Inspection on 19/01/09 for 6 Lord Street

This inspection was carried out on 19th January 2009.

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

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

Other inspections for this house

6 Lord Street 09/01/07

6 Lord Street 24/01/06

6 Lord Street 06/09/05

6 Lord Street 08/03/05

6 Lord Street 25/11/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: 6 Lord Street 6 Lord Street St Annes On Sea Lancashire FY8 2DF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Denise Upton     Date: 2 2 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: 6 Lord Street 6 Lord Street St Annes On Sea Lancashire FY8 2DF 01253722800 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): jilldavis.lorddurham@tiscali.co.uk Mr David Calwell Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 3 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 3 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD The maximum number of service users who can be accommodated is: 3 Date of last inspection Brief description of the care home Lord Street Care Home is currently registered to accommodate up to three adults who have a learning disability. The home is located in a quiet residential area of St Annes but within easy reach of the main shopping centre of the town and community facilities and resources. Communal areas of the home are domestic in character and each resident is accommodated in single bedroom accommodation. Service users access the local community and are an accepted part of it. The staff group ensure there is a homely and comfortable atmosphere in the home and that service users are enabled and empowered to maintain and maximise their independence. The current range of fees are variable and dependent on the level of service required. Care Homes for Adults (18-65 years) Page 4 of 33 Brief description of the care home Further information regarding this can be obtained from the homeowner/manager at Lord Street Care Home. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection focused on outcomes for the people living at the home and involved gathering information about the service from a wide range of sources over a period of time. The visit to the home was unannounced and looked at all the key minimum standards plus the standard relating to supervision arrangements for staff. At the time of the site visit there were two people resident at the home. The inspector spoke with the homeowner/manager, the support worker on duty and the two residents living at the home. On this occasion, there were no Commission for Social Care Inspection (CSCI) resident surveys completed, however three completed staff surveys were returned. Information was also gained from the annual quality assurance assessment (AQAA) Care Homes for Adults (18-65 years) Page 6 of 33 completed by the homeowner prior to the visit taking place. This is a self assessment that focuses on how well outcomes are being achieved for people using the service. The homeowner was asked to tell us what they thought they did well, what they need to do better and what they have improved upon. This helps us to determine if the homeowner viewed the service they provided in the same way that we do. We feel this form was filled in truthfully and that thought and effort had been given to completing the form. A number of records were viewed and a tour of the building took place looking at communal areas of the home, bathrooms and individual bedroom accommodation. Time was also spent observing the relationship between staff and residents as they went about the days activities. This all helped to form an opinion as to whether Lord Street care home was meeting the needs and expectations of the people who live there. The last key inspection took place in January 2007, with an annual service review in December 2007. An annual service review is a summary of our knowledge of a service that has not had a key inspection in the last year. It is also how we decide if a service is still as good as we thought it was at the last key inspection or annual service review. The report relating to the annual service review is held at the CSCI office and would be made available on request. What the care home does well: What has improved since the last inspection? What they could do better: There is a good system in place to make sure that only suitable people are employed at the home. Part of this involves a robust recruitment process including obtaining the necessary references and clearances before the person starts working at the home. However it was difficult from the recorded information, to establish the exact date the Care Homes for Adults (18-65 years) Page 8 of 33 new employee actually started working in the home and assisting residents. It has been recommended that the start date of each new employee is clearly highlighted. This would help to ensure that residents are protected. One resident has medication prescribed that only needs to be taken when necessary. Although this medication is rarely required, there should be some written instructions for staff to follow of when it would be appropriate to give this medication. Support staff would then all have the same written information of when this prescribed medication should be given. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 33 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 33 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. There is a good system in place to introduce people to the home, with sufficient information provided and strengths and needs assessments completed. This is to make sure that prospective residents know that their needs and requirements could be met. Evidence: Lord Street care home has a good system in place for assessing a prospective new resident. Although no new residents have been admitted since the last inspection, the homeowner confirmed that a thorough in-house strengths and needs assessment would be undertaken prior to a new resident moving into the home. Relevant risk assessments would also be undertaken to help confirm whether a personalised service could be provided for the individual and to help ensure compatibility with other users of the service living in the prospective residents proposed new home. Written information obtained from other sources would also be taken into account and the family or other supporters of the individual would be