Inspection on 01/03/10 for Priory Lodge

This is the latest available inspection report for this service, carried out on 1st March 2010.

CQC found this care home to be providing an Excellent 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

Priory Lodge 23/02/06

Priory Lodge 15/12/04

Priory Lodge 18/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 25/04/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Priory Lodge 62 Priory Street Colchester Essex CO1 2QE     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: Jane Greaves     Date: 0 1 0 3 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 30 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 30 Information about the care home Name of care home: Address: Priory Lodge 62 Priory Street Colchester Essex CO1 2QE 01206797243 01206790756 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr David Krishnalall Jangali care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Persons of either sex, under the age of 65 years, who require care by reason of a mental disorder, excluding learning disability or dementia (not to exceed 20 persons) Date of last inspection Brief description of the care home Priory Lodge is a purpose build residential unit for individuals who have mental health problems. There are 20 places for people aged 18-65 years old. Priory Lodge is based in a residential street in the centre of Colchester within walking distance of all amenities. The previous inspection reports produced by the Commission for Social Care Inspection were available in the entrance hall of the home. Fees charged for the accommodation and care provided at Priory Lodge ranged from £389.93 to £779.52 Dependent on the assessed level of need. This information was supplied to the commission on 1st March 2010. 20 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 30 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 site visit that took place over 7 1/2 hours. At this visit we considered how well the home meets the needs of the people living there and how staff and management support people. A tour of the premises was undertaken, care records, staff records, medication records and other documents were assessed. Time was spent talking to, observing and interacting with people living at the home, visitors and staff. Prior to the site visit the manager had completed and sent us (Care Quality Commission) the homes Annual Quality Assurance Assessment (AQAA). This is a self assessment document required by law and tells us how the service feels they are meeting the needs of the people living at the home and how they can evidence this. Care Homes for Adults (18-65 years) Page 5 of 30 Before the site visit a selection of surveys with addressed return labels had been sent to the home for distribution to residents and staff. Views expressed by visitors to the home during the site visit and in surveys responses have been incorporated into this report. Feedback on findings was provided to the manager throughout the inspection and the opportunity for discussion and clarification was given. We would like to thank the residents, the manager, the staff team and visitors for the help and co-operation throughout this inspection process. The previous key inspection of this service took place on 13th April 2007. Care Homes for Adults (18-65 years) Page 6 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Daily records need to contain more detail about the individual care and support provided for each person and the social activity and stimulation provided for individuals. This recording will form a basis for regular monthly reviews of care and support to ensure the regimes in place continue to meet peoples needs and aspirations. The manager needs to ensure that the medication administration systems provide an accurate record and audit trail of all medicines held within the home. This is so there is a clear record to confirm that people have received their medication in the right dosage at the right time. The registered manager had been absent from the service due to illness for short periods over the past 12 months. During this time, routine auditing and monitoring of daily practice had suffered resulting in the shortfalls identified at this inspection site visit. However, the registered manager was able to demonstrate that she had put systems in place to identify shortfalls and had created action plans to address these in a timely manner. Care Homes for Adults (18-65 years) Page 7 of 30 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 30 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 30 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 know that their needs will be met within the home. Evidence: A welcome pack was given to each person living at the home for them to keep in their rooms. The pack included a copy of the Service User Guide, Residents Charter of Rights, Admissions Policy and Procedure, Policy on things such as introductory visits, care planning, equal opportunities and meeting peoples needs. The Service User Guide could be made available in large print, Braille or audio listening according to individuals needs. The home had no new admissions since the previous Key Inspection of April 2007. There were two people considering moving into the home at the time of this inspection visit and the manager was able to demonstrate what actions the service was taking to ensure a smooth transition into the home and that the needs and preferences of all residents were being considered. Records were available to show that the manager had obtained an assessment of Care Homes for Adults (18-65 years) Page 10 of 30 Evidence: prospective residents needs from the previous establishment they had lived in. The service then undertook their own assessment of needs that focused entirely of the needs from the prospective residents perspective. This tells the home all about them, what they hope for and want to achieve,and the support they need to live their lives as independently as possible. The homes own assessment was completed gradually during a period of formal and informal visits and overnight stays. This gradual period of integrating people into the service ensured that the new admission was confident they would be happy to make Priory Lodge their home and also that the established residents living at the home would be happy to accept a new house mate. Records confirmed that people considering making Priory Lodge their home had visited the home, sometimes spontaneously and sometimes with friends with them. Records showed they had stayed for various mealtimes and overnight. We looked at two care files belonging to people living in the home and there was evidence of ongoing assessment to ensure their needs continued to be met according to their individual preferences. The staff training matrix showed that the staff team received all the basic core training necessary to ensure they had the skills and knowledge to support people to keep safe and healthy. Records also confirmed additional training that staff were offered, more detail is