Inspection on 11/01/10 for Mount Lodge

This is the latest available inspection report for this service, carried out on 11th January 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mount Lodge 16/03/07

Mount Lodge 06/09/05

Mount Lodge 22/04/05

Mount Lodge 26/08/04

Mount Lodge 17/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Mount Lodge 5 Upper Avenue Eastbourne East Sussex BN21 3UY     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: Gwyneth Bryant     Date: 1 1 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 28 Information about the care home Name of care home: Address: Mount Lodge 5 Upper Avenue Eastbourne East Sussex BN21 3UY 01323411312 01323411312 mountlodge@cht.org.uk www.cht.org.uk Community Housing and Therapy Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Emma Louise Pyle Type of registration: Number of places registered: care home 16 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 to be accommodated is 16 The registered person may provide the following category of service only: Care home only( PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Mental disorder, excluding learning disability or dementia (DE) Date of last inspection Brief description of the care home Mount Lodge, first registered in 1993, is a therapeutic community run by Community Housing and Therapy, (CHT), for 16 adults, between the ages of 18 and 65, who are experiencing mental health and emotional difficulties, excluding learning disability or dementia. Many service users (clients) have `dual diagnosis? and in addition to their psychiatric condition may also have problems with substance misuse. The premises comprise of a large, three storey detached house, with an extensive garden to the rear Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 16 Brief description of the care home and parking space at the front of the building. Service user accommodation comprises of single rooms, each fitted with a washbasin. Communal areas include two large lounges, a separate dining room, an additional quiet lounge and a kitchen and laundry room. Sufficient toilets and bathrooms are provided throughout. The home is situated in a residential area of Eastbourne, a short walk from the town centre amenities, including shops and the main line railway station. A local bus service passes near by. Clients involvement is a significant aspect of the organisations approach to community care. Regular group discussion meetings form the basis for much of the structured work within the community. Independence and self-awareness is promoted within the community and clients are encouraged to contribute to the dayto- day running of the home, including cleaning and planning and preparing meals. Weekly fees are negotiated on an individual basis depending on the needs of clients but would normally range between £436.80 to £975.00 with clients paying for specific toiletries and any extra leisure activities. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection which began at 08:55 and ended at 14:30. The purpose of the inspection was to check compliance with key standards and other standards. There were fourteen people in residence on the day of which one was due to move into supported housing on the day of the site visit. Three resident were involved in the inspection as were the Registered Manager and three therapists. A number of documents and records were viewed; including personnel files, medication charts and care plans. One bedroom was visited as were three communal bathrooms, three communal toilets and the communal lounge and dining areas. Prior to the site visit we asked the Registered Providers to complete an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. It was thoroughly completed and returned when we asked for it. Information from the AQAA is included in this report as required. Care Homes for Adults (18-65 years) Page 6 of 28 Care Homes for Adults (18-65 years) Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People moving into the home benefit from an admission process that ensures their individual needs and aspirations are comprehensively assessed and identified as being able to be met prior to moving into the home. Evidence: The pre admission documents for two residents were viewed and were found to be comprehensive and demonstrating that there is input from both social and healthcare professionals. As part of the care planning process all people moving into Mount Lodge have the opportunity to stay overnight or for meals and to attend one of the community meetings prior to moving in. All residents have a six month trial period during which time they are regularly reassessed to ensure they are committed to the ethos of Mount Lodge which is to re-integrate residents into the wider community. All residents have an extensive psychiatric assessment prior to moving into the home to ensure they are suitable for the project and reduce the likelihood of a placement breakdown. Although residents have complex care needs the assessments are written in plain English with little use of clinical jargon which ensures prospective residents Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: and their supporters are able to have a good understanding of what the home offers and how needs will be met. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of care planning provides staff with a good foundation to support individuals in a way that both enables and protects them. People living in Mount Lodge are fully consulted and enabled to make decisions about their lives. Evidence: Two care plans were viewed and found to be comprehensive and included clear information on preferred daily routines with evidence that the basis of care provision is person centred. Residents are consulted on the contents of their plan and are encouraged to sign to indicate that they are happy with the contents. Residents spoken with confirmed that they were involved in compiling their care plans and were aware of what was agreed within their plans and any limitations on their daily lives. As with the pre admission assessments care plans are also written in language that enables residents to easily understand them, despite the complex needs of individuals and the need for specialist input from a variety of sources. Additional information based on input from the key workers, social workers and Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: healthcare professionals are included in care plans. Care plans are reviewed monthly but are updated if changes are identified in the interim period. The