encouraged to become fully involved, if appropriate. Diversity and equality issues in respect of each prospective Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: resident are given close attention. This is to make sure that individual care needs, interests, hobbies, sexuality, religious and cultural beliefs are taken into account, respected and addressed. Information about the home is produced in a pictorial format and complimented by written material. The prospective resident is gradually introduced to the home, the staff group and the people that live there. All introductions are planned to take place at a pace suitable to the individual. Only when the full assessment process is completed, including taking into account the views and thoughts of the prospective resident, will a decision be made as to whether an appropriate service could be provided. The care file of one resident was observed in detail. This confirmed that although some time ago, a thorough pre admission assessment had been conducted prior to the person moving into the home. The support worker spoken with stated that sufficient written and verbal information was provided prior to a new resident taking up residence at the home in order to provide a good, consistent service. Although the residents spoken with could not really remember the detail of their pre admission assessments, both confirmed that their wants and needs were being met and that Its alright living here. Care Homes for Adults (18-65 years) Page 12 of 33 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 living at Lord Street care home are able to make choices about their lifestyle and are helped to maintain their independence so life at the home meets their expectations. Evidence: Each resident had an individualised and detailed, person centred care plan that includes the good practice of addressing personal care, intellectual and emotional support, social support, work requirements, religious, cultural and relationship needs, that were being met. The staff team have worked hard with people living at the home, developing care plans that are unique to them so they receive the right amount of care and support that meets their needs. This is developed in conjunction with the resident, family members and the staff team. Information in the AQAA confirmed that during this time, every effort is made to ensure that the individual remains the central focus. The person centred plans provided good information about the strengths, needs, wants and wishes of each person. This meant that staff knew exactly what they needed to do Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: to support the person in order to meet their needs in the way they preferred. The person centred plans focused on what people wanted to do and what they were able to do themselves, which helped people using the service to maintain their independence and chosen lifestyle. This also ensured that as far as possible, the residents were enabled and supported to make their own informed decisions and have the right to take some responsible risks. From observation of records, is was evident that person centred plans are regularly reviewed on a planned basis or more frequently if required. Individual risk assessments and risk management plans are also in place covering a wide range of situations such as personal care, transport, walking and holidays. This helps to protect people from risk or harm. Risk assessments are also regularly reviewed to make sure that the information is current so that any identified risks are, as far as possible, eliminated or minimised. Each resident also has an individual health action plan, weekly activities and daily activities plan, and a All About Me plan that had been developed in an easy read and pictorial format to make the All About Me plan more meaningful for the resident. The health action plan, activities plans and the All About Me plan had been agreed and signed by the resident and the manager. This shows that residents are involved in their support plans and can have their say in what they want the support plans to say for staff to follow. Staff also maintain informative and meaningful daily record communication sheets. This means that there is a clear record maintained of what each person has done during the waking day and night time period that helps to establish if the current support plan is meeting needs or if some adjustment and update is required to respond to the differing wants and needs of the individual. Staff who completed a Commission for Social Care Inspection (CSCI) questionnaire and the support worker spoken with, all felt that a very good standard of care was provided. One member of staff told us, Our clients are always put first, everyone listens to the clients, there is no favouritism, we work as a team. Another person told us, We listen to our service users and we make sure that their needs are always met. Both residents were pleased to be living at the home and said that they decided what they wanted to do everyday. It was clear from observing the everyday interaction between the two residents and the support worker that residents are encouraged and enabled to make decisions about every day matters such as what to eat for tea and Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: where they should go out to in the afternoon, these decisions were clearly of the residents choice, that was very much part of everyday life. Care Homes for Adults (18-65 years) Page 15 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities are organised according to peoples preferences and staff provide good support to ensure that family and friendship links are maintained. Residents benefit from a well balanced diet that suit their taste and choice. Evidence: Residents are supported to take part in meaningful and appropriate activities as part of their chosen lifestyle. Each person has a weekly plan of activities, which reflects their own likes and preferences. The person centred planning process helps to identify and maintain existing interests and also encourages looking for new activities that the individual resident may enjoy. Lord Street Care Home has a sister home nearby accommodating the same number of people. Residents from both homes often enjoy each others company and a resident Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: from one home may choose to go out with a