Inspection on 12/10/09 for The Lodge

This is the latest available inspection report for this service, carried out on 12th October 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Lodge 18/10/06

The Lodge 09/11/05

The Lodge 19/04/05

The Lodge 26/10/04

The Lodge 17/06/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 26/11/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: The Lodge 21 Roundshead Drive, Off Jiggs Lane Warfield Bracknell Berkshire RG42 3RZ     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: Denise Debieux     Date: 1 2 1 0 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 32 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 32 Information about the care home Name of care home: Address: The Lodge 21 Roundshead Drive, Off Jiggs Lane Warfield Bracknell Berkshire RG42 3RZ 01344424982 01344424982 lichunrong@hotmail.com www.voyagecare.com Milbury Care Services Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Pearl Southard Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 5 The registered person may provide the following category/ies 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 categories: Learning disability - LD Date of last inspection Brief description of the care home The Lodge is situated close to Bracknell town centre and local amenities. The home provides care and accommodation for up to five service users with learning disabilities. The service users all have single bedrooms, there are three bedrooms located on the ground floor and two bedrooms on the first floor. There are bathroom facilities located on the ground and first floor. The home has a large kitchen with dining area, lounge, Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 5 2 8 1 0 2 0 0 8 Brief description of the care home conservatory and a secluded garden to three sides of the building. There is some off road parking available to the front of the property. Fees range from £1266.44 to £1332.90 per week. This information was provided on 12th October 2009. Care Homes for Adults (18-65 years) Page 5 of 32 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: The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This unannounced visit formed part of a key inspection and was carried out on 12th October 2009 starting at 9.45 am. The manager was present as the representative for the establishment. It was a thorough look at how well the service is doing. It took into account detailed information provided by the manager and any information that CQC/CSCI has received about the service since the last inspection on 28th October 2008. The people who live at this home prefer to be referred to as service users. For clarity and consistency this term will be used throughout this report. On the day of this visit each of the five service users were involved in the inspection and information was gained from three on duty staff. Prior to the inspection, survey forms were sent to all service users, ten social and health care professionals and ten Care Homes for Adults (18-65 years) Page 6 of 32 members of staff employed at the home. Survey forms were returned by four service users, one social and health care professional and six members of staff. These survey forms were correlated and the results were shared with the manager during the inspection. Comments made on the survey forms, both positive and negative, were included in the correlation and shared with the manager. Care was taken to exclude any comments that could identify the writer. The manager demonstrated a pro active attitude to the results of our survey and plans to explore any concerns raised further as part of the homes quality assurance process. Some of the comments made to us on the day of this visit and made on the survey forms are quoted in this report. Observations of the interactions between staff and service users were also used to form the judgements reached in this report. The home sent us their annual quality assurance assessment (AQAA) when we asked for it. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. The AQAA was well written and gave us all the information we asked for. Service users care plans, staff recruitment and training records, menus, health and safety check lists, activity records, policies, procedures, medication records and storage were all seen and assessed on the day of this visit. We looked at how well the service was meeting the standards set by the government and have in this report made judgements about the standard of the service. We would like to thank the service users and staff for their time, assistance and hospitality during this visit and the service users, social and health care professional and staff who provided additional information and participated in the surveys. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: The organisations staff recruitment practices continue to be of concern and the requirement made at the last inspection has not been met. This is potentially placing service users at risk of harm or abuse. In line with CQC enforcement methodology, we will hold a management review meeting to discuss our ongoing concerns with the providers staff recruitment practices and decide what course of action we will follow. In order to facilitate identified improvements, reduce time taken away from service Care Homes for Adults (18-65 years) Page 8 of 32 users in repetitive administration tasks and to enable service users to have the opportunity to participate fully in drawing up their new care plans and other documents in appropriate formats a recommendation has been made that the organisation provide the home with a computer system and internet access. 