included within the staffing section of this report. Care Homes for Adults (18-65 years) Page 11 of 30 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. People receive individualised care and support based on their identified needs. Evidence: We looked at two care files, these included information about how much support people needed and what activities of daily living they were able to undertake independently without support from staff. The support plans that we looked at included information about the individuals likes and dislikes, their activity chart and details of how they liked to be supported. Each of the support plans we looked at was signed and agreed by the person and/or their advocate showing that they had been fully involved in its creation. The information available for staff to follow to ensure people received consistent care and support varied. For example one care plan stated that a person needed support from staff to have a bath. There was no detail about what level of support was required to keep the person safe whilst maintaining their independence, privacy and dignity as much as possible. Another care plan provided very good information about Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: how a person liked to be supported to settle down for a good nights sleep. for example: Likes to go to bed between 8 and 9 pm. Likes to have Horlicks and supper at 7:45pm. Prefers lights off, door shut, and to be checked by staff during the night, likes 2 pillows. We saw that people sometimes chose to write their own daily records. These were often hard to read however were a good source of evidence to show that people were fully involved with their plan of care and life within the home. Peoples own written records included helped in the kitchen and went out in the afternoon for a drink. Overall, daily notes completed by the staff team, were not very detailed and did not always provide good information to show what support people had received or what activities they had been involved with on the day. Staff we spoke with demonstrated very clear and detailed knowledge of what support was provided for people and how they had spent their day. Both the care plans we looked at contained evidence they had been reviewed monthly, people had signed their care plans to indicate they had been involved in this review to ensure their needs continued to be met. It was evident that care plans were working documents currently, the manager reported that they were due to be reviewed and updated in a new format in April. This will include identifying smaller goals for residents to work towards and people will be able to track their own achievements. Records showed that the people living at Priory Lodge had regular meetings and the notes of these showed that discussions took place around peoples likes and dislikes, the food provided at the home, the environment people lived in and any future activities they would like to do. Each person living at the home had a named key worker and this role was scheduled to be further developed to give the key worker the responsibility of auditing and monitoring care plans to ensure they continue to accurately reflect peoples needs, preferences, goals and achievements. The support plans that we looked at showed that people contributed towards the running of the home with support from staff, and people spoken with confirmed this. Each of the care files that we looked at contained risk assessments together with clear plans on how to manage any identified risks. The risks that were covered by these plans included areas such as smoking, aggressive/violent behaviours, propensity to suicidal behaviour or self harm, inappropriate sexual behaviours, refusal to take prescribed medications, risk of choking, falls and kitchen access. We spoke with Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: outside professionals involved with people living at the service, they told us they were very confident in the care and support provided for people living at Priory Lodge however did report that people needed to be supported to take more risk in the activities of daily life. We spoke to relatives of people living at Priory Lodge as part of this inspection, they told us: We have no concerns at all, (persons name) is very happy there (Persons name) is much better than they have ever been, much better communication skills We are always made welcome when we visit, we are able to see any paperwork that we want They always keep us up to date with any issues relating to our relative Life for the people at priory Lodge continues to get better all the time Friendly staff, they always manage to find ways to motivate people. Care Homes for Adults (18-65 years) Page 14 of 30 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 are supported to live a lifestyle that meets their identified needs and preferences. Evidence: Priory Lodge is situated in the heart of Colchester Town and therefore many local amenities are available to the residents such as pubs and restaurants. Discussion with residents and staff together with evidence in daily records showed that people were supported to access the local amenities with support or independently. The managers AQAA stated the service has supported residents to become more independent giving way for their own personal growth. The managers AQAA acknowledged that the service could improve by encouraging residents to suggest activities most suited to their needs. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: Daily recording did not always provide an accurate picture of the interaction, activity and entertainment provided for the people living at Priory Lodge. For example one persons activity records showed they had daily shopping trips and a visit from a relative in February. This does not give an indication of what the person enjoyed doing with their day, how the service provided stimulation for the person or how staff engaged the person in activities of daily life. That being said, the registered manager did acknowledge that this was an area that needed more work and dedicated hours were in the process of being deployed in this direction. People living at Priory Lodge had access to electronic games such as Nintendo Wii and Play stations and a Karaoke machine. The manager told us that enthusiasm for these games came and went, residents told us they had enjoyed playing 10 pin bowling on the Wii and how this had become quite competitive between them. The Priory Gallery was being created in a communal hallway by a staff member assisting the residents in selecting and mounting photographs to provide memories of activities, outings and celebrations that take place at the home. As at the previous inspection residents were supported to chair their own house meetings, records showed that areas such as the menu, activities, outings and decor of the home were discussed at these meetings. Meeting minutes also showed that residents were involved in the planning and preparation for events taking place in the home such as the Christmas party and Birthday