resident(s) of the other home with staff support to enjoy a leisure or recreational activity. The support worker spoken with explained that most residents of both homes had known each other for a long time and good friendships had developed. This shows that residents are encouraged to socialise with people of their choice, at a time of their choice, in an activity of their choice. Both residents were involved in meaningful and appropriate activities that they had decided for themselves. This helps people to feel motivated and stimulated and promote a sense of achievement and well being. During discussion, both residents said that they enjoyed the activities that they had chosen for themselves and that the staff team were helpful and interested in what they did. One person said, I get on alright with all the staff. A member of staff told us, Management always make sure staff are available to meet clients needs. When they need one to one time there is always a staff member on shift to take that individual out. Good records are kept of all activities undertaken. Both residents were planning a holiday for the coming year, and one resident had very recently been supported to visit friends in another part of the country. Family and friendships links are positively encouraged. Friends and family are welcome to visit at any time and staff are active in ensuring that good communication is established and maintained. The manager explained that a birthday list and a list of other special events is maintained, and with staff support, cards and presents are bought and delivered on time. Families and friends are invited to birthday parties and at Christmas and all maintain a good relationship with others family and friends. This helps to create a strong sense of family involvement and encourages residents to continue to be very much a part of their family. Daily routines at the home are flexible and adapted to fit in with the days activities. Involvement in domestic tasks varies according to abilities and motivation. However both residents are involved with these tasks and are supported by staff to do certain household tasks including preparing and cooking meals. This supports choice and self determination regarding daily living activities. Throughout the home there were photographs of individuals enjoying a variety of activities. This had helped to created a sense of achievement and one of the residents spoken with was clearly very proud of what he did. It was very evident that there was a very good rapport between both residents and staff that helps people living at the home feel comfortable and safe. It was also evident that privacy, dignity and respect are core values that staff strive to maintain at all times. Assessment and care planning includes likes and dislikes regarding meals. Although Care Homes for Adults (18-65 years) Page 17 of 33 Evidence: residents choose the meals of their choice on a daily basis, healthy eating is encouraged with plenty of fresh fruit and vegetables being available. Resident also enjoy eating out in bars, cafes and restaurants. Residents choose what they would like to eat at breakfast with a light lunch midday and the main meal of their choice, served in the evening. One resident now makes his own breakfast, lunch and light snacks and another makes his own lunch for work. Specialist meals could be provided if required. Care Homes for Adults (18-65 years) Page 18 of 33 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 health and personal care needs were being met by support staff that respected their privacy and dignity. Evidence: Both residents had a Health Action Plan with concise, individual information including details of health care appointments, outcomes and follow up visits to ensure that each residents personal and health care needs are fully met. These gave clear guidance to support staff on how to provide personal care to each individual resident that respected their privacy and dignity. Times for getting up and going to bed are flexible and vary according to the activities planned for the day. The core values of care including maintaining privacy and dignity form part of the induction training programme and is reinforced through additional training that is made available, routine monitoring of work practices and supervision arrangements. The support worker spoken with gave a good account of how he protected peoples privacy and one of the residents spoken with said that he felt alright with staff. There is a good balance to the staff group that enables residents a choice of male, Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: female and age related preferences when delivering personal care. Lord Street care home has developed a policy and procedures for the safe administration of medication. In the main, medication procedures are adhered to. All staff are required to sign the medication policy to confirm that they have read and understood the content. Staff with responsibility for the administration of medication have all received appropriate medication training. This helps to keep people safe and ensure that the support staff have the necessary skills and understanding to handle medicines safely. Medication is securely stored. However it was noted that on two recent occasions the medication administration record showed a dose omission without explanation. This suggests that occasionally support staff are not following the medication procedure. It is important that as soon as medication is given to each resident, this is immediately recorded. If medication is not given for some reason or refused by the resident, this should also be clearly recorded. This would ensure that a correct record of medication administered is maintained and provided a clear audit trail of medication in the home. Although there is a record maintained of medication received into the home and on leaving the home, along with patient information leaflets, it was noted that were no protocols in place with regard to a prescribed medication that is only to be taken when required. Whilst this medication is rarely required, a specific written protocol should be developed to indicate when and under what circumstances it would be appropriate for staff to administer this medication. This would provide staff with clear guidance of when this medication should be given and ensure consistency of use. Staff are very alert to