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 9 of 32 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 10 of 32 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. Service users can be 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. Evidence: There have been no new service users move into the home since the last inspection. Four people moved in when the home opened in 1997 and the fifth person moved in two years later. The home have an in depth procedure for the pre admission assessment and admission of new service users and it was confirmed that this procedure would always be followed. In the AQAA, to demonstrate what the home does well, the manager stated that: The home makes sure that people can decide if they want to live in it and if it is the right place for them. We identify the needs of the individual from assessment of need and continually review this assessment, including family with service users agreement in this process. New service users are offered introductory visits to the service, service Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: users are involved in and agree to their individual plan. The service users surveyed all felt they had received enough information prior to moving to the home and they all confirmed they had been asked if they wanted to move to The Lodge. In the AQAA the manager set out their plans for improvement over the next twelve months: Ensure continued review of documentation to ensure that the current formats meet the needs of the service users. Involve service users and relevant others in this process. Continually evaluate current documentation and ensure appropriate actions are taken. Care Homes for Adults (18-65 years) Page 12 of 32 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. Service users needs and goals are met. The home has a plan of care that the service user, or someone close to them, has been involved in making. Service users are able to make decisions about their life, with support if they need it. This is because the staff promote their rights and choices. Service users are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. Evidence: In the AQAA, to demonstrate what the home does well, the manager stated: Provide an individual plan based on the assessment of need, clearly indicating individualised procedures that may be necessary. The plan is drawn up with the involvement of the service user, family/friends/advocate and relevant agencies as appropriate. Service users are enabled and supported to make decisions in all areas of their lives with the support of friends/family/advocate/IMCA where appropriate. This statement was supported by the findings on the day of this inspection. Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: Care plans for two service users were sampled and both were seen to be comprehensive, person centred, well set out and easy to follow. Care plans are drawn up with service users and are reviewed on a regular basis and amended if needs change or a new concern arises. The staff document daily in a separate diary for each service user to evidence that individual goals and needs are being met. The care plans were seen to be very individualised and included the service users personal preferences in how they would like to be supported and also risk assessments for all activities, with clear guidelines for staff to follow to minimise any associated risks. Since the last inspection all care plans have been rewritten and it was seen from the files that the service users had been fully involved in this process. Four completed service user survey forms were received prior to this inspection. All service users stated that they could do what they wanted to do during the day, in the evening and at weekends. On the day of this visit, service users were seen to be choosing what they did and where they went within the home. Staff were seen to be helpful and offered assistance where needed or requested. Data provided in the homes AQAA does not identify any service users with specific religious, racial or cultural needs at this time. However, from the evidence seen and comments received, we consider that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. In the AQAA the manager set out their plans for improvement over the next twelve months: In addition to the copy that is kept in the individuals care file, provide every service user with a copy of their individual plan in a format appropriate to their needs. Care Homes for Adults (18-65 years) Page 14 of 32 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. Each service user is treated as an individual and the care home is responsive to his individual and diverse needs. 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 service users to follow personal interests and activities. Service users are able to keep in touch with family, friends and representatives and the home supports them to have appropriate relationships. Service users 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. Service users have healthy, well-presented meals and snacks, at a time and place to suit them. Evidence: The daily routines at the home reflect the requirement to promote independence, individual choice and freedom of movement. Service users confirmed they could Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: choose what to do, when they wanted. This was also confirmed by observations made on the day of this visit. In the AQAA, to demonstrate what the home does well, the manager stated that they: Enable service users to experience a wide range of leisure activities, support to continue with existing activities. Ensure that service users finances are maintained and available when service users need to purchase items, assist and support service users to develop their budget plans. Provide opportunities within individual activity plans to participate in the local community, provide trained staff in relevant areas, maintain relationships with the local community, provide access to vehicles, assist and support in accessing local transport, flexibility in rotas to support chosen activities, provide the support to access annual holiday of individual choices and/or day trips. The home ensures that the service users lead a positive and fulfilling a lifestyle as possible. They involve the service users, as far as they are able in the planning and quality of their lifestyle. This statement was supported by the findings on the day of this inspection. One service user has a part time job and another service user has recently started an art course at the local college. Each service user has a weekly activity schedule that is based on his or her known interests