, the Data Protection Act 1998, Freedom of Information Act and in the best interests of the service users. The feedback from the expert by experience who accompanied us on this inspection was that the atmosphere in the home was very calm and that service users told her that they are encouraged to make choices with support from Staff. She also noted that the interaction between service users and staff was very positive. Care Homes for Adults (18-65 years) Page 14 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use services are able to make choices about their life style, and are supported to develop their life skills in all areas including social, educational, cultural and recreational activities. Evidence: The service offered at Hart Lodge is one of rehabilitation, and it is to the success of this service that there is a turnover of service users as they reskill and move onto more independent forms of living. Central to the homes aims and objectives is the promotion of the individuals right to live an ordinary and meaningful life in the home and the community, and service users are encouraged and supported to enjoy all the rights and responsibilities of citizenship. Central to the care and support provided is the importance of respect for the human rights of people in the areas of fairness, equality, dignity, respect and autonomy. Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: Service users are encouraged and supported to enjoy a full and stimulating lifestyle with a variety of options to choose from. One service user is employed, another is beginning an art diploma course in the Autumn and another has started attending a day centre. Trips to the cinema, theatre, shops, local cafes and pubs are also enjoyed by the service users, and all are members of the local library. We were talking to one service user who told us I went shopping last week on my own and I bought myself this blouse and another one. This service user was very proud of the fact that this trip was undertaken independently. The service seeks the views of the service users and considers their varied interests when planning the routines of daily living. Routines are very flexible and service users can make choices in major areas of their life. The service actively encourages and provides opportunities for people using the service to develop and maintain social, emotional, communication and independent living skills where appropriate. The service supports and enables people to make informed choices within a risk assessment framework, providing links to specialist support when needed. This includes developing and maintaining family and personal relationships. Outcomes for people living at Hart Lodge are generally positive, and there is evidence that they are enjoying the life opportunities that they experience. People are encouraged to be involved in all areas of daily living in the home, and this includes taking responsibility for keeping their bedrooms clean and tidy, laundry, shopping, planning meals and meal preparation. Some service users are self-catering and are given money to purchase their own food requirements but they have to provide receipts and their diets are monitored by the key workers to ensure that the meals are nutritional and balanced. These service users have their own store cupboard and a separate small refrigerator. The care plans viewed indicated that dietary intake and weights were being monitored where appropriate and necessary. Some meals are arranged for all of the service users so that they, and staff, can enjoy a meal together. The home has good contacts with the other two homes in the organisation and there are often shared activities. Hart Lodge recently held a barbecue and friends and neighbours were invited. The home has developed good relationships with the local neighbourhood. Care Homes for Adults (18-65 years) Page 16 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs, and on the principles of respect, dignity and privacy. Evidence: The support around personal and healthcare is very person centred with support provided based upon the rights of dignity, equality, fairness, autonomy and respect. Staff were observed to be very aware that the way in which support is provided is a key issue for people with mental health illnesses. Individual care plans clearly record the personal and healthcare needs of the service users, and also detail how these will be delivered. Some service users are on a smoking programme to try to reduce the number of cigarettes which they smoke on a daily basis, and this does seem to be having a positive effect. As part of this programme, the service has installed a talking smoke alarm in some of the bedrooms. All support is flexible, consistent and able to meet the changing needs of the service users. The use of a key worker system has meant that staff have expert knowledge about the individual service users personal and healthcare needs. Staff were observed to respond appropriately and sensitively in various situations. Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: As this is a rehabilitation service, all service users are encouraged to manage their own healthcare. All are registered with a GP and have access to all National Health Service healthcare facilities in the community. To ensure the good mental health of service users the service recognises the importance of ensuring that regular appointments with GP, psychiatrists, community psychiatric nurses and other healthcare professionals are kept by the service users. Where necessary, the service arranges for healthcare professionals to visit the home. The organisation also employs a clinical advisor who visits the home on a regular basis to give support and advice. As service users are on various sections of the Mental Health Act, all necessary risk assessments are in place and, these are known by staff and service users, are monitored and regularly reviewed. Staff are very alert to changes in mood, behaviour and general wellbeing and fully understand how they should respond and take action. The service has developed an efficient medication policy, procedure and practice guidance. This is essential in a service which is committed to supporting service users to eventually be self-medicating, which is a very important aspect of his/her rehabilitation. Staff involved in the administration of medication have undertaken training. The programme towards self-medication for service users is on a gradual step basis with the individual