changes of mood and behaviour and the support worker spoken with confirmed that he was aware of the agreed action that should be taken. There was evidence of regular reviews of medication held with the individual residents General Practitioner (G.P.) That helps to ensure that the correct medicines and dose of medication is prescribed to individuals in order to safeguard, promote and maintain health. Residents are asked to sign a consent form to allow staff to administer their prescribed medication or alternatively self administer their own prescribed medication either totally or in part following the successful outcome of a formal risk assessment. Care Homes for Adults (18-65 years) Page 20 of 33 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. Complaints are handled well and taken seriously ensuring people feel listened to. Good safeguarding procedures help to make sure that people remain safe. Evidence: The complaint procedure is made available to all residents and incorporated in the Service User Guide in an easy read and pictorial format to make it more meaningful for residents to understand. Residents personal files contained a complaint card that was also in an easy read format to enable residents to make a complaint if they so wished. If a resident needed support to make a complaint, staff would assist or an external advocate or family member would become involved. However a resident spoken with said that if he had any concerns he would tell staff or talk to Dave (Homeowner/registered manager). The support worker spoken with was very clear about what he would do if a complaint was made to him. Since the last key inspection, the Commission for Social Care Inspection received two anonymous complaints. The homeowner was asked to investigate these internally using the homes complaint procedure. The investigations were thorough with a written record being kept of the complaint, how the complaint was investigated, the outcome of the complaint and any action taken to minimise a further complaint about the same or a similar matter. The vast majority of the elements of both complaints were not upheld. However this shows that complaints are taken seriously and that the Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: management team viewed complaints and concerns positively as an opportunity to learn and to ensure that a good service continues to be provided. During the visit, it was clear that people living at the home had formed good relationships with staff, meaning that any issues could be raised and dealt with informally as part of day to day life at the home. Lord Street care home continues to have a variety of policies and procedures in place for the protection of residents. This includes an adult protection policy and a whistle blowing policy to help protect people living at the home from abuse or discrimination. All staff have received training regarding protection and abuse and this topic is also regularly discussion during one to one supervision and at team meetings. This helps to remind staff of the importance of protecting residents and the responsibility of the staff group in this matter. Care staff also receive guidance in respect of adult protection as part of their National Vocational Qualification training (NVQ). The staff member spoken with said he had easy access to policies and procedures and would immediately refer any matter to the registered manager for appropriate action to be taken. A support worker who completed a CSCI staff survey told us, The home has policies and procedures and concerns are dealt with straight away. A second person told us, We have very good policies and procedures in place, I had a concern just recently which was dealt with straight away. Since the last key inspection, a short random inspection took place to look specifically at the way residents monies held in safe keeping were recorded. Since this time, changes have been made to the way residents monies are handled and recorded. This has helped to protect users of the service and to provide a clear audit trail of residents monies. A copy of this report can be obtained on request from the Commission. Care Homes for Adults (18-65 years) Page 22 of 33 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. A clean, pleasant and comfortable environment is provided. Evidence: Lord Street care home is situated in a quiet residential area close to local shops and amenities. Observation of communal areas of the home and individual bedroom accommodation showed that the building appeared well maintained, homely and comfortable. All bedrooms are for single occupancy, decoration and refurbishment of the home is on-going. Bedroom decoration reflects the interests of the occupant and each resident is encouraged to personalise their bedroom by bringing their own personal items, such as pictures and ornaments. Residents are also able to choose their own colour for carpets, and wall coverings and are encouraged to choose their own furniture for the bedroom. This helps people living there to feel that this is their home and that they can have their say about what they want knowing that if at all possible, it will be provided. There are many photographs of resident and staff throughout the home taken when residents have been on holiday, at parties, trips out and birthdays and Christmas. This makes the internal environment very homely and personal for the people who live there. Communal areas consist of a lounge to the front of the building Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: and a separate dining room/kitchen at the rear. Bedroom accommodation is located on the ground and first floor of the building. Bedroom doors are provided with an appropriate lock with the occupant retaining the key if they so wish to ensure privacy and dignity. Risk assessments are in place. A locked facility is also provided for the safe storage of personal items. At present there is a spiral staircase to access the upper floor. Although it was very clear that this caused no problem what so ever for current residents who used the stairs with ease, the existing risk assessment in respect of the stair case should be kept under regular review. This would be especially important should the dependency needs of either resident change or if a new resident was admitted to the home. This would help to ensure people remain safe and any risk minimised. Since