and hobbies. The activity schedules sampled were seen to be varied and included activities both within and outside the home in the local community. One service user spoke with us about his holiday this year and what he had done. During the day service users were going out and returning, one service user went out to work, another went to college and two service users went to town for lunch. It was obvious during this inspection that the staff team are open and flexible and that no two days are the same. Service users were seen to be making decisions, at the time, as to whether they wanted to do what was on their schedule or to do something different. The menu for the week of this visit was seen to be varied and well balanced, the care plans sampled demonstrated that advice is sought from a local dietician, for individual service users, as and when needed. We were advised that service users plan and prepare their meals, using photo and picture cards, as aids and with assistance and guidance from the staff where needed. Each service user takes a turn at choosing the menu for the communal evening meal. On the day of this visit at lunchtime, service users chose what they wanted to eat and at what time, to fit in with the activities they had planned. In the AQAA the manager set out their plans for improvement over the next twelve months: We will continue to support all of the service users to have the kind of life Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: they want with all of the support services and professional involvement to enable this to happen. We will ensure that all of the service users have access to the resources to choose and go on at least one holiday or day trips of their choice with the staff they wish to be supported by wherever this is possible. We will access the professional assistance of a speech therapist to support the development of communication methods. A further increase in activities to meet individual and group needs and wishes will again be another area we will continue to focus on with particular attention being paid to first time experiences. We will look at further development of in-house activities. Care Homes for Adults (18-65 years) Page 17 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users 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 service users 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. Evidence: During this visit two care plans were sampled and it was seen that all health care needs were incorporated into the plans. Diary notes evidenced that staff take prompt action to deal with any new health problem that may occur and care plans were specific with information for staff to follow when supporting service users to manage any long term or acute conditions. We spoke with one service user who has recently been in hospital, he told us how pleased he was to be back home and that all the staff were looking after him very well. At the last inspection a requirement and recommendation were made in reference to reviewing the bed that had been provided for one service user. Since that inspection the manager arranged for the service users needs to be assessed and his bed has Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: now been replaced with one more suitable and more domestic in nature. The service user told us how he likes his new bed and that it is better than his old one and more comfortable. The previous requirement and recommendation have been met. In the AQAA, to demonstrate what the home does well, the manager stated that: We provide all of our service users with the personal support they require in their preferred way and meet the physical and health needs of all of the service users. Personal preferences are shown in the Individual and Person Centred Plans and all health related support needs are identified and actioned in the Health Action Plan. Support services and professionals are accessed as and when needed to ensure the service users have access to support services/equipment they need after a need has been identified. Personal care is undertaken in a respectful way and staff are aware of issue of dignity and privacy. All service users who have to receive in house visits from professionals are supported to do so in the privacy of their own rooms and with the support of their key worker wherever possible. All staff who administer medication only do so after a rigorous training and supervision process which is reviewed annually. This statement is supported by the findings on the day of this visit. Medication is provided mostly in the blister pack system. The administration of some medications was observed and the medication administration records (MAR), medication storage, policies and procedures were all sampled and found to be in good order. During this inspection, all interactions observed between staff and service users were polite and respectful of service users privacy and dignity. Staff never entered service users private rooms without knocking and awaiting permission to enter. All personal care was carried out behind closed doors. In the AQAA the manager set out their plans for improvement over the next twelve months: To ensure all documentation is reviewed evaluated and amended when necessary, including the Individual, Person Centred and Health Action Plans which, once fully developed, will be reviewed at least twice a year and whenever there is a change in need or preference. Care Homes for Adults (18-65 years) Page 19 of 32 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. If service users 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 home safeguards service users from abuse, neglect and self-harm and takes action to follow up any allegations. Evidence: The home has a complaints procedure in place that is available to all service users, has been individualised to the home and is included in their service users guide. There is a whistle blowing policy in place and the home have a copy of the latest Berkshire Safeguarding Adults Policy and Procedure. Training in safeguarding adults is included in the homes staff induction and all staff receive regular updates on any changes to