being very involved in understanding how they view their illness and the important part medication plays in keeping them well and stable in the community. Because this is a rehabilitation service, neither staff nor service users generally have to deal with dying and terminal care. However, where a service user may have a terminal illness or degenerative condition in addition to mental health illnesses, advice and training is sourced to ensure that the correct care is being given in all aspects of the individuals social and healthcare. Care Homes for Adults (18-65 years) Page 18 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure, are protected from abuse and have their rights protected. Evidence: The ethos of the home is that it welcomes complaints and suggestions about the service, uses them positively and outcomes are used to improve the service for the benefit of service users and staff. We spoke to service users and healthcare professionals who told us that they were extremely satisfied with the service, and service users told us that they feel safe and well supported by staff. It was apparent during the inspection that staff know the importance of taking the views of the service users seriously, and that listening and responding to issues is extremely important. All service users are given a copy of the complaints procedure in a format which they can understand, and we were told by some service users that they knew how to complain and who to. One service user told us I can talk to my key worker and also the manager always listens to me. Complaints received are logged together with the actions taken in response to them. The service encourages people to use advocacy services. Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: The service has a whistle blowing policy and staff know that if they blow the whistle on bad practice that they will be supported by the organisation. The service is clear when an incident needes to be referred to the local authority as part of the local procedures for safeguarding, and is open and transparent in discussions with external bodies. All staff working at the home have undertaken training in safeguarding adults. Knowledge and understanding of this is checked regularly at supervision and also discussed at team meetings. Staff are also trained to respond appropriately to physical and verbal aggression, and fully understand the use of physical intervention as a last resort. This is also why staff are very alert to changes in mood and behaviours in the service users, especially as some people may self-harm. Staff are also vigilant to the potential for abuse between service user and service user(s). Care Homes for Adults (18-65 years) Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables service users to live in a safe, well-maintained and comfortable environment, which encourages independence. Evidence: We undertook a tour of the home and found that the living environment is appropriate for the lifestyle and needs of the service users. It is homely, clean, safe and comfortable, well maintained and reflects the individuality of the people living there. There are paintings on the walls which have been done by one of the service users and he was extremely proud of these, and spent time talking to us about the paintings. The organisation goes that extra mile to continue to provide an environment that fully meets the needs of all of the service users, and ensures that the decoration and furnishings are always maintained to a very good standard. The home is in keeping with the community setting and it does not stand out as different from other houses in the road. There is very good access to community facilities and services. The environment is fully able to meet the changing needs of people, along with their cultural and specialist care needs. The management has a proactive infection control policy and they work closely with their own staff and service users. Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: Service users are fully involved in decisions about the decor and any changes in their communal and personal accommodation, and the service is creative in involving people in decision-making to ensure that all service users are as fully involved as is possible. All bedrooms are single and of a good size and all have an en suite facility. The fixtures and fittings are of a high standard, well maintained and adapted to meet the wishes of the individual. Service users are encouraged to personalise their rooms. As part of the rehabilitation programme for each service user is the need for him/her to understand the need to keep their bedrooms to a good standard of cleanliness. Service users have a key to their bedrooms. The garden area is well maintained and this is used constantly by service users. Those who smoke are encouraged to do this outside of the home, and a covered, fixed shelter with seating has been built in part of the garden area. The kitchen and laundry are designed to enable and promote the involvement of service users in undertaking domestic tasks and as part of developing or maintaining independence. Where necessary risk assessments are in place to ensure the health and safety of service users using the kitchen and laundry. Access is only limited where the risk assessment indicates such a need. Care Homes for Adults (18-65 years) Page 22 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service, and to ensure the smooth running of the service. Evidence: The service has a very good record of staff retention and there is little use of agency staff. Permanent staff tend to cover any gaps in the rota caused by staff sickness or annual leave. This is extremely good for service users as it provides consistency and continuity in the care and support given to them. Staffing levels on the day of the inspection were appropriate and these are flexible to ensure that the needs of the service users are being met at all times. Because this is a rehabilitation service, it is essential that the staff team has a balance of all the skills, knowledge and experience to meet the needs of people using the service. We spoke to staff during the inspection and they were able to demonstrate a thorough understanding of the particular needs of individuals and deliver highly effective person centred care. On the day of the inspection we were able to talk with a newly recruited member of staff who told us I have already had training and am spending time getting to know the service