celebration dinners. All residents and relatives spoken with and surveyed as part of this inspection praised the quality of the food and the menu provided. Residents were supported to access the kitchen to make drinks and snacks during the course of the day, we saw risk assessments in place to support this activity. We saw a supply of Easter Eggs in the managers office, these had been bought in readiness to distribute to individual residents at Easter. The manager told how she had liaised with the diabetes nurse to obtain direction for those people living with diabetes to ensure they could enjoy some chocolate at Easter, the same as other residents, whilst keeping them safe and well. Relatives spoken with as part of this inspection told us: (Persons name) is very happy there, gets very good care but doesnt get out very much. There is a lack of things to keep (Persons name) interested but they are very happy and made friends, they regard Priory Lodge as their home and their family. My relative is always able to telephone me, we sometimes arrange to meet up in Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: town, they always look smart and well turned out Sunday lunch is lovely, we never hear a bad word said about the food at Priory Lodge. Care Homes for Adults (18-65 years) Page 17 of 30 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. Peoples personal and health care needs will be fully met according to their individual needs. The medication practice is generally good, some shortfalls in recording and administration may put people at risk of medication errors. Evidence: People living at Priory Lodge told us that staff supported them with their personal care needs in a way that they prefer. The manager said in their AQAA The residents at Priory Lodge continue to have their individual care needs met and We encourage residents, where appropriate, to manage their own medication. We saw staff entering peoples bedrooms, they knocked on the door and waited for a response from the occupant before entering the room. Throughout the inspection site visit we observed that the residents were comfortable and relaxed in presence of the staff members. The manager told us that from from April each persons key worker would also be responsible for monitoring and auditing the care plans, alongside residents, to ensure Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: they are kept up to date as working documents. We saw evidence in the care plans that confirmed people were supported to access healthcare support from various health professionals such as GPs, Consultants, specialist nursing teams, Chiropodists, Optician etc. Records were maintained to show what the outcomes were from meetings with healthcare professionals. Records showed that peoples weights were regularly monitored and action was taken if any areas of concern were identified. Healthcare professionals spoken with as part of this inspection process gave positive feedback regarding the care provided for the people living at Priory Lodge. Excellent care, never had any concerns and Well trained staff provide sound and caring support were some of the comments received. We looked at the medication storage and administration practice at the home. Medication was stored in locked trolley secured to the wall in the downstairs office when not in use. Much of the medication in the home was provided in a Monitored Dosage System. We noted that some boxes and bottles of medication had not been dated to indicate when they had been opened. The staff confirmed they were aware of the necessity to do this in order to keep an accurate audit trail of the medications held at the home, however we found this had not been done routinely. We noted there were some gaps in recording on the Medication Administration Records. This meant it may not always be possible to be sure if people had been given their medication or if they had refused it. These recording omissions had already been identified by senior staff and marked for further investigation. We looked at staff training records, these showed that staff responsible for the administration of medicines in the home had received training and a refresher course had been arranged for April 2010. Care Homes for Adults (18-65 years) Page 19 of 30 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 know that their concerns will be dealt with and that they will be protected from harm and abuse. Evidence: There has been one written complaint received by the home since the last inspection. Records showed that this had been handled in accordance with the homes policy and procedures for dealing with complaints. There had been no complaints or concerns raised with us (CQC) about the service since the previous inspection in April 2007. The manager was able to tell us of some issues that had been raised verbally with the staff and management team. These had not been recorded as complaints and therefore it was not possible to assess how they had been dealt with or how they had contributed to the development of the service. We noted that there had been a number of compliments made to the service from families and representatives of the people living there. We noted that complaints forms and information about how to make a complaints were available in the communal hallway of the home. Families and representatives of people living at Priory Lodge told us they knew how to raise any concerns, one person said: If I have any worries I am very confident that I Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: can talk to any of the staff and it will be sorted and another person said: I think it is very good there, no complaints. The homes abuse policy is regularly reviewed, there had been no safeguarding issues since the previous inspection visit of 2007. Staff training records showed that all the staff team had received training to provide them with the awareness of adult safeguarding procedures. Staff we spoke with had a good awareness of the actions to take should they suspect abuse. We looked at staff recruitment records, these showed that all checks had been made that were necessary to ensure the people working at Priory Lodge were safe to work with this vulnerable group of people. Care Homes for Adults (18-65 years) Page 21 of 30 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 excellent 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 homely, comfortable safe environment. Evidence: We took a physical tour of the home as part of this inspection site visit, the home was clean, fresh and tidy. There was a continuous programme of redecoration at Priory Lodge, at this visit the kitchen was being refurbished with the communal lounge area next on the agenda. Resident meeting minutes showed that people had been consulted about the colour schemes of these areas and new furniture had been ordered in readiness. Some of the bedrooms had been redecorated since the previous inspection visit and some of the wooden window frames had been replaced. The managers AQAA showed that plans for 2010 included the refurbishment