the local safeguarding procedures. All staff surveyed stated that they knew what to do if anyone raised concerns about the home and the service users surveyed all said they knew who to talk to if they are not happy. The manager and the two senior support workers have all attended training in the Mental Capacity Act and the Deprivation of Liberty Safeguards and have shared that learning with the other staff during team meetings. Information leaflets are available in the office for reference and guidance for the staff. In the AQAA, to demonstrate what the home does well, the manager stated that: We Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: provide a clear and effective complaints policy and ensure all service users are aware of its existence and how to use it. We provide a robust procedure for responding to any suspicion, allegation or evidence of any type of abuse along with a provided Whistle Blowing Policy. All staff have received Protection Of Vulnerable Adults training and are given information about who they can make a complaint to or raise concerns with both within the service but within the organisation as a whole. Service users finances are thoroughly protected by organisational Policy and Procedures being followed whenever individuals or service monies are handled. Access to monies is restricted to the management team of the service with all transactions being recorded on the day the transaction takes place. A rigorous internal and external audit process is in place. This statement is supported by the findings of this inspection. All service users spoken with said they knew how to complain, if they wanted to, and said that the staff always listen and take action. Service users financial records are checked once a week by one of the seniors, monthly by a representative of the provider organisation and a yearly, full audit is carried out by the head office. In the AQAA the manager set out their plans for improvement over the next twelve months: Develop policies in more formats to meet a wider range of needs. The organisation is planning to develop a national service user forum to enable service users to share their views/concerns/ideas to senior managers within the company. Care Homes for Adults (18-65 years) Page 21 of 32 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 location and layout of the home is suitable for its stated purpose. It is accessible, safe and well maintained. The home was found to be clean and hygienic and to meet service users individual and collective needs in a comfortable and homely way. Evidence: The Lodge is situated close to Bracknell town centre and local amenities. The service users all have single bedrooms, there are three bedrooms located on the ground floor and two bedrooms on the first floor. There are bathroom facilities located on the ground and first floor. The home has a large kitchen with dining area, lounge, conservatory and a secluded garden to three sides of the building. Laundry facilities are sited on the ground floor with washing machines suitable for the needs of the service users at the home. On the day of this visit we were shown around all areas of the home and grounds, with the exception of four bedrooms. The furniture and furnishings were seen to be of a good quality and specialist equipment is provided, if needed by the service users. Personal bedrooms were all seen to be highly personalised to the individual service users wishes. Since the last inspection many improvements have been made to the home: the causes of the ongoing problems with damp, especially in one bedroom, have finally been identified and rectified, meeting a requirement made at the last Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: inspection; all personal rooms and communal areas have been redecorated with the exception of one bedroom, two bathrooms and one toilet, all of which are scheduled to be started soon. A new kitchen has been fitted and many of the carpets and curtains have been replaced. Service users spoken with confirmed they had been fully involved in choosing the new colour schemes and planning the refurbishments. Following the last inspection, and in February this year, we were advised by the Operations Director (South) of the organisation that: The remaining windows that have not previously been double glazed are to be to replaced, but again this is dependant on better weather conditions and again has been scheduled for April. This work has not been carried, to date, and the manager has not yet been given a date for when this work will be started. In the AQAA, to demonstrate what the home does well, the manager stated: Provide an accessible, homely, clean, hygienic, safe, well maintained, and comfortable environment to meet individual service users needs and current legislation. Provide all service users with their own personal space in a self contained single room, with suitable furniture and fittings and encourage/support to add their own personal belongings that reflect their culture, beliefs and personalities. Provide comfortable and fully accessible communal facilities that reflect service users needs and preferences. This statement is supported by the findings on the day of this visit. Service users who returned survey forms all said that the home is now always fresh and clean and two service users explained to us how they had chosen their colours for their rooms. On the day of this visit the home was found to be warm and bright with a homely atmosphere and a high standard of housekeeping apparent. In the AQAA the manager set out their plans for improvement over the next twelve months: Further redecoration in communal rooms and service users private areas. Refurbish an individual service users en-suite to meet change in need. Organise a regular contract gardener to maintain borders and shrubs. Care Homes for Adults (18-65 years) Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have safe and appropriate support as there are enough competent, qualified staff on duty at all times. Service users needs are met and they are supported because staff get the right training, supervision and support they need from their