users. The support that I am receiving is very good and I am enjoying my work. It was also apparent that the staff team support each other and share skills and knowledge with colleagues. The roles and Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: responsibilities of staff are clearly defined and understood, based on accurate job descriptions. The service has a highly developed recruitment procedure that has the needs of service users at its core. The recruitment of good quality carers is seen as integral to the delivery of an excellent service. The service is very selective, with the recruitment of the right person for the job being more important than filling the vacancy. It is important that a prospective member of staff is able to demonstrate an ability to commit and adapt to the changing needs of the service users. All new staff have to serve a probationary period of 6 months. At the end of this time the employment is reviewed and either confirmed or not. We did discuss the possibility of involving service users in the recruitment procedure, and the manager has told us that she will take this into consideration for future recruitments. The manager demonstrated a proactive approach and a very good understanding of equality and diversity issues throughout the recruitment, induction and training process. Staff members told us that training is good and that it is targeted and focused on improving outcomes for service users. The service uses external, as well as internal, trainers to deliver this training. The induction and training for new staff entails an understanding of mental health and the different forms the illnesses take. It also includes the rehabilitation programme each service user is following and the different ways of communication. It also includes an understanding of the different roles of the health professionals involved with each service user. There is regular training to update staff on mental health and relative issues. All staff have undertaken training in the safeguarding of vulnerable adults. Each member of staff has a developmental file and they are free to request any training needs they may have that is relevant to their job. 90 of the current staff team has achieved NVQ level 2 or 3. All staff undertake regular supervision every 6 weeks with the appropriate records being maintained. Staff meetings are used for information, consultation and training and staff are involved in the development of the service, together with service users. Minutes of these meetings are taken and retained on file. Care Homes for Adults (18-65 years) Page 24 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on openness and respect, has effective quality assurance systems, and is run by a qualified, competent manager. Evidence: The registered manager has the required qualification and experience and is highly competent to run the home and to meet its stated aims and objectives. It was evident during the inspection process that Hart Lodge is being well managed and is meeting its stated aims and objectives. The manager has a sound knowledge of the organisations strategic and financial planning systems and how the plan for the home fits with these. The manager works effectively and in collaboration with external agencies and the Commission. All staff spoken to throughout the visit spoke very positively about how well supported they felt by the manager. Through staff training, supervision and good management, service users are receiving a high standard of care and support to assist their move to more independent living. Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: Equality and diversity, human rights and person centred thinking are given priority by the manager who was able to demonstrate a high level of understanding and best practice in these areas. We spoke to service users and staff who told us that the manager listens to them and that they feel valued. Some healthcare professionals told us that the manager is effective and provides consistently high quality services. The manager ensures that staff follow the policies and procedures of the home, and that they have access to training materials and documents. Practice and performance are discussed during supervision and team meetings. Spot checks and quality monitoring systems provide evidence that practice reflects the homes policies and procedures. We looked at a wide range of records and other documents including fire safety, health and safety checks, gas, electric and found these to be detailed, and up to date. Fire alarms are tested weekly fro a different point in the home, and staff and service users regularly participate in fire evacuation procedures. The home has efficient systems to ensure effective safeguarding and management of service users money and valuables. Because of the rehabilitation nature of this service, people are supported to manage their own money, and where some people may not currently have these skills the support and encouragement is provided to give them this independence. The manager and her staff recognise the importance of good risk assessments being in place and these are regularly reviewed and updated where necessary. They also recognise that risk assessments must be underpinned by promoting independence, choice and autonomy, but within the confines of the various sections of the Mental Health Act which service users may be subject to. Working practices within the home are safe and there are no preventable accidents. The service proactively monitors its health and safety performance and consults experts and specialist agencies on these issues where necessary. Regulation 26 visits as required under the Care Homes Regulations 2001 are being undertaken. The manager ensures that she is up to date with current and new legislation and both she and staff have undertaken training on the Mental Capacity Act 2005. Currently there have been no referrals under the Deprivation of Liberties Safeguards. Care Homes for Adults (18-65 years) Page 26 of 29 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 27 of 29 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 34 It is recommended that the manager considers the possibility of involving service users in the recruitment processes for new staff members. This would give service users involvement in the employment of people who are supporting them in their rehabilitation. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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