of bathroom facilities including laying new flooring and repainting. Peoples bedrooms were personalised and clearly reflected the characters of the people living there. Infection control training had been provided for all staff and a refresher course has Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: been planned for 2010. Infection control strategies had been put in place to combat the threat of Swine Flu. All residents spoken with reported being very happy with the their home and told us they felt it belongs to us. Relatives told us: Beautiful place, fantastic place, it is kept spotless, everyone living there is so motivated, one big happy family. Care Homes for Adults (18-65 years) Page 23 of 30 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. People receive safe and effective support from a well trained staff team who understand and do what is expected of them. Evidence: We looked at staff rotas, these showed there were 3 staff on duty to cover daytime shifts and 2 staff at night. In addition the home employs a housekeeper and cook. The home employed 17 care staff including the registered manager and floor manager. Records showed that the registered provider regularly attended the home on weekday afternoons to provide additional support where needed. The manager reported that a new member of staff was due to start to work at the home imminently. This appointment was to provide admin support for the service and computer skills for both residents and the staff and management team. The managers AQAA stated: Priory Lodge will ensure the correct training is put in place so the day to day running of the home is kept to a high standard. All care staff working at the home had achieved a minimum of NVQ level 2, 5 staff members had achieved NVQ level 3 and 1 person was working towards the NVQ level Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: 4 qualification. Records showed that all basic core staff training was up to date and that dates had been scheduled for refresher courses for 2010. This included medication administration, Infection Control, Food Hygeine, Health and Safety, Basic Life Support and Safeguarding Vulnerable Adults. The homes Investors in People report from November 2009 stated that the service has a strong commitment to ongoing staff development and that there is a strong sense of value amongst staff resulting in high morale and motivation. We looked at recruitment records, this included those of a staff member employed to work at the home since the previous inspection visit. this showed that the manager operated a robust recruitment process that ensured the right people were employed to work at Priory lodge. All new staff employed to work at the home undertook a structured induction programme that included the principles of care and safe working practices. The registered manager had been absent from the home due to illness for periods during the previous 12 months, this had resulted in some staff supervisions not being recorded. Staff and management confirmed that informal supervision had taken place and there was a continuous observation of staff practice on a daily basis whilst they carried out their duties in the home. Staff spoken with said that they felt well supported by the management and that they communicated well through the use of handovers and regular staff meetings. Family members told us: It is very well run and the staff are wonderful. Care Homes for Adults (18-65 years) Page 25 of 30 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 well run home that is managed in their best interests. Evidence: The home holds the Investors in People Award and received a themed assessment in November 2009. The report from this assessment stated that: The registered manager is a role model to both managers and staff within the home, she has developed and encouraged leadership and management qualities at all levels. and that Staff felt that management had created an environment where they feel they can put forward any ideas for improvement and there is constructive 2 way feedback. The floor manager had achieved the NVQ level 4 and the Registered Manager had achieved the Leadership in Management Award. The homes Investors in People report from November 2009 stated The very positive style of management and the NVQ training at all levels has ensured that the home has motivated, well trained staff. The manager has had periods of absence from the service due to illness over the past 12 months. There were some areas of routine monitoring and auditing that had Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: suffered as a result. The manager had identified these areas and had put strategies in place to rectify these shortfalls. The proprietor had not routinely been undertaking monthly audits of the home as required under regulation. However he had been involved with the day to day running of the home every weekday and, as observed at this inspection visit, he maintained good contact and interaction with residents and staff. The proprietor had been providing this extended support at the home during a period of management illness. There were quality assurance systems in place that contributed to the continuous improvement and development of positive outcomes for the people living in the home. Annual quality assurance questionnaires were distributed to residents. Advocates, key workers and next of kin encouraged and enabled individuals to complete the questionnaires. Relatives, visitors to the home and outside professionals were also surveyed as part of the quality assurance process. Residents meeting minutes provided evidence to confirm that they were regularly consulted about the way the home was run. Our observation on the day of this visit showed that the residents were totally at ease with the registered manager and her staff team and were eager to engage with them. We checked a random sample of the cash and cash transaction records belonging to people living in the home and we found them to be accurate and up to date. All records were available to show that regular checks are made to ensure peoples health, safety and welfare are protected. Records showed that water temperatures were regularly checked however, it was the same 3 water outlets that had been checked in recent months. This does not ensure that water temperatures throughout the home were maintained safely. Care Homes for Adults (18-65 years) Page 27 of 30 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 28 of 30 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 20 13 The registered person must ensure the recording, handling, safekeeping and safe administration of medication. This refers to maintaining accurate Medication Administration Records and ensuring there is a clear audit trail of all medications in the home. This is to ensure that people are protected from the risk of any medication errors. 31/03/2010 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 29 of 30 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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