managers. Current staff recruitment practices do not meet the requirements of legislation and are potentially placing service users at risk of harm or abuse. Evidence: The current staff team consists of the manager, two senior support workers, six support workers and four bank support workers. The staff rota evidenced that staff are provided in sufficient numbers to meet the needs of the service users at the home. The morning (7.30 am to 2.30 pm) shift is usually covered by two support workers, with extra staff scheduled if needed to facilitate planned activities, two support workers usually cover the afternoon/evening shift (2.30 pm to 9.30 pm), again with additional staff if needed and the night staff consists of one waking support worker and one sleeping on the premises and available if needed. At present the home also has an additional member of staff working the day shifts due to the recent, increased needs of one service user. Of the eight care staff, four hold a National Vocational Qualification (NVQ) level 2 or Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: above in care, with a further two booked on the course and expected to start their NVQ training before the end of the year. At the last inspection concerns were raised about the organisations recruitment practices and a requirement was made. Following that inspection we were told that all files for staff working at the home at that time had been reviewed and any discrepancies found had been rectified. During this visit we sampled the recruitment file for the one person who is working at the home who has been employed in the past twelve months. Evidence that an enhanced Criminal Record Bureau (CRB) and Protection of Vulnerable Adult (POVA) list check had been obtained was accepted by us in the form of written details of the certificate number and date obtained, which had been sent by the providers head office. The file sampled contained proof of identity, two references, a completed application form, and a full employment history with any gaps in employment explained. However, the recruitment procedures were still not in line with the requirements of the regulations and the outstanding requirement has not been met by the provider. Although the person had documented two previous employments working with vulnerable adults or children, no references had been sought and the persons reasons for leaving those jobs had not been verified. Both of these checks are required before a person is allowed to work at the home. Parts of the recruitment process are carried out by the human resources department at the providers regional/head office, the outstanding requirement states that the provider must ensure that all staff involved in recruitment are fully aware of and adhere to the requirements of the legislation. This includes staff employed by the provider outside the home if they are involved in recruitment. The provider has an arrangement with CSCI/CQC for the central storage of records, part of this agreement is that information on recruitment checks is provided by the central location and stored at the home. The form used by the provider for this purpose was filed in the persons file. It is of concern that some of the information provided on this form was not correct. Someone from the human resources department had stated that they had verified the persons reasons for leaving previous employment with vulnerable adults. This was not the case. It was also noted that no accountable person (this must be either the responsible individual for the organisation or the registered manager of the home) had verified or signed the contents of the form, this does not comply with the providers arrangement with CSCI/CQC. In line with CQC enforcement methodology, we will hold a management review meeting to discuss our findings in relation to ongoing concerns with the providers staff recruitment practices. In the AQAA, to demonstrate what the home does well, the manager stated that: We operate a robust recruitment policy and practice adhering to relevant current standards and legislation. As set out above, this Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: statement is not supported by the findings on the day of this inspection. Staff induction is in line with the mandatory Skills for Care common induction standards and we were advised that staff are supervised until they have completed their induction. Staff are booked on additional training and updates as the courses become available. The staff training log sampled evidenced that staff have received training as required and have been scheduled for update training when due. In the AQAA, to demonstrate what the home does well, the manager stated that: Staff work a flexible rota which ensures that the needs and wishes of the residents are met. There is a thorough induction programme and all staff support the new individual. All staff are paid to attend both internal and external training sessions and a training and development plan is in place for the service and each staff member. This statement was supported by the findings of this inspection. Staff who returned survey forms all confirmed that they are given training which is relevant to their role, helps them to understand and meet the individual needs of service users and keeps them up to date with new ways of working. One member of staff commented that: In terms of training (capacity building) the home is excellent. Team work is also excellent. All interactions between service users and staff, observed on the day of this visit, were caring and respectful and staff showed a good understanding of how each individual service user liked things to be done. Of the four service users who returned survey forms, all said that the staff listen and act on what they say and that the staff treat them well. In the AQAA the manager set out their plans for improvement over the next twelve months: To explore an increasing range of training courses available which will supplement the existing mandatory and specialist training to enhance the life experiences of all of the service users. We will continue to develop the team to ensure a continuity in care and