the last inspection various environmental improvements have been made to the home. A new kitchen, bathroom suite and shower have been fitted, a new pump, thermostat and pipework has been provided to ensure adequate central heating and hot water and new carpets have been laid throughout. In addition, some new double glazed units have been fitted to some windows, the lounge has been redecorated and a new lounge suite purchased. This has helped to provide a warm, comfortable and homely environment for people to live. Both residents spoken with said they were happy with the accommodation provided and confirmed that their individual bedroom was comfortable and had their own things in the bedroom. Laundry facilities are domestic and suited to the needs of the home. The majority of staff have received infection control training as part of Learning Disability Award Framework (LADF). The remaining staff will undertake this training in due course. However the homeowner/manager is aware that this training was only brief, and is now looking to provide more in-depth refresher training to ensure that the staff group have updated training. This will help to ensure that staff are aware of current best practice with regard to infection control and help prevent the possibility of cross infection. Care Homes for Adults (18-65 years) Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements, recruitment and training ensure that people are cared for and supported safely. Evidence: Information in the AQAA confirmed that there are ten support workers who support people in both homes. National Vocational Qualification (NVQ) training is promoted, with five members of the staff team having achieved Level 2 or above. In additional three members of staff are working towards the Level 2 of this award. Newly appointed staff undertake the Learning Disability Award Framework induction training whilst completing their three month probationary period that can be extended if required. Lord Street care home also provides good additional training that is valued by staff. Further training in specialised areas is provided specific to the individual needs of the people living at the home and to develop the skills and knowledge of the individual member of staff. This helps to ensure that a good, individualised service is provided by a well trained staff team. Recent training has included, management of aggression which included simple, effective techniques that helped to build staff confidence when dealing with aggressive situations. Recent training for some staff has also included, Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: dementia care training, Mental Capacity Act training, person centred planning (PCP) and risk assessment training. Staff are encouraged to self evaluate their own training and development needs and through regular one to one supervision arrangements and annual appraisals, staff are given opportunity to put forward their ideas and suggestions. Staff comments on the training they had received were very positive. One person wrote on a CSCI survey, Recently we had somebody come down to the house and give us training on the Mental Capacity Act and on another occasion, people delivered training on advocacy. From these two days I have learnt a lot and it helps me understand my job role. Another person told us, Training is regularly updated with new courses being offered to me all the time. This same person went on to say, I love my job, I have been given a great opportunity to further my career in the care industry. I have done a lot of training and I am currently doing my NVQ level 2 which is great progress and should be finished by March 2009. A third person wrote, All training is given and updated when needed. I am about to go on PCP training next week relating to my job. Another person said, Very happy in my job, I have become very confident and I am looking forward to commencing my NVQ 3 with support from my colleagues. The recruitment records of two recently appointed members of staff were viewed. Recruitment documents included; application form, medical history, a personal statement by the applicant, qualifications and training information, a Criminal Records Bureau (CRB) clearance and a check against the nationally held list of people have been deemed unsuitable to work with vulnerable people. Interview notes are kept and copies of certificates relating to training completed with their previous employment were also available. This robust system helps to ensure that only suitable people are employed that have the personal qualities to work with vulnerable people. The homeowner/manager recognises the importance of recruiting staff that have the qualities that people like such as being supportive, caring, understanding, friendly and kind and a staff vacancy will remain vacant until a suitable person is interviewed and appointed. Although good recruitment records are kept, it was difficult from the records held to establish the exact date a newly appointee person actually started working at the home or spending time with residents. It is recommended that this be clearly recorded. This is especially important with regard to POVA First and CRB clearances. For any person that has regular contact with residents, excluding family or friends, but including potential staff/volunteers, at minimum a satisfactory POVA first must be obtained and the person must be directly supervised prior to the full CRB clearance being received. Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: Shortlisted applicants visit the home and spend time with residents who are then asked if they would like that person to work at the home and support them. Their responses are taken into account when considering a suitable person to appoint. Information in the AQAA stated that staff are recruited from different cultures, faiths and the staff team are diverse with regard to age, gender and sexuality and have different knowledge and experience to help address the individual needs of residents. The staff team work well together in delivering a good service. A support worker told us, We listen to our service users and we make sure that their needs are met always. We work together as team members, everybody is very open and all staff including management get on very well. There was evidence of formal one to one staff supervision taking place on a regular basis. The supervision notes provided good information and action plans are completed. Annual appraisals also take place that includes self appraisal and self development plans. Staff who completed a CSCI survey and the support worker spoken with all said that they felt well supported in their work. Informal day to day staff supervision is ongoing. This gives staff opportunity to meet regularly and also in private with the homeowner/manager to discuss their practices in the home, plan future training needs and discuss how these can be achieved. The training provided is valued by staff. Care Homes for Adults (18-65 years) Page 27 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is being run in the best interests of the people who live there and their welfare is promoted and protected. Evidence: The homeowner/registered manager at Lord Street care home has many years experience in the care and support of people with learning disability and has successfully achieved the Registered Managers Award. This is a more advanced, nationally recognised, training award specifically for people that manage a service where care is provided and helps to show that the homeowner is keen to further his own training in order to manage the home well. Residents spoken with said that they liked all the staff and comments from staff about the homeowner/manager were all very positive. One support worker told us, I meet with my managers on a regular basis, they keep me informed and up to date. Another person said, The right support is always there when we need it. There is experience and knowledge through the service to help and support. A third person said,I find our management very approachable and they always listen to my views. This shows that staff feel well Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: supported by a manager who values the views and opinions of support staff in developing the service and in providing a personal and individualised service to the people living at the home. Ways to gain information regarding quality assurance about the home and whether the support offered is meeting residents needs, is considered important. Various quality assurance systems are in place including, questionnaires for residents and their family, planned residents meetings that are held regularly, and staff meetings. Good minutes are kept of all meetings held. Information in the AQAA completed by the homeowner/manager, said, As we are very open to ideas we feel that our staff play an important role within the business and we value their input. A resident spoken with said he liked the resident meetings that are informal and said that he could have his say about things that matter to him and about the things that he would like to do. The home has also successfully maintained the Investors in People award (an external quality assurance monitoring organisation) demonstrating that there is a commitment to have the quality of care provided, assessed both internally and externally. Person centred plans are in place and are reviewed and updated on a regular basis. This gives a natural opportunity to gain feedback about the service from the resident, their family, or any other interested party involved in the review. Residents also enjoy frequent daily dialogue with members of staff. This helps residents to say what they think about any aspect of their life at the home, at a time of their choice without waiting, so that any matters could be immediately addressed. A quality development plan which incorporates recent objectives for the home is available and information in the AQAA, told us that one of the improvement plans for the coming year was to involve staff more with business plan ideas. This involvement of staff and the sharing of ideas, will help to generate a future business plan, that is based on collective thoughts and opinions, that should help to ensure the continued improvement of the service for the benefit of the residents. There are good arrangements in place for maintaining the health and safety of those living at the home. Maintenance records were available to confirm that various health and safety checks are maintained on a regular basis including, gas, electrical installation, small electrical appliance testing, and fire equipment testing. Staff are provided with mandatory key, health and safety training comprising of first aid training, manual handling, health and safety training, food hygiene training and infection control training. However the current infection control training is being reviewed and it is hoped that a more in-depth course will be provided. This helps to ensure that residents and staff are protected and safeguarded with regard to maintaining health and safety. Care Homes for Adults (18-65 years) Page 29 of 33 Evidence: A generic environmental risk assessment is in place that is regularly reviewed along with a separate fire risk assessment. Health and safety policies are also in place to advise and direct staff, that are also regularly reviewed. This shows that the health and safety of all those that live and work at Lord Street care home are taken seriously. Care Homes for Adults (18-65 years) Page 30 of 33 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 31 of 33 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 20 The medication administration record should always be completed immediately after the medication has been administered. This would then provide an accurate record of the medication administered or alternatively not given or refused, and provide a clear audit trail of medication into the home, administered to residents and returned to the chemist for disposal. It is recommended that a clear protocol be developed with regard to individual when required medication. This would give staff clear written guidelines of when and under what circumstances the when required medication should be given and help to ensure consistency of use. It is recommended that the date a new member of staff actually begins their employment at the home or has regular contact with residents be clearly recorded. This would provide a clear record and help to protect residents. 2 20 3 34 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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) Commission for Social Care Inspection (CSCI). 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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