principles applied are based on residents in Mount Lodge taking responsibility for all actions and to work with therapists to improve all aspects of their daily lives. The care documentation outlines the action to be taken to promote independence and self reliance. While living at Mount Lodge clients are given a sense of structure and routine in their daily life and there is an expectation that they will mostly adhere to the set routines. Regular community support meetings allow clients to share their views on community living and for them to make choices on how the group lives together in a positive way. A key worker system is in place ensuring that individuals receive consistent care from a named individual and residents spoken with knew who their key worker was. Each care plan also includes details of the relationships important to the individual, including parents, siblings, friends in addition to health and social care professionals. In addition to care plans detailed daily notes are maintained which outline how individuals spent their day and whether or not they need additional staff time. Discussion with the Manager, two staff and observation of their practices, it was evident that they have developed good relationships with the people they support and a good understanding of their needs as individuals. Care plans included information as to how individuals were consulted, both singly and as a group to ensure they have the opportunity to participate in the day-to-day running of the home. The home does not manage the finances of individuals but will support them with budgeting if necessary. Rather than residents being given the opportunity to participate in the day-to-day running, the expectation is that they will, in effect, manage all of the day-to-day decision making and take responsibility for those decisions. There are group meetings three times a week which residents chair and take responsibility for the minute taking. These meetings are used to decide the tasks individual residents are responsible for, including doing the shopping, cooking and cleaning. The inspector joined residents for the meeting on the day and it was evident that they are supported to make decisions as a community and support other residents if required. Comprehensive risk assessments were in place to ensure residents can safely maximise their independence. Risk assessments are rated on a scale of one to five with detailed information on the hazards and clear direction to staff on reducing the risk. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Mount Lodge benefit from the ability to lead independent lives where they are appropriately supported to develop their educational, vocational and social skills and are involved in planning balanced and nutritious meals. Evidence: People living in the home have a opportunities to participate in activities both within the home and in the wider community. The home has recently introduced an Art Group once a week and artwork produced by residents had been mounted on the wall in the dining room. In addition there is a weekly gardening activity to both ensure the garden remains tidy and to enable residents to develop or enjoy a hobby. As the core principle of Mount Lodge is to enable residents to be re-integrated into the wider community part of residents time is spent on day-to-day tasks to enable them to develop the skills for independent living. There was evidence in care plans to Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: demonstrate that residents have holidays with family and during the group meeting an outing to the cinema was discussed. The residents group also discussed getting a take away meal as this was a regular event but had lapsed due to the Christmas period. Some residents go to day centres and other outreach projects of their choice. Where appropriate, residents will be supported and encouraged to find employment, attend or voluntary work if the resident requires. There was evidence in a care plan to show that one person is partaking in a distance learning course of their choice. Residents may have visitors at all reasonable times and residents who move into the wider community are able to return to Mount Lodge to maintain links with residents. One person who was leaving the home on the day said they regarded the other residents and staff as their family and would maintain links with them all. This person spoke very positively of their time in Mount Lodge and praised staff and other residents for the support they gave. Although residents are able to invite friends and family to visit and see them in private, there are times when restrictions need to be implemented for the benefit of everyone who lives in Mount Lodge. Any restrictions are clearly documented and agreed with the resident and other interested parties. All residents have a key to their bedrooms and are encouraged to use them. During the site visit residents were seen to be given their personal mail and staff knocked on bedroom doors before entering. Residents are able to develop relationships in the home with each other and it was evident that comfortable working relationships, based on mutual respect and trust, had been developed with staff members. Residents are expected to take responsibility for shopping, cleaning and cooking in the home and during the community meeting residents allocated these tasks between themselves. They also devised the weekly menu and it was good to note that the vegetarian options were included for those residents who do not eat meat. Discussion with a senior therapist found that staff only intervene to advise on healthy options if necessary. Discussion with the manager found that lunch is informal and flexible and staff eat with residents to facilitate social interaction. Residents are expected to eat their evening meal in the dining room although some choose to remain in their rooms on occasions. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home benefit from the provision of flexible and respectful personal and healthcare support and are protected by the systems in place to manage medication. Evidence: Care plans clearly outline the individual preferences in respect of the delivery of care with particular reference to respecting choice, privacy, dignity, however most of the support is in the form of prompts rather than hands-on care. Staff spoken with individually and during the post group briefing were knowledgeable about the needs of individuals in the home and how best to meet those needs. While daily routines are flexible, some structure is built into the daily routines for the benefit of residents and they are expected to attend group meetings and one-to-one sessions with therapists. One care plan indicated that the individual does not always respond well to a planned one-to-one session therefore they are encouraged to attend a spontaneous session at a time of their choosing. Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: Care plans included detailed information on the input of healthcare professionals and residents are encouraged and prompted to make appointments with other healthcare providers such as with their GPs and dentists. Currently none of the residents are able to safely self medicate but the medication records did show that one person self medicates a prescribed cream. The storage and administration of medication were found to be satisfactory. Medication administration records were mostly clear, accurate and up to date. There were three gaps found in the administration records and a therapist explained that these would be filled in during the audit. The inspector explained that this is falsifying records and good practice is that an explanation for any gap is recorded on the rear of the administration record. This was discussed with the manager who agreed to revise the practice and also stated that the change to a MDS medication system enabled staff to quickly and easily check any errors. There has been two medication errors in the last twelve months and the home followed the correct procedure, ensuring that any risk to residents was minimised. The home has a controlled drugs cupboard that meets the latest legal requirements and there is a controlled drugs register. There was evidence in the register that dates and amounts of medication had been overwritten. This was discussed with the manager who agreed to ensure that, in future, staff would cease this practice, therefore no requirement was made. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints procedure with evidence that service users feel that their views are listened to and acted upon and service users are further protected by satisfactory safeguarding adult procedures. Evidence: Information in the AQAA indicated that there are policies and procedures on both complaints and safeguarding adults. The complaints log was viewed and the home has not received any complaints in the last twelve months. Should residents have any concerns, these are dealt with through the group meetings or addressed during one-to-one sessions with key workers. Therefore concerns are dealt with immediately and resolved as a group. The ethos of the home is open, therefore residents are encouraged to deal with any issues informally. The manager said there had been one complaint sent to the provider but this was related to the trial period for one resident and not a reflection on staff. The latest audit carried out by the providers showed that all staff are trained in safeguarding adults as part of the induction process. Additional training is provided both by in-house and external trainers. Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: There has been one recent safeguarding adult investigation, due to an incident of arson, and the providers responded in line with the correct procedures. As a result of the alert a comprehensive action plan was sent to the commission outlining both immediate action and future action to ensure residents are protected in future. In addition the home has reported three other safeguarding issues within the last twelve months, of which one resulted in an investigation and each were as a result of the home making an alert. On each occasion the home dealt with the incidents effectively and in line with current guidance. The issue of deprivation of liberty should not arise for residents in Mount Lodge as the focus is on an open house policy with residents using it as their own home and without unnecessary restrictions. One person may need a best interest assessment and this was discussed with the manager who had a good understanding of the issue and will further consider such action should it be necessary. Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements should be made to all parts of the home to ensure it is safe, well maintained and comfortable in which to live. Evidence: Mount Lodge is a large three storey house that has been adapted for current use. A tour of the premises was carried out and one bedroom, three communal bathrooms and three communal toilets were visited. All residents have a key to their rooms and their privacy is respected, therefore only the one bedroom was visited as this resident invited the inspector into their room. The manager explained that a new kitchen has recently been installed and there were plans to also replace the flooring in due course. The one bedroom visited was attractively decorated and there was evidence to show that it had been personalised with ornaments and posters. It was noted that it was necessary to use a multi-plug extension and good practice suggests that addition electrical wall sockets should be provided. Although the one bedroom visited was in good decorative order and the communal rooms suitable for use, generally the environment needs to be improved. There was carpet missing and evidence of burns on the stairs from the arson attack and corridors and bathrooms are in need of redecoration and refurbishment. Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: Discussion with the manager found that the home has recently been allocated a maintenance person who covers four of the other homes in the project. Information in the AQAA shows that there is a monthly maintenance plan but during the group session, a resident highlighted that lights in three bathrooms need to be replaced. While it is good that residents are able to report shortfalls, it is important for such repairs to be identified on a weekly basis and addressed promptly. The lack of good decor in the communal areas and bathrooms detract from the community spirit within the home and the input from staff to improve the lives of residents. As a result of the recent safeguarding alert there is a plan to install CCTV to the outside entrance areas for security purposes. Infection control training is provided for all staff and staff support residents to live in ways that reduce the risk of cross infection. Anti-bacterial hand wash is available in all communal bathrooms and toilets. The laundry room is satisfactory and washing machines are domestic as commercial machines are not necessary. Communal lounges and dining rooms were homely, giving a feel of a family home, although they lacked ornaments, it is for the residents benefit that the home is simplified to facilitate easy cleaning. As residents do all the cleaning within the home the grounds and car park need to be maintained to reduce the amount of dirt and mud that is walked into the home. Subsequent to the site visit the registered provider sent a comprehensive plan of action to address all the shortfalls identified during the inspection. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Mount Lodge benefit from a dedicated and competent team of staff and are protected by the robust recruitment procedures. Staff have both the skills and support to enable them to perform their roles effectively. Evidence: The AQAA states that emphasis is placed on recruiting well qualified staff at Mount Lodge. All staff that are required have a minimum degree in psychology. The recruitment records for three people were viewed and it was clear that this is followed in practice. Mount Lodge has a policy to enrol all staff on a Community Therapist course which will allow them to achieve a Masters degree after three years. Currently the home has two social work students who are there to practice their skills and add to their learning. There is the manager, her deputy and two therapists on duty each weekday with one night member of staff and two therapists on duty for each weekend daytime shift. In addition there is a 24 hours on-call system which enables staff to call for advice or assistance. The recruitment records for three staff were viewed and and all had provided all the Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: required documentation including Criminal Record Bureau checks, two written references and proof of identity. All new staff undergo an extensive induction period, in addition to shadowing experienced staff. New staff typically do a one-year apprenticeship before being promoted to a therapist. There are weekly staff meetings in addition to all staff having one hour a week for reflection which enables them to reflect on their own practice. There is also a handover session each weekday to ensure staff are clear on any changes to an individuals needs. The audit carried out by the head office showed that staff turnover at Mount Lodge was low which indicates that staff are happy and motivated. Staff spoken with were very positive about working in the home and it was clear they gained significant job satisfaction in supporting residents. Community Housing Therapy are committed to staff training in addition to the Masters course all staff receive additional training in safeguarding adults, infection control, first aid, fire safety and health and safety. Training is provided by a mixture of in-house training and by external training providers. Following the arson incident all staff had fire safety training updated to ensure they remain aware of good practice. The home does not employ a cook or cleaner as it is part of residents rehabilitation programme to carry out these tasks in order to prepare them for the transition to living in the wider community. Feedback from residents was very positive and it was evident that the support from staff enables them to gain confidence in their abilities. Comments included I am so glad I came to this home its great and This is a good place, so much better than some of the other homes Ive been in. Observation of staff during the site visit showed they worked as a team with the focus on the wellbeing of residents at all times. It was good to note that all staff were pleased that one resident was leaving the home to move into supported housing which is the ultimate aim for residents who come to Mount Lodge. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is well managed and all aspects of the welfare, safety and health of people living in the home are protected and promoted. Evidence: Since the last inspection the Manager is now registered with the Care Quality Commission. She has worked at Mount Lodge for a number of years and has the skills, qualifications and experience to manage the home and provide clear leadership and direction to staff. All aspects of the service were discussed with her and she is clear about how the service needs to improve and to ensure that the residents remain at the heart of the service. The atmosphere of the home is open and throughout the site visit staff were obviously comfortable coming to the office and approaching her with any queries. She is very knowledgeable about the day-to-day practice of the home and equally knowledgeable about the individual needs and preferences of people living in Mount Lodge. All accidents are recorded and monitored as part of the quality monitoring process to Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: ensure that any risk areas can be addressed promptly. The home does not manage the finances of anyone living in the home although staff will assist them with budgeting. All staff are trained in fire safety and regular fire drills are carried out including during the night hours. Following the arson incident the service has ordered an updated fire risk assessment and are considering fitting self closing devices to all fire exits. In addition, all staff have received additional fire safety training. These measures indicate that the home takes the safety of residents and staff seriously and that it will respond positively to reduce future risks. Information in the AQAA indicated that regular safety checks are carried out on all equipment, including electrical and gas appliances and systems. The AQAA showed that some policies and procedures had not been updated since 2007 and good practice suggests that they are reviewed annually to ensure they reflect current legislation and good practice. There have been improvements in the quality monitoring systems since the last inspection with the introduction of surveys for families, residents and social and healthcare professionals. Although there were only a few surveys returned responses were, in the main, positive with only the environment receiving lower scores. Information in the AQAA indicated that there are plans to improve on all aspects of the service. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 24 23 That improvements are made to all parts of the communal areas, garden and car park. To ensure service users have a more pleasant home. 18/04/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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