ensure that all those meeting the criteria have access to NVQ2 training. Care Homes for Adults (18-65 years) Page 26 of 32 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. Service users can have confidence in the care home because it is run and managed appropriately. Service users 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 service users and staff because health and safety practices are carried out. Evidence: The manager has now filed her application to become the registered manager of the home and her application is currently being processed. She has been employed within the organisation for eleven years and holds an NVQ level 3 and 4 in care and has recently obtained her Registered Managers Award qualification. She has been the manager at The Lodge since April 2008. At the last inspection a requirement was made that the provider must put systems in place to enable the manager and staff to keep up to date with current and changing Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: legislation, to access new best practice guidance and to follow developments and upcoming changes in social care regulation. The manager advised us that she has arranged a subscription to a professional publication to keep her updated with changes in current legislation and practice and also that she attends managers meetings with other local managers which provides a forum for sharing best practice. The manager continues to use her home computer to access the CQC website when looking for our guidance on meeting regulations and standards. The home have recently had broadband fitted but it can only be used with company equipment and the home has not been provided with a computer to date. Last year the staff explained that paperwork that needed to be typed was taken to the Henley regional office, however that office has now closed so that is no longer an option. This continues to mean that staff time is taken away from service users by having to hand write most documents or the staff taking work home and using their own equipment. The requirement has been met but the recommendation for the company to provide computer equipment to the home is repeated in this report. Service users views are sought on a regular basis and monthly visits by a representative of the responsible individual take place as required. In the AQAA, to demonstrate what they do to ensure that the views of service users are promoted and incorporated into their work the manager stated: Service users meetings, and service users also attend regular house meetings. This is to facilitate inclusion for all throughout the year where we discuss new ideas for improved service delivery, operational issues which may affect either or both those who live or work at the service, budgets, forthcoming events or activities. The Annual Service Review gives us feedback regarding the quality of service delivery, service users are supported to participate and communicate their views. The review also involves professionals and the residents family and friends who are all invited to take part in this important piece of work. The outcomes from this document are then used to develop a service development plan for the next year thus ensuring a continued development of service delivery. This statement was supported by the findings on the day of this inspection. All necessary health and safety checks are carried out by the staff at the home with documentary evidence inspected of routine fire practices and evacuations. Fire equipment checks, daily checks of fridge and freezer temperatures and a number of up to date maintenance certificates were seen. All records were up to date and well maintained. In the AQAA the manager set out their plans for overall improvement over the next twelve months: Improve timescales for routine maintenance. Continue to develop the garden areas. Continue to improve opportunities for individuals to access activities in Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: the wider community and continue to develop Individual Support Plans and review on regular basis. Continue to support staff through all aspects of training to ensure that they have the skills and knowledge to support all individuals in the delivery of excellent care practices. Staff spoken with were complimentary about the improvements the manager has achieved over the past year and all felt that the home now runs well and has a clear sense of direction. When asked on their survey forms whether they felt they have enough support, experience and knowledge to meet the different needs of the service users, four staff members answered always and two answered usually. Additional comments received from staff about what they feel the home does well included: Good communication among staff. Good staff/service user interaction, the staff treat each person as an individual and support service users to be as independent as possible. Support staff well. All interactions observed between the staff and service users on the day of this inspection were inclusive, caring and respectful and demonstrated that the home has a close and caring staff team. Care Homes for Adults (18-65 years) Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 34 19 The registered person must 30/11/2008 ensure that all staff involved in recruitment are fully aware of, and adhere to, the requirements of the Care Homes Regulations 2001 as amended by The Care Standards Act 2000 (Establishments and Agencies) (Miscellaneous Amendments) Regulations 2004. In order to protect the service users from the potential risk of harm or abuse. Care Homes for Adults (18-65 years) Page 30 of 32 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 37 It is recommended that the organisation provide the home with a computer system and internet access to facilitate identified improvements, reduce time taken away from service users in repetitive administration tasks and to enable service users to have the opportunity to participate fully in drawing up their new care plans